Clinical Presentation
A 44-year-old male intravenous drug abuser with hepatitis C and acquired immunodeficiency syndrome, now presenting with progressive back and chest pain.
Imaging Findings
(A, B) Contrast-enhanced computed tomography (CT) shows an osteolytic lesion and fluid density involving the lower thoracic spine (arrows), with a paraspinal low-density mass displacing the aorta and other vessels anteriorly, as well as a left-sided pleural effusion.
Differential Diagnosis
• Bacterial spondylodiskitis (vertebral osteomyelitis): Vertebral body destruction and paraspinal fluid (abscess) are characteristic findings of bacterial infection of the vertebral bodies and disk.
• Osteolytic tumor: Primary (e.g., plasmacytoma, lymphoma) or secondary (e.g., metastasis from lung cancer, breast cancer) tumors may also present as vertebral body erosion, pathologic fracture, and paraspinal bleeding.
• Vertebral body fracture:
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