MR Imaging in Cryptococcal Spondylitis

A previously healthy 42-year-old black woman had posterior midthoracic tenderness; a right-sided paraspinous soft-tissue mass; and progressive, bilateral leg weakness . On examination she was afebrile and had reduced strength in both lower extremities. Chocolatecolored pus was aspirated from the paraspinous soft-tissue mass. The results of a complete blood cell count and CSF analysis were normal. Chest radiographs showed infiltrates in the lower lobes and hilar adenopathy. Sputum culture yielded only Pseudomonas maltiphilia . Cultures for fungi and mycobacteria were negative. MR showed an abscess in the dorsal chest wall communicating with collections in the right paravertebral and prevertebral spaces and the epidural compartment (Fig. 1 A). Prevertebral extension of the process was evident from T8 to T1 0. T2-weighted images (2000/80/ 1 [TR(TE(excitations]) showed compression of the spinal cord at T9T1 0, increased signal intensity within T9 and T1 0, and mild loss of height of T9 (Figs. 1 B and 1 C). Neither loss of height nor increased signal intensity was seen at the T8-T9 or T9-T1 0 disk levels. T1 weighted (800(11/2) fat-suppressed (ChemSat, GE Medical Systems, Milwaukee, WI) images obtained after administration of gadopentate dimeglumine showed enhancement of T8 , T9 , and T1 0 and the T9T1 0 disk. The enhancement of T8 and the T9-T1 0 disk suggested sites of infection not appreciated on the unenhanced MR images (Figs. 1 D and 1 E). After chest CT showed calcified hilar and mediastinal lymphadenopathy, tuberculous spondylitis was suggested as the most likely diagnosis. Surgical drainage of the abscess led to significant clinical improve-