Spinal tuberculosis; A study of the disease pattern, diagnosis and outcome of medical management in Sri Lanka.

Background: Sri Lanka has an intermediate burden of tuberculous disease. Most patients with spinal tuberculosis (STB) are managed with medical treatment alone as advanced surgical facilities are not freely available. Objective: To describe the clinico-demographic and imaging pattern of STB and to assess the outcome of medical treatment in the local setting. Design: Descriptive case series. Methods: All patients diagnosed with definite or probable STB, had their symptomatology and investigations recorded. They were followed up with anti-TB treatment (ATT) according to standard guidelines. An initial six-week tapering course of steroid was given when there was an evidence of neural involvement. Results: Of 32 patients with STB, backache was the commonest presenting feature (92%). Nine had lower limb neurological deficits. Uni-focal upper lumbar involvement was the commonest disease pattern noted in the series. High ESR (84%) and Mantoux positivity (53%) were frequent. 72% had end-plate changes on imaging. 53% had paraspinal soft tissue components. The triad of backache, high ESR and end-plate and/or paraspinal disease on CT/MRI showed a diagnostic sensitivity of 81.2%. Response to ATT was satisfactory in 87%. Poor neurological response was seen among some with large paraspinal collections or extensive vertebral damage at diagnosis. Conclusion: This study showed that backache over one month, high ESR and specific CT/MRI features helped diagnosis of STB, in the absence of definitive evidence. Medical management alone, comprising a prolonged course of ATT with an initial steroid cover when indicated, appeared to be safe and effective in the local setting for uncomplicated STB.

Silent rupture of aortic aneurysm mimicking lung malignancy.

Extra-pulmonary diseases may mimic pulmonary lesions on chest radiography. We report a case of a silent rupture of an atherosclerotic thoracic aortic aneurysm with peripheral thrombus formation, that closely mimicked a complicated lung malignancy.