Devoted to diagnostic and interventional spine imaging and therapeutics


Imaging Manifestations of Granulomatous Diseases of the Spine 2012

General Spine

Asif, Abdullah, M.D.
Augusto, Elias, M.D., Non ASSR Member
Alex, A, Dombrowski, M.D., Non ASSR Member



Spine is not an uncommon site for granulomatous diseases. Granulomatous inflammation is a specific type of chronic inflammatory process characterized by accumulations of modified macrophages called epithelioid cells. Granulomatous lesions in children are usually infectious in origin. In adults, non-infectious granulomatous diseases are not uncommon. The goal of this presentation is to review the imaging manifestations of infectious and non-infectious granulomatous lesions of the spine.

Methods & Materials

A systematic approach to imaging diagnosis of granulomatous lesions of the spine will be provided. Infectious granulomas may be due to bacterial or fungal microorganisms. Bacterial infections include mycobacterial and non-mycobacterial agents. Mycobacaterial infections include tuberculosis and non-tuberculosis entities. Non-mycobacterial infectious agents include Bartonella, Klebsiella, and Brucella. Fungal infections in the head and neck include aspergillosis, mucormycosis, blastomycosis, cossidiodomycosis, histoplasmosis, and candidiasis among other rare etiologies. Non-infectious granulomatous diseases include Wegener's granulomatosis, rheumatoid diseases, Chrugg Strauss, sarcoidosis, and amyloidosis.


Radiologically, granulomatous lesions of the spine are often difficult to distinguish. Clinical history and an analytical approach to imaging can aid in narrowing down the differential diagnosis. Cross-sectional imaging demonstrates the exact anatomic location, extent, and involvement of adjacent structures.


The diagnosis and treatment of granulomatous diseases continues to evolve to this day, and perhaps due to their relative scarcity, continue to create a diagnostic dilemma to physicians of all specialties. These diseases have manifestations in the spine, and many patients initially present to the radiologist with imaging studies. Imaging does not always provide a specific diagnosis of granulomatous lesions but should help narrow the differential diagnosis, thereby helping to guide patient treatment. Recognition of typical and atypical imaging patterns can allow radiologists to more accurately approach the correct diagnosis and aid in better clinical management of these conditions.

References/Financial Disclosures

The authors have nothing to disclose and have no conflict of interests.