An 11-year-old boy presented with gradual-onset paresis and painless scoliosis. CT and MRI demonstrated contiguous 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 significant airway compression was made.