Lumbar mass as the presentation form of a tuberculous spondylodiscitis.

Received 23 March 2011, received in final form 16 April 2011. Accepted 26 April 2011. A 32-year-old man presented with an increasing lumbar mass which was initially noted 5 months before admission. He reported a 4-month history of minor low back pain radiating to his right leg and night sweats. Physical examination revealed only a left painful lower lumbar tender mass. Lumbar MRI demonstrated spondylodiscitis over L3-L4 complicated by epidural abscess, as well as bilateral psoas abscesses spreading through the posterior abdominal wall on the left side (Figure). The patient was then submitted to a L3 hemilaminectomy with biopsy and surgical debridement of the L3-L4 intervertebral disc space. Histopathological examination showed tuberculous granuloma and the patient was properly treated. After break out of the purulent material from the vertebral body, a psoas abscess may develop and expand through the path of least resistance. The presentation thus depends on the anatomical path of abscess’ dissemination. In this regard, a lower lumbar mass may occur when the purulent material leaves the psoas above the iliac crest extending posteriorly through the inferior lumbar triangle or Petit’s triangle.