Pediatr Radiol (2005) 35: 11591160

DOI 10.1007/s00247-005-1544-1

C L I N ICA L I M A G E

Savvas Andronikou Nicky Wieselthaler Tracy Kilborn

Significant airway compromise in a child with a posterior mediastinal

mass due to tuberculous spondylitis

Received: 23 April 2005 / Accepted: 14 June 2005 / Published online: 3 August 2005
Springer-Verlag 2005

An 11-year-old boy presented with gradual-onset paresis

and painless scoliosis. CT and MRI demonstrated con-
tiguous thoracic vertebral and disc destruction with a
large prevertebral soft-tissue mass that demonstrated an
enhancing wall. The trachea was compressed (>50%)
between the soft-tissue mass and the great vessels
(Figs. 1 and 2). The patient had no clinical features of
acute airway compromise. The diagnosis of tuberculous
spondylitis with signicant airway compression was
made.
Mediastinal masses often present with non-specic
signs and symptoms or are discovered incidentally
(50%), but they can lead to the development of acute
airway compromise [1, 2]. Signicant airway compro-
mise can be dened by clinical severity or by the radio-
logical demonstration of >50% narrowing of the
trachea. In one study, 88% of patients with airway
compromise showed airway compression on radiological
imaging [1].
Factors associated with acute airway compromise
include anterior location of a mediastinal mass and a
diagnosis of lymphoma [1]. Neurogenic tumours,
which are posterior mediastinal masses, are not usu-
ally associated with airway compromise unless they
are very large [1, 3]. Tuberculous spondylitis causes a
posterior mediastinal mass in children in the form of a
paravertebral abscess [4]. Thoracic involvement occurs Fig. 1
in 83% of patients and a paravertebral mass occurs in
98% of patients imaged with MRI [4]. There is one

report of a child with vertebral osteomyelitis causing

tracheal displacement [2], but this report of airway
compression due to a tuberculous paravertebral mass
S. Andronikou (&) N. Wieselthaler T. Kilborn
Department of Radiology, in a child is unique.
Red Cross Childrens Hospital,
School of Child and Adolescent Health,
University of Cape Town, Cape Town,
South Africa
E-mail: docsav@mweb.co.za
1160

References

1. Lam JC, Chui CH, Jacobson AS, et al (2004) When is a medi-

astinal mass critical in a child? An analysis of 29 patients. Pediatr
Surg Int 20:180184
2. Merriman TE, Taylor RG, Nattrass GR (1997) Vertebral oste-
omyelitis in an infant presenting with posterior mediastinal
mass. Pediatr Surg Int 12:541543
3. Donnelly LF, Strife JL, Bisset GS III (1997) The spectrum of
extrinsic lower airway compression in children: MR imaging.
AJR Am J Roentgenol 16:5962
4. Andronikou S, Jadwat S, Douis H (2002) Patterns of disease on
MRI in 53 children with tuberculous spondylitis and the role of
gadolinium. Pediatr Radiol 32:798805

Fig. 2