Cavitary Pulmonary Infarction Mimicking Koch’s Disease

Pulmonary infarction (PI), defined as localized destruction (necrosis) of lung tissue due to obstruction of the arterial blood supply by an embolus, is a rare condition because of the dual blood supply of the lungs. It occurs more in elderly patients who typically have associated co-morbidities, such as chronic heart and lung disease, which affect blood circulation. Pulmonary infarction may present with chest pain, fast breathing, blood tinged cough and fever, resembling more common conditions such as bacterial pneumonia and tuberculosis. High index of suspicion is required for early diagnosis of this condition as mortality from this condition can be as high as 70%. We present a case of cavitary pulmonary infarction in a middle-aged female with no major risk factors for pulmonary embolism who was initially managed as a case of pulmonary tuberculosis. The clinical presentation, pathogenesis, imaging findings and management of PI have also been discussed. The purpose of this report is to increase the awareness of this less common condition among clinicians and highlight the radiologic differences between PI and the more common inflammatory diseases of the lung.

Atypical Presentation of Cervical Pott’s Disease: A Case Report

Tuberculous spondylitis, also known as Pott’s disease, is due to infection of the spine by mycobacterium tuberculosis (MTB) leading to vertebral body and inter-vertebral disc destruction. It is the most common form of musculoskeletal tuberculosis most frequently affecting the thoracolumbar spine and is commoner in young people. Onset of this condition is insidious and its clinical presentation is non specific. However, Pott’s disease may be complicated by neurologic deficits including paraplegia or even quadriplegia, with huge health, economic and psychological burden. Following is a case report of Pott’s disease involving the cervical spine in a 33-year old farmer presenting unusually with paraplegia and a negative Mantoux test. It is reported because this very uncommon condition is highly treatable, and there is need for a raised index of suspicion in order to diagnose this condition early, thus limiting its complications. The role of MRI in diagnosis of Pott’s disease is also highlighted.