RESUMO
BACKGROUND: The aims of this study were to identify the predictive factors for microbiological diagnosis through disco-vertebral biopsy (DVB) in patients with pyogenic vertebral osteomyelitis (PVO) and negative blood cultures, and compare the performance of DVB under fluoroscopic versus scanographic guidance. METHODS: We performed a cohort study comparing positive and negative DVB among patients with PVO. All cases of PVO undergoing a DVB for microbiological diagnosis in our center were retrospectively reviewed. Infections due to Mycobacterium tuberculosis, infections on foreign device, and non-septic diseases were excluded. Anamnestic, clinical, biological, microbiological, as well as radiological data were collected from medical charts thanks to a standardized data set. RESULTS: A total of 111 patients were screened; 88 patients were included. Microbiological cultures were positive in 53/88 (60.2%) patients. A thickening of the paravertebral tissue ≥10 mm on magnetic resonance imaging (MRI) in axial MR scans was a predictive factor of DVB microbiological positivity (52.4% vs. 13.3%; p = 0.006; OR = 5.4). Overall, 51 DVB were performed under fluoroscopic guidance and 37 under scanographic guidance. Considering lumbar DVB, 25/36 (69.4%) of cases yielded positive results under fluoroscopic guidance versus 5/15 (33.3%) under scanographic guidance (p = 0.02; OR = 4.4). No adverse event linked to DVB was notified. CONCLUSION: Every patient with PVO and negative blood cultures should undergo a DVB. A thickening of the paravertebral tissue ≥10 mm on MRI is associated with a higher rate of positive DVB culture. A lumbar DVB under fluoroscopic guidance is more sensitive than under scanographic guidance to identify the micro-organism involved.
Assuntos
Disco Intervertebral/patologia , Vértebras Lombares/patologia , Osteomielite/diagnóstico , Doenças da Coluna Vertebral/diagnóstico , Infecções Estafilocócicas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Abscesso Epidural/diagnóstico , Abscesso Epidural/patologia , Feminino , Fluoroscopia/métodos , Humanos , Biópsia Guiada por Imagem/métodos , Disco Intervertebral/microbiologia , Vértebras Lombares/microbiologia , Masculino , Pessoa de Meia-Idade , Osteomielite/microbiologia , Osteomielite/patologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Doenças da Coluna Vertebral/microbiologia , Doenças da Coluna Vertebral/patologia , Infecções Estafilocócicas/patologia , Tomografia Computadorizada por Raios X/métodos , Adulto JovemRESUMO
As coronavirus pandemic continue to spread over the world, we have to be aware of potential complications on hospitalized patients. We report a case of a 79-year-old woman with COVID-19 pneumonia complicated by combined arterial and venous thrombosis of upper mesenteric vessels. As unenhanced chest CT scan plays a key role in managing the COVID-19 pandemic, we should pay attention to indirect signs of thrombosis.