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Aim: was to demonstrate possibilities of timely radiological diagnosis and treatment of spinal tuberculosis in a patient with a single lung after pleuropneumonectomy for fibrocavernous pulmonary tuberculosis.

Materials and methods: patient, 26 y.o. female, country inhabitant, grocery store clerk. She was hospitalized to the National Medical Research Center for Phthisiopulmonology and Infectious Diseases of the Ministry of Health of the Russian Federation with a diagnosis: “Tuberculosis spondylitis Th12-L2, focal tuberculosis S2 of the single right lung in the infiltration phase. M.Tb(-). Pleuropneumonectomy for fibrocavernous tuberculosis of left lung (December 18, 2018)”. To clarify etiology and lesion volume and to determine surgical treatment tactics, multispiral computed tomography (MSCT) of lungs and thoracolumbar spine and subsequent percutaneous trephine biopsy of the L1 vertebra were performed.

Results: according to MSCT data, destruction of Th12-L1-2 vertebral bodies was revealed; in single right lung, medium-intensity focal lesion with a diameter of 5 mm in C1, a small calcinate in C2, and a subpleural focal lesion in C4 were visualized. Small-focal dissemination was observed throughout the entire length of single lung. Bacteriological study of biological material taken during trephine biopsy revealed the growth of Mycobacterium tuberculosis, confirmed by diagnostics of polymerase chain reaction (PCR). Taking into account the pulmonary pathology, operation was performed in the volume of resection of Th12-L1-2 bodies and antero-lateral spinal fusion with a Mesh body replacement implant with bone autoplasty from left-side access, transpedicular fixation (TPF) of Th11-L3 with a four-screw structure under intraoperative radiation control. As a result of treatment, patient was discharged in a satisfactory condition.

Conclusions: presented case report demonstrates the importance of timely radiological diagnosis in patients with combined infectious lesions of lungs and spine for obtaining of complete information about the state of respiratory and bone systems, using MSCT and interventional radiology methods and for determination of pathological process etiology. It made it possible to perform timely diagnosis and complex surgical intervention with the most sparing and light surgical access to affected vertebrae in tuberculosis spondylitis from the side of previous pleuropneumonectomy.





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