Pleuropulmonary complications of thoracic vertebral osteomyelitis.

In the preantibiotic era, pyogenic thoracic vertebral osteomyelitis was often complicated by mediastinal abscess, empyema, or necrotising pneumonia which arose by contiguous invasion late in the disease and progressed to bacteraemia and death.' Since the advent of antibiotics, however, the disease more often presents insidiously and may simulate mediastinal tumour, or gastrointestinal, genitourinary, or neurological disease.2 3 We have recently treated two patients with pleuropulmonary disease caused by pyogenic osteomyelitis involving thoracic vertebrae. In both, neoplasms were suspected initially and the true problem uncovered only after extensive investigation.