This report describes a 27-year-old male patient with advanced spondylitis tuberculosa, who, being suspected of having a malignant tumour, was submitted to a CT-guided biopsy. Treatment comprising CT-controlled insertion of a permanent drain, and antituberculous chemotherapy and dorsal stabilisation, was administered. A high-risk intervention (diagnostic and therapeutic thoracotomy with the attendant acute danger of paraplegia was avoided through the use of the most up-to-date imaging procedures available.