Presentation
Presents with proprioceptive deficits in the hind limbs. Known mitral valve degeneration with ruptured chordae tendinae.
Patient Data
The C3-4 intervertebral space is severely narrowed. There is lysis associated with the C3-4 end plates surrounded by sclerosis. There is mild spondylosis associated with the same intervertebral space. In the remainder of the spine, there is ventral spondylosis in the distal thoracic spine and lumbar spine. On the lateral projection of the thoracic spine the trachea is deviated dorsally and there is a diffuse interstitial pattern of the visible portions of the lung. On the VD projection of the thoracic spine, there is a bulge in the cardiac silhouette in the region of the left auricle and mild abaxial deviation of the mainstem bronchi.
Discospondylitis. Cardiomegaly with left atrial enlargement.
Case Discussion
The symmetric destruction of adjacent vertebral endplates indicates infection originating from the intervertebral disc. The bridging spondylosis is a stabilizing process due to loss of connective tissue. A CSF tap and fluoroscopic or CT guided aspirate of the C3-4 intervertebral disc with cytology and culture could be attempted to definitively diagnose discospondylitis and determine the infectious agent (i.e. bacterial vs. fungal). Urinalysis and culture are often performed to evaluate for bacterial cystitis as a potential source of the infection.
The left atrial enlargement is consistent with the known mitral valve disease.
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