A paraspinal shadow.

There are many causes of localized displacement of the paraspinal line, including spinal disease, lymphadenopathy, descending aortic aneurysm, traumatic haematoma, even extramedullary haemopoiesis and oesophageal varices. However, in association with intervertebral disc space narrowing, tuberculous and pyogenic osteomyelitis must be excluded. Bone metastases rarely narrow the intervertebral disc space and the same can be said for trauma and lymphoma. The lamellar pleural reactions and blunting of the costophrenic angles could certainly also be due to tuberculosis. The CT appearances indicate relatively minor bone changes but marked surrounding soft tissue swelling in keeping with the plain film findings. Tuberculosis was subsequently proven on biopsy.