Tuberculous spondylitis, otherwise known as Pott’s disease, is a spinal infection associated with tuberculosis and characterized by a sharp angulation of the spine where tubercle lesions are present. A variety of radiological patterns are seen in the mycobacterial infections. Thus, a systematic approach to the radiological evaluation of patients with suspected tuberculosis is essential and includes not only chest imaging pattern recognition, but also integration of the available demographic, clinical and laboratory information. AIDS, drug resistance, and population stresses are the key reasons that may cause an epidemic increase in the future, unless brought under control. The only real proof of the presence of tuberculosis is the isolation of smear or culture of Mycobacterium tuberculosis from patients in the sputum, other fluids or tissues. Paraplegia is the most common clinical presenting symptom of Pott’s disease; however, depending on the level of the infection the disease may also present as quadriplegia. It may be complete and acute with bladder paralysis and inability to walk. Some patients complain of deformity, pain, or of general weakness and ill health which brings them to the physician. Although the destructive process of spinal tuberculosis is best imaged by CT or MRI, plain radiography and standard tomography are very useful tools, particularly if the underlying pathological process is understood. The original tuberculous focus may be marginal, central or subperiosteal and is usually in the vertebral body. In the early stages of infection, the intervertebral disc space usually remains normal. The transverse processes are rarely involved except as part of the spread of infection. A primary tuberculous infection produces pneumonia, which appears as an area of consolidation. The lesion is almost always single and it may be of any size involving up to the whole lobe of the lungs; it may however occur more often in the upper lobes. The consolidation is usually homogeneous rather than patchy. Clinically, the patient may present at any age with high temperature and the physical findings of lobar pneumonia. There may be M. tuberculosis in the sputum or gastric lavage, but failure to find the bacteria does not exclude the diagnosis. CT and MRI are the important imaging methods of tuberculosis of the CNS. Tuberculosis involves the CNS by hematogenous spread. The tubercle bacilli may be spread anywhere but are most commonly found over the cerebral and cerebellar hemispheres and the ventricular system. Any granuloma may develop into a tuberculoma, forming a mass anywhere on or within the meninges. A tuberculoma may be single or nodular, or there may be more than one; during development a few of them may become tuberculous cerebral abscesses. These have thin walls and are smooth but can be multiloculated. Many have surrounding edema, which can be demonstrated by CT (hypodense) and T2-weighted MRI (hyperintense). On both CT and MRI, there is contrast enhancement. If there is central necrosis, this does not enhance and will lead to the formation of a ring-shaped mass. The differential diagnosis for tuberculous meningitis in the early stages includes any pyogenic infection. Tuberculomas can be mistaken for an intracranial neoplasm, or almost any other disease process causing the formation of a mass lesion in the brain (such as subacute trauma, hemorrhage, pyogenic abscesses or hydatid disease). A careful clinical history, clinical examinations and a high index of suspicion are very important. The best way to image any part of the skeleton will depend very much on the site involved, but because tuberculous bone infections are so often multifocal and may be present in different parts of the skeleton, scintigraphy is a very valuable method which helps in early investigation.
