Images in Clinical Rheumatology
Thoracic spondylodiscitis due to lung-spinal fistula from a cavitating lung injury
Espondilodiscitis torácica secundaria a fístula pulmono-espinal por lesión pulmonar cavitada
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(B) Chest CT: right lung consolidation occupying the azygo-esophageal recess, with aire-fluid level and calcium deposits, as well as a marked crush and destructuring located at the T5-T6. (C) Thoracic spine MRI (coronal): central necrotic-cystic zone occupyping the disc space of the T5-T6 and fistulous communication with the adjacent right lung injury. (D) Thoracic spine MRI (sagittal): diffuse gadolinium enhancement and kyphotic deformity with canal stenosis located at the T5-T6.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A Caucasian 72-year-old man with chronic obstructive pulmonary disease and paraparesis caused by thoracic spinal cord injury due to traffic accident twenty-five years ago. He presented to the emergency room with one week of cough with purulent sputum, dyspnea with 88 percent of blood oxygen saturation, intermittent fever up to 38<span class="elsevierStyleHsp" style=""></span>°C and worsening of bilateral lower limbs weakness.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination was notable for crackles on auscultation in the upper and middle fields of the right lung, as well as spastic paraparesis with normal rectal tone. Blood test showed increased C-reactive protein 15<span class="elsevierStyleHsp" style=""></span>mg/dL (reference range 0.5–1). Chest X-ray showed right paratracheal infiltrates (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Chest CT showed cavitating right lung consolidation and crush located at T5-T6 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Thoracic spine MRI showed lung-spinal fistula and signs suggestive of spondylodiscitis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C and D).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">An empirical antibiotic treatment was initiated with intravenous piperacillin–tazobactam for a presumed bacterial thoracic spondylodiscitis related to contiguous right-side cavitating pneumonia.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1,2</span></a> Microbiological investigations were all negative.</p><p id="par0020" class="elsevierStylePara elsevierViewall">To pursue definitive diagnosis, the patient underwent evaluation for percutaneous CT-guided spinal needle biopsy.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> However, he died on the seventh-day hospital stay due to massive hemoptysis and irrecoverable cardiac arrest. The family of the patient refused autopsy.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-09-21" "fechaAceptado" => "2022-11-02" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1950 "Ancho" => 2340 "Tamanyo" => 312446 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest X-ray: right paratracheal infiltrates. (B) Chest CT: right lung consolidation occupying the azygo-esophageal recess, with aire-fluid level and calcium deposits, as well as a marked crush and destructuring located at the T5-T6. (C) Thoracic spine MRI (coronal): central necrotic-cystic zone occupyping the disc space of the T5-T6 and fistulous communication with the adjacent right lung injury. (D) Thoracic spine MRI (sagittal): diffuse gadolinium enhancement and kyphotic deformity with canal stenosis located at the T5-T6.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Espondilodiscitis infecciosa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Oropesa Juanes" 1 => "M.I. González-Cruz" 2 => "J. Calvo Catalá" 3 => "C. Campos Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1699-258X(08)71818-7" "Revista" => array:6 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2008" "volumen" => "4" "paginaInicial" => "126" "paginaFinal" => "127" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21794515" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pyogenic spondylodiscitis due to pleurovertebral fistula complicating radiofrequency ablation of pulmonary carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.R. Ferretti" 1 => "F. Arbib" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.diii.2014.11.032" "Revista" => array:6 [ "tituloSerie" => "Diagn Interv Imaging" "fecha" => "2015" "volumen" => "96" "paginaInicial" => "511" "paginaFinal" => "513" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25704148" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "CT-guided needle biopsy in vertebral osteomyelitis: study of factors that could influence in culture yield" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.J. Fragío Gil" 1 => "R. González Mazarío" 2 => "J. Ivorra Cortés" 3 => "A.J. Cañada Martínez" 4 => "M. Salavert Lleti" 5 => "J.A. Román Ivorra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.reumae.2020.08.007" "Revista" => array:6 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2022" "volumen" => "18" "paginaInicial" => "20" "paginaFinal" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35090608" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001900000004/v1_202304141104/S2173574323000382/v1_202304141104/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001900000004/v1_202304141104/S2173574323000382/v1_202304141104/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574323000382?idApp=UINPBA00004M" ]
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