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Table of Contents    
BRIEF REPORT
Year : 2020  |  Volume : 68  |  Issue : 5  |  Page : 1201-1202

Mediastinal Widening in a Patient with Paraplegia: An Unusual Cause


Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India

Date of Web Publication27-Oct-2020

Correspondence Address:
Dr. Ravindra K Garg
Department of Neurology, King George Medical University, Lucknow - 226 003, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.299151

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 » Abstract 


The common causes of mediastinal widening are lymphadenopathy, pericardial effusion, paravertebral abscess, and aortic aneurysm. We present a patient with spinal tuberculosis, paravertebral abscess, and plural effusion that led to mediastinal widening. In this patient, Chest X-ray was deceptive.


Keywords: Mediastinal widening, paraplegia, paravertebral abscess, tuberculosis
Key Message: In a patient with spinal tuberculosis of thoracic region, X-ray chest may be deceptive. X-ray chest may show mediastinal widening.


How to cite this article:
Uniyal R, Garg RK, Pandey S, Kumar N, Malhotra HS. Mediastinal Widening in a Patient with Paraplegia: An Unusual Cause. Neurol India 2020;68:1201-2

How to cite this URL:
Uniyal R, Garg RK, Pandey S, Kumar N, Malhotra HS. Mediastinal Widening in a Patient with Paraplegia: An Unusual Cause. Neurol India [serial online] 2020 [cited 2020 Nov 24];68:1201-2. Available from: https://www.neurologyindia.com/text.asp?2020/68/5/1201/299151




Mediastinal widening is defined as mediastinal width of more than 8 cm on chest X-ray posteroanterior view.[1] Its common causes are lymph node enlargement secondary to sarcoidosis, tuberculosis, or lymphoma.[2],[3] Mediastinal widening can also occur due to pericardial effusion, paravertebral abscess, idiopathic aneurysm of azygos vein, achalasia, and primary or secondary neoplasms.[2],[3],[4] We report an interesting patient, who presented with paraplegia and X-ray chest revealed mediastinal widening.


 » Case Report Top


A 55-year-old man presented with backache and weakness of both lower limbs of two months duration. He also had dry cough for ten days. His general examination was normal. On neurological examination, patient had spastic paraplegia without any bladder and bowel disturbances. Sensory level was at T12. The vertebral column examination was normal. All laboratory parameters were normal. His chest X-ray revealed a marked mediastinal widening [Figure 1]. Later, contrast-enhanced computed tomography of thorax and spinal magnetic resonance imaging were performed. Contrast-enhanced computed tomography of thorax revealed right-sided loculated pleural effusion abutting vertebral column. Spinal magnetic resonance imaging revealed vertebral discitis involving in T11-12 vertebra along with a large paravertebral pus collection. The lesion was extending along the parietal pleura and connected with localized pleural effusion. [Figure 2] Computed tomography-guided biopsy was done. Biopsy material demonstrated Mycobacterium tuberculosis by cartridge-based nucleic acid amplification test. The patient was given anti-tuberculosis treatment. Patient was able to walk unaided after two months.
Figure 1: Chest X-ray posteroanterior view shows mediastinal widening

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Figure 2: Thoracic contrast-enhanced computed tomography showing loculated pleural effusion adjacent to vertebral column. (Left) Spinal magnetic resonance imaging shows vertebral destruction of T11 and T12 vertebrae with involvement of intervertebral disc. (Middle) Gadolinium-enhanced images shows enhancement of the vertebral lesion and lateral extension of the lesion to the right parietal pleura culminating into pleural effusion. (Right)

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 » Discussion Top


In this case, chest X-ray revealed a deceptive picture of mediastinal widening. However, computed tomography of thorax revealed the paravertebral abscess and loculated pleural effusion located posteriorly in right side. Gadolinium-enhanced magnetic resonance imaging of spine clearly demonstrated extension of the vertebral lesion to the pleura and formation of loculated pleural effusion. Pleural involvement in spinal tuberculosis is uncommon.[1],[5] It usually occurs with associated pulmonary disease or after operative interventions. Whether pleural involvement occurs before or after the spinal involvement is not exactly known. However, occurrence of pleural effusion in spinal tuberculosis without pulmonary involvement suggests possibility of extension of lesion from the adjacent vertebrae to pleural spaces. In our case, pleural involvement occurred due to extension of vertebral lesion to the parietal pleura which led to inflammation of pleura and subsequent pleural effusion. In a patient with spinal tuberculosis, paravertebral abscess and plural effusion collectively led to the mediastinal widening.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 » References Top

1.
Hashim Z, Kumar N. A case of disseminated tuberculosis with mediastinal widening. Austin J Pulm Respir Med 2017;4:1049.  Back to cited text no. 1
    
2.
Chawla RK, Madan A, Chawla A, Chawla K. Mediastinal widening: An interesting quiz. Lung India 2016;33:95.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Dua R, Singhal A. A cause of mediastinal widening. Lung India 2016;33:453-4.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Raskin J, Van Bleyenbergh P. Normalization of mediastinal widening after successful treatment of mediastinal tuberculosis. Acta Clinica Belgica 2016;71:269-70.  Back to cited text no. 4
    
5.
Malhotra HS, Garg RK, Raut TP. Pleural involvement in spinal tuberculosis. Am J Trop Med Hyg 2012;86:560.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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