不典型肺结核合并不典型脊柱结核临床较为少见,有时容易与肺癌骨转移相混淆,诊断较为困难,本院收治1例肺结核并胸腰椎及骶髂结核患者,患者无明显结核中毒症状,实验室及影像学检查基本不支持结核的诊断,术后病灶病理学检查符合结核。诊疗过程报道如下。患者男,29岁,因“腰痛2个月余,发热1个月余”于2012-12-20入我院。患者2个月前腰部扭伤后感疼痛,弯腰或活动时加重,最初患者无发热、夜间盗汗、乏力,无咳嗽、咳痰,无胸闷、憋气,就诊当地诊所行推拿等治疗,效果差。1个月前开始出现发热,体温波动在38~38.9℃,下午较高,偶有夜间盗汗、乏力,晨起咳少量白色粘痰,患者就诊于当地医院,行腰椎CT(图1)及胸部CT(图2)检查,发 Atypical pulmonary tuberculosis with atypical spinal tuberculosis clinically rare, and sometimes easily confused with bone metastases of lung cancer, the diagnosis is more difficult, the hospital admitted to a case of pulmonary tuberculosis and thoracolumbar and sacroiliac tuberculosis patients, patients with no obvious symptoms of tuberculosis, laboratory and Imaging imaging does not support the basic diagnosis of tuberculosis, postoperative pathological examination consistent with tuberculosis. The treatment process is reported below. Male patient, 29 years old, because of “low back pain more than 2 months, fever more than 1 month ” in 2012-12-20 into our hospital. Patients 2 months ago, lumbar sprain pain, increased or aggravated when bending over, the initial patient without fever, night sweats, fatigue, no cough, sputum, no chest tightness, suffocation, visiting local clinics, massage and other treatment, the effect is poor. 1 month ago began to appear fever, body temperature fluctuations in 38 ~ 38.9 ℃, higher in the afternoon, occasional night sweats, fatigue, morning cough a small amount of white phlegm, the patient was treated at a local hospital line lumbar CT (Figure 1) and chest CT (Figure 2) check, send