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Abid W, Ladeb MF, Chidambaranathan N, Peh WCG, Vanhoenacker FM. Imaging of musculoskeletal tuberculosis. Skeletal Radiol 2024:10.1007/s00256-023-04556-5. [PMID: 38231262 DOI: 10.1007/s00256-023-04556-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
Tuberculosis (TB) represents a major public health problem worldwide. Any tissue may be infected. Involvement of the musculoskeletal (MSK) system account for 1-3% of all tuberculous infections. MSK TB may manifest as tuberculous spondylitis, arthritis, osteomyelitis, and soft tissue infections. Although TB spondylitis may present with distinctive imaging features compared to pyogenic infections of the spine, the imaging semiology of extra-spinal TB infections is mostly nonspecific and may mimic other lesions. TB infections should therefore always be considered in the differential diagnosis, particularly in immunocompromised patients. The aim of this article is to review the imaging features of spinal and extra-spinal MSK TB. Magnetic resonance imaging is considered the modality of choice to make the diagnosis and to evaluate the extent of the disease.
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Affiliation(s)
- Wiem Abid
- Department of Radiology, (Vrije Universiteit Brussel), University Hospital Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Mohamed F Ladeb
- Department of Radiology, MT Kassab Institute of Orthopaedics, Tunis, Tunisia
| | - Natesan Chidambaranathan
- Department of Radiology & Imaging Sciences, Apollo Hospitals, 21, Greams Lane, Chennai, 600 006, India
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Republic of Singapore
| | - Filip M Vanhoenacker
- General Hospital Sint-Maarten Mechelen, Liersesteenweg 435, 2800, Mechelen, Belgium.
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat, 655, B-2650, Edegem, Belgium.
- Faculty of Medicine and Health Sciences, University of Antwerp, Ghent and KU Leuven, Belgium.
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Gupta A, Kaur G, Goyal D, Chopra V. An unusual site of articular tuberculosis-A series of three conservatively managed cases. Indian J Tuberc 2022; 69:359-363. [PMID: 35760487 DOI: 10.1016/j.ijtb.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/06/2021] [Indexed: 06/15/2023]
Abstract
Tuberculosis (TB) infection of the Sternoclavicular joint (SCJ) is a rare entity, with 1-2% of all osteo-articular cases reported. We report a series of three cases of TB of the SCJ, in the patients presented with swelling of SCJ. Cytology showed chronic granulomatous pathology in all three cases, with one patient having Cartridge base nucleic acid amplification test positive for TB and another one having acid fast bacilli positive on Ziehl Neelsen staining. All three were put on antitubercular treatment (ATT) that resulted in significant improvement. A high index of suspicion of TB to be maintained in cases with swellings at unusual sites especially in high burden countries like India. Similarly, gradually progressive osteoarticular swellings without systemic features should also raise suspicion of tubercular etiology, as diagnosis was delayed for about 4 months in two of our cases and about 1 year in the third case. The application of newer technologies such as CBNAAT can help in early microbiological confirmation of paucibacillary disease leading to early diagnosis and prevention of possible complications.
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Affiliation(s)
- Aditi Gupta
- Department of Pulmonary Medicine, Government Medical College, Patiala, India.
| | - Gagandeep Kaur
- Department of Pulmonary Medicine, Government Medical College, Patiala, India.
| | - Deepak Goyal
- Department of Pulmonary Medicine, TB Hospital, Government Medical College, Patiala, India.
| | - Vishal Chopra
- Department of Pulmonary Medicine, Government Medical College, Patiala, India.
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3
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Hussain S, Khan Z, Akhtar N, Jeys L, Parry M, Grimer RJ. Anatomical distribution, the incidence of malignancy and diagnostic workup in the pathological lesions of the clavicle: a review of 410 cases. Arch Orthop Trauma Surg 2022; 143:2981-2987. [PMID: 35778528 DOI: 10.1007/s00402-022-04511-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 06/09/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND The clavicle poses a diagnostic dilemma of the pathological lesions due to the wide range of pathologies seen at this site. This study aimed to identify and stratify various pathologies seen in the clavicle and to guide ways of investigation for diagnosis based on age, site and investigation findings. MATERIALS AND METHODS Four hundred and ten cases with clavicle lesions were identified in our database. Data were collected about the patient's medical history, previous investigation, inflammatory markers radiological investigations and biopsy. All patients were worked up and managed after discussion in a multidisciplinary team meeting (MDT). RESULTS Non-malignant lesions accounted for 79% of cases. Infection was the most common diagnosis (39%) and the commonest diagnosis in those less than 20 years of age. 73% of the lesions were found at the medial end of the clavicle. Malignant tumours were 21%, while primary benign bone tumours accounted for only 14%. 50% of the malignant lesions were due to metastatic disease. The risk of malignancy increases with advancing age. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were not sensitive as a diagnostic tool in cases of osteomyelitis confirmed by histology. Magnetic resonance imaging (MRI) was noted to have high sensitivity and specificity for identifying the nature of a lesion and diagnosis. CONCLUSION We have identified age as a positive predictor of a malignant cause in pathological lesions of the clavicle. MRI should be considered in all these cases. CRP and ESR have poor predictive values in diagnosing infection in the clavicle. Patients presenting with clavicle lesions should be discussed in a specialist MDT and undergo a systemic diagnostic workup, still in some cases, diagnosis can be speculated based on the patient's age, location of the lesion within the clavicle and the features seen on the MRI scan. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Shakir Hussain
- The Oncology Department, The Orthopaedic Oncology Unit, The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK.
| | - Zeeshan Khan
- The Oncology Department, The Orthopaedic Oncology Unit, The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - Naved Akhtar
- The Oncology Department, The Orthopaedic Oncology Unit, The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - Lee Jeys
- The Oncology Department, The Orthopaedic Oncology Unit, The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - Michael Parry
- The Oncology Department, The Orthopaedic Oncology Unit, The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - Robert J Grimer
- The Oncology Department, The Orthopaedic Oncology Unit, The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
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4
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Mansour J, Raptis D, Bhalla S, Heeger AP, Abbott GF, Parkar N, Hammer MM, Kiernan J, Raptis C. Diagnostic and Imaging Approaches to Chest Wall Lesions. Radiographics 2022; 42:359-378. [PMID: 35089819 DOI: 10.1148/rg.210095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chest wall lesions are relatively uncommon and may be challenging once they are encountered on images. Radiologists may detect these lesions incidentally at examinations performed for other indications, or they may be asked specifically to evaluate a suspicious lesion. While many chest wall lesions have characteristic imaging findings that can result in an accurate diagnosis with use of imaging alone, other entities are difficult to distinguish at imaging because there is significant overlap among them. The interpreting radiologist should be familiar with the imaging features of both "do not touch" benign entities (which can be confidently diagnosed with imaging only, with no need for biopsy or resection unless the patient is symptomatic) and lesions that cannot be confidently characterized and thus require further workup. CT and MRI are the main imaging modalities used to assess the chest wall, with each having different benefits and drawbacks. Chest wall lesions can be classified according to their predominant composition: fat, calcification and ossification, soft tissue, or fluid. The identification or predominance of signal intensities or attenuation for these findings, along with the patient age, clinical history, and lesion location, can help establish the appropriate differential diagnosis. In addition, imaging findings in other organs, such as the lungs or upper abdomen, can at times provide clues to the underlying diagnosis. The authors review different chest wall lesions classified on the basis of their composition and highlight the imaging findings that can assist the radiologist in narrowing the differential diagnosis and guiding management. ©RSNA, 2022.
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Affiliation(s)
- Joseph Mansour
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., D.R., S.B., C.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P.H., G.F.A.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.P.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, St Louis University Hospital, St Louis, Mo (J.K.)
| | - Demetrios Raptis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., D.R., S.B., C.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P.H., G.F.A.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.P.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, St Louis University Hospital, St Louis, Mo (J.K.)
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., D.R., S.B., C.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P.H., G.F.A.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.P.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, St Louis University Hospital, St Louis, Mo (J.K.)
| | - Allen P Heeger
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., D.R., S.B., C.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P.H., G.F.A.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.P.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, St Louis University Hospital, St Louis, Mo (J.K.)
| | - Gerald F Abbott
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., D.R., S.B., C.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P.H., G.F.A.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.P.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, St Louis University Hospital, St Louis, Mo (J.K.)
| | - Nadeem Parkar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., D.R., S.B., C.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P.H., G.F.A.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.P.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, St Louis University Hospital, St Louis, Mo (J.K.)
| | - Mark M Hammer
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., D.R., S.B., C.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P.H., G.F.A.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.P.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, St Louis University Hospital, St Louis, Mo (J.K.)
| | - Julia Kiernan
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., D.R., S.B., C.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P.H., G.F.A.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.P.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, St Louis University Hospital, St Louis, Mo (J.K.)
| | - Constantine Raptis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., D.R., S.B., C.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P.H., G.F.A.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.P.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, St Louis University Hospital, St Louis, Mo (J.K.)
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5
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Tordjman M, Pouchelon C, Canouï E, Omri M, Dion E. Sternal mass caused by Mycobacterium tuberculosis in an immunocompetent young adult. J Travel Med 2021; 28:6134593. [PMID: 33580959 DOI: 10.1093/jtm/taab021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 11/14/2022]
Abstract
Differential diagnosis of sternal masses in migrant patients should include tuberculosis. Imaging characteristics on computed tomography scan and magnetic resonance imaging are of great interest. Sternal tuberculous abscess exhibits a slightly hyperintense rim on T1-weighted pre-contrast images that can be associated with osteomyelitis of the sternum.
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Affiliation(s)
- Mickael Tordjman
- Department of Radiology, Hôtel Dieu Hospital, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Clara Pouchelon
- Department of Internal medicine, Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Etienne Canouï
- Antimicrobial Stewardship Team GH Paris Centre, Cochin Hospital, APHP, Paris, France
| | - Manel Omri
- Department of Radiology, Hôtel Dieu Hospital, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Elisabeth Dion
- Department of Radiology, Hôtel Dieu Hospital, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
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Jain M, Parija D, Kumar P, Naik S. Misdiagnosed sternoclavicular tuberculosis presenting as a non-healing ulcer. BMJ Case Rep 2021; 14:e244454. [PMID: 34426429 PMCID: PMC8383862 DOI: 10.1136/bcr-2021-244454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mantu Jain
- Department of Orthopaedics, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Orissa, India
| | - Debasish Parija
- Department of Orthopaedics, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Orissa, India
| | - Pankaj Kumar
- Department of General Surgery, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Odisha, India
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
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7
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Upadhyaya GK, Kumar A, Iyengar KP, Agarwal A, Jain VK. Current concepts in the diagnosis and management of tuberculosis of the elbow joint. J Clin Orthop Trauma 2021; 19:200-208. [PMID: 34150492 PMCID: PMC8185235 DOI: 10.1016/j.jcot.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/05/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022] Open
Abstract
Elbow is an uncommon joint to be affected by Mycobacterium tuberculosis infection. It is involved in approximately 1-5% of all cases with musculoskeletal tuberculosis (TB). Early diagnosis of TB of the elbow joint can be easily missed due to an indolent natural history, delay in presentation, and varied clinical features. Delay in diagnosis can lead to irreversible osteoarticular destruction and loss of joint function. Careful clinical assessment, adequate imaging, microbiological, and/or histopathological confirmation of Mycobacterium tuberculosis infection is essential for early diagnosis of TB of the elbow joint. Judicious and early administration of anti-tubercular therapy can lead to preservation of the joint and a satisfactory functional outcome. Surgical intervention may be needed in later stages of the disease to achieve control of the infection, correction of deformity, instability, and restoration of function.
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Affiliation(s)
- Gaurav Kumar Upadhyaya
- Department of Orthopaedics, All India Institute of Medical Sciences, Raebareli, UP, India
| | - Amit Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, Raebareli, UP, India,All India Institute of Medical Sciences, Raebareli, UP, India
| | | | - Anil Agarwal
- Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India,Corresponding author. Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Science, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India.
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8
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Extrapulmonary Tuberculosis masquerading as chest wall malignancy: Just never ceases to surprise! IDCases 2021; 24:e01114. [PMID: 33898260 PMCID: PMC8055601 DOI: 10.1016/j.idcr.2021.e01114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 11/22/2022] Open
Abstract
With the emergence of the acquired immunodeficiency syndrome, we witnessed a higher incidence of disseminated and extrapulmonary tuberculosis. The infection sites commonly include lymph nodes, pleura, and osteoarticular areas, although any organ can be involved. Given the atypical presentation of the extrapulmonary disease, it poses a significant diagnostic challenge for the physicians; therefore, a high index of suspicion should be maintained, particularly where tuberculosis is endemic. Here we present a case of isolated chest wall tuberculosis in an immunocompetent patient.
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Swarup MS, Bhatt S, Rawal R, Tandon A, Dangwal S. Tuberculosis, a great masquerader: A case series unveiling rare sites of musculoskeletal involvement through imaging. SA J Radiol 2020; 24:1919. [PMID: 33101726 PMCID: PMC7564854 DOI: 10.4102/sajr.v24i1.1919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/06/2020] [Indexed: 12/16/2022] Open
Abstract
Skeletal tubercular infections that do not involve the spine or large joints are rarely encountered. This case series aims to highlight the importance of imaging in diagnosing skeletal tuberculosis (TB) at uncommon sites in clinically unsuspected patients by demonstrating specific imaging findings. We present the clinical details and imaging findings of seven pathologically confirmed cases of extraspinal skeletal TB. A multimodality imaging approach including radiography, ultrasonography (USG) and computed tomography (CT) scan was used in most cases. The imaging studies revealed an infective soft tissue collection over different sites including the sternoclavicular joint, acromion process, chest wall and temporo-mandibular joint, along with destruction and erosion of the underlying or adjacent bones. In tubercular endemic countries, strong clinical suspicion should be entertained in cases presenting with a soft tissue collection, even around unusual skeletal sites.
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Affiliation(s)
- M Sarthak Swarup
- Department of Radiology, University College of Medical Sciences and GTB hospital, Delhi, India
| | - Shuchi Bhatt
- Department of Radiology, University College of Medical Sciences and GTB hospital, Delhi, India
| | - Rajesh Rawal
- Department of Radiology, University College of Medical Sciences and GTB hospital, Delhi, India
| | - Anupama Tandon
- Department of Radiology, University College of Medical Sciences and GTB hospital, Delhi, India
| | - Saumya Dangwal
- Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
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10
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Burud I, Ikram MA, Tata MD, Jaafar J. Tuberculous cold abscess of sternoclavicular joint: a case report. Pan Afr Med J 2020; 36:16. [PMID: 32774593 PMCID: PMC7388635 DOI: 10.11604/pamj.2020.36.16.20697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/11/2020] [Indexed: 11/20/2022] Open
Abstract
Bone and joint tuberculosis is a serious medical problem; tuberculosis of sternoclavicular joint is rare. We present a case of a healthy 37-year old man with sternoclavicular joint tuberculosis. The subject presented with a three weeks history of left sternoclavicular joint painless swelling without fever or weight loss. He had no previous history of pulmonary tuberculosis. Laboratory testing revealed erythrocyte sedimentation rate of 70 mm/hour, C-reactive protein of 30 mg/liter and a normal leucocyte count. Biopsy of the lesion showed caseous necrosis and pus culture revealed Mycobacterium tuberculosis. He was treated with joint debridement and anti-tuberculous medications. Tuberculosis resolved completely but post-infection patients had residual joint arthritis. Tuberculosis may infect unusual joints such as the sternoclavicular joint.
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Affiliation(s)
- Ismail Burud
- Department of Surgery, International Medical University, Clinical Campus, Seremban, Malaysia
| | - Mohammad Arshad Ikram
- Orthopaedic Department, International Medical University, Clinical Campus, Seremban, Malaysia
| | | | - Junalina Jaafar
- Department of Histopathology, Hospital Tuanku Jaafar, Seremban, Malaysia
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11
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Kumar S, Jain VK. Sternoclavicular joint tuberculosis: A series of conservatively managed sixteen cases. J Clin Orthop Trauma 2020; 11:S557-S567. [PMID: 32774029 PMCID: PMC7394813 DOI: 10.1016/j.jcot.2020.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Sternoclavicular joint tuberculosis is rare with non-specific signs and symptoms thus making correct clinical diagnosis difficult. Delay in diagnosis results in destruction of osteo-ligamentous structures, spread of abscess to deeper planes as well as bursting through skin resulting in joint instability and scar formation. MATERIAL AND METHODS All the cases of sternoclavicular joint tuberculosis presented to the orthopaedic outdoor between 2004 and 2017 were evaluated clinico-radiologically along with cyto-histopathological and/or microbiological tests to ascertain the diagnosis before initiation of treatment. RESULTS There were 11 males and 5 females patients aged 11-65 years (mean, 35 years). Aspiration or curettage of the swelling was performed, and the diagnosis was confirmed in 12 cases by cytology, AFB stain, TB polymerase chain reaction, culture or a combination of these. In 4 patients, anti-tubercular treatment was initiated on clinical suspicion. CONCLUSION Diagnosing sternoclavicular tuberculosis requires multimodal approach. A strong clinical suspicion is required as the presentation is often atypical. Early detection of disease and with conservative treatment resulted in complete remission and minimal long term disability.
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12
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Pathologic Clavicle Fracture Secondary to Propionibacterium acnes Abscess: Case Report and Review of Literature. Indian J Orthop 2020; 55:273-276. [PMID: 34113431 PMCID: PMC8149526 DOI: 10.1007/s43465-020-00042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 02/04/2023]
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13
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Bains L, Lal P, Chand T, Gautam KK, Beg MY, Kumar P. Isolated primary cold abscess of the sternum: a case report. J Med Case Rep 2019; 13:267. [PMID: 31445516 PMCID: PMC6708553 DOI: 10.1186/s13256-019-2210-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/30/2019] [Indexed: 11/23/2022] Open
Abstract
Background Musculoskeletal tuberculosis forms 10–25% of extrapulmonary tuberculosis which mainly involves the spine or weight-bearing joints. Tuberculous involvement of the sternum is a rare clinical entity even in countries where tuberculosis has high prevalence. Primary tuberculous sternal osteomyelitis accounts for approximately 0.3% of all types of tubercular osteomyelitis and the probable source appears to be extension from paratracheal or hilar lymph nodes. Despite tuberculosis being a common disease in endemic countries and worldwide, a thorough literature search of the PubMed database for keywords “primary tuberculosis of sternum” and “primary tuberculous osteomyelitis of sternum” yielded 30 and 22 articles, respectively. Case presentation We present an unusual case of a large dumb-bell-shaped cold abscess arising due to infection of the sternum. A 23-year-old immunocompetent Asian woman presented with a gradually progressing painless swelling on anterior chest wall for the last 5 months. She had a large visible swelling on anterior chest wall which was 12.5 cm in diameter, soft, non-tender, temperature was not raised, and fluctuant. Magnetic resonance imaging showed a large dumb-bell-shaped hyperintense collection in upper anterior chest wall with marrow edema and cortical irregularity in left side of manubrium. Pus was positive for nucleic acid testing (cartridge-based nucleic acid amplification test) for Mycobacterium tuberculosis and later culture was also positive. She was started on anti-tubercular therapy and aspirated twice. Currently, she has completed 6 months of therapy and the swelling has now disappeared. Discussion Swelling, pain localized to sternum, or ulceration of the skin with discharging sinus along with or without constitutional symptoms are the usual presentation. A high element of suspicion is needed for early diagnosis and treatment to prevent its complications. Sternal mycobacterial infections are categorized as primary, secondary, and/or acquired postoperatively. Although radiological investigations aid in diagnosis, the diagnosis is established by positive culture or histopathological examination. Anti-tubercular therapy is the mainstay of treatment with standard four-drug regimen for 6–9 months. Surgical drainage of the abscess should be considered only if it does not resolve by aspiration and anti-tubercular therapy.
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Affiliation(s)
- Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India.
| | - Pawan Lal
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Tirlok Chand
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | | | - Mohd Yasir Beg
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Pritesh Kumar
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
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14
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Feki W, Ketata W, Mkaouar N, Charfi S, Moussa N, Yangui I, Kammoun S. [Isolated sternal tuberculosis in immunocompétent adult]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:96-99. [PMID: 29580725 DOI: 10.1016/j.pneumo.2018.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/14/2018] [Accepted: 02/16/2018] [Indexed: 06/08/2023]
Abstract
Isolated sternal tuberculosis is a rarely described entity even in countries where tuberculosis is endemic. We report the case of 25 old years patient who presented with a chest wall mass. Imaging concluded to a (ring-enhancing hypodense soft tissue mass surrounding the sternum with sternal fracture). Malignancy was eliminated by a core needle biopsy. We noted clinical and radiological recovery with medical tuberculosis treatment. Neoplastic origin was removed by biopsy and anatomopathological study of the lesion.
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Affiliation(s)
- W Feki
- Service de pneumologie, université de Sfax, CHU Hédi Chaker, Sfax, Tunisie.
| | - W Ketata
- Service de pneumologie, université de Sfax, CHU Hédi Chaker, Sfax, Tunisie
| | - N Mkaouar
- Service de pneumologie, université de Sfax, CHU Hédi Chaker, Sfax, Tunisie
| | - S Charfi
- Laboratoire d'anatomopathologie, université de Sfax, CHU Habib Bourguiba, Sfax, Tunisie
| | - N Moussa
- Service de pneumologie, université de Sfax, CHU Hédi Chaker, Sfax, Tunisie
| | - I Yangui
- Service de pneumologie, université de Sfax, CHU Hédi Chaker, Sfax, Tunisie
| | - S Kammoun
- Service de pneumologie, université de Sfax, CHU Hédi Chaker, Sfax, Tunisie
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Sternoclavicular joint tuberculosis: A series of 9 cases. Indian J Tuberc 2017; 64:221-224. [PMID: 28709493 DOI: 10.1016/j.ijtb.2017.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 01/04/2017] [Indexed: 11/21/2022]
Abstract
Tuberculosis (TB) is a chronic disease that may affect any part of the human body. Though the osteoarticular TB is not uncommonly seen, TB of the sternoclavicular joint (SC joint) is an infrequently reported condition. The very fact that many physicians have never seen a single case of SC joint TB in their entire career makes them never think of this condition in cases of chronic swellings of the medial end of clavicle. We are reporting here our experience with nine cases of SC joint TB that were treated by us. Delay in diagnosis in each of the case was a common feature, and they had been treated in line of inflammation elsewhere. Diagnosis was arrived at by clinical, radiological, and microscopic examinations. Six of the reported cases responded well to antitubercular chemotherapy, and in one of the cases, chemotherapy was combined with debridement, which was actually done during biopsy and primarily for tissue diagnosis; in another two cases, immunomodulation therapy for HIV was given along with antitubercular therapy. Tuberculous etiology should be considered for patients presenting with atypical sites of skeletal inflammation, and a high index of suspicion by the treating physician is necessary to make early diagnosis and appropriate treatment.
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16
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Abstract
Despite significant improvements in the diagnosis and treatment of tuberculosis achieved during the last 3 decades, tuberculosis still remains one of the deadliest communicable diseases worldwide. Tuberculosis is still present in all regions of the world, with a more significant impact in developing countries. This article reviews the most common imaging manifestations of primary and postprimary tuberculosis, their complications, and the critical role of imaging in the diagnosis and follow-up of affected patients.
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Affiliation(s)
- Carlos Santiago Restrepo
- Department of Radiology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 7800, San Antonio, TX 78229-3900, USA.
| | - Rashmi Katre
- Department of Radiology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 7800, San Antonio, TX 78229-3900, USA
| | - Amy Mumbower
- Department of Radiology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 7800, San Antonio, TX 78229-3900, USA
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17
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Boruah DK, Sanyal S, Sharma BK, Prakash A, Dhingani DD, Bora K. Role of Cross Sectional Imaging in Isolated Chest Wall Tuberculosis. J Clin Diagn Res 2017; 11:TC01-TC06. [PMID: 28274020 DOI: 10.7860/jcdr/2017/23522.9185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/08/2016] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Isolated chest wall tuberculosis though a rare entity, the incidence of it has been on rise among immunocompromised population making it an important challenging diagnosis for the physicians. Its clinical presentation may resemble pyogenic chest wall abscess or chest wall soft tissue tumour. Sometimes it is difficult to detect clinically or on plain radiograph. AIM The present study was conducted with an aim to evaluate the common sites and varying appearances of isolated chest wall tuberculosis. MATERIALS AND METHODS A hospital based cross-sectional retrospective study was conducted in Assam Medical College and Hospital, a tertiary care centre in North East India. The study group comprise of 21 patients (n=15 male and n=6 females) with isolated chest wall tuberculosis without associated pulmonary or spinal involvement who were subjected to Computed Tomography/Magnetic Resonance Imaging (CT/MRI) of the thorax following initial Ultrasonogram (USG) evaluation of the local site. Pathological correlation was done from imaging guided sampling of the aspirate or surgery. RESULTS Variable sites of involvement were seen in the chest wall in our patients (n=21), with chest wall abscess formation being the most common presentation and rib being the most common bony site affected in the thoracic cage. Bony sclerosis was noted in 11 patients (52.4%), periosteal reaction in 10 patients (47.6%) and sequestration in five patients (23.8%). CT/MRI not only localized the exact site and extent of the abscesses which facilitated guided aspirations, but also helped in detecting typical bony lesions thereby, differentiating from pyogenic osteomyelitis besides ruling out associated pulmonary or pleural involvement in such patients. CONCLUSION Cross-sectional imaging plays an important role by giving a wholesome picture of both soft tissue and bony pathology. It is important to have adequate understanding of the radiologic manifestations of the chest wall involvement and complications of tuberculosis to facilitate diagnosis and in assessing response to treatment on follow up in patients.
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Affiliation(s)
- Deb Kumar Boruah
- Assistant Professor, Department of Radiodiagnosis, Assam Medical College , Dibrugarh, Assam, India
| | - Shantiranjan Sanyal
- Consultant Radiologist, Department of Radiology, Airedale General Hospital , Keighley, West Yorkshire, United Kingdom
| | - Barun K Sharma
- Associate Professor, Department of Radiology, Sikkim Manipal Institute of Medical Sciences , Gangtok, Sikkim, India
| | - Arjun Prakash
- Postgraduate Student, Department of Radiodiagnosis, Assam Medical College , Dibrugarh, Assam, India
| | - Dhabal D Dhingani
- Postgraduate Student, Department of Radiodiagnosis, Assam Medical College , Dibrugarh, Assam, India
| | - Karobi Bora
- Postgraduate Student, Department of Radiodiagnosis, Assam Medical College , Dibrugarh, Assam, India
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Zou J, Shi Z, Mei G, Xue J, Gu W, Li X. Two-stage operation to treat destructive midfoot tuberculosis: 14 cases experience. Orthop Traumatol Surg Res 2016; 102:1075-1080. [PMID: 27575733 DOI: 10.1016/j.otsr.2016.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/17/2016] [Accepted: 07/18/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Tuberculosis (TB) in midfoot is often secondary to tuberculosis elsewhere in the body. The experience and literatures to treat midfoot tuberculosis are rare. Up until now, no successful method is reported to treat midfoot tuberculosis. HYPOTHESIS Stage surgery is an effective method to treat midfoot bone TB. MATERIAL AND METHODS Between January 2008 to January 2011, 14 patients who were diagnosed midfoot tuberculosis and suffered stage operation were enrolled. All the patients had been diagnosed definitely relying on imaging examination and laboratory tests preoperatively. Two-stage operation was performed to all patients. At the first stage, TB tissue and infective tissue were completely removed and replaced by antibiotic bone cement. Normal foot length and arch would be restored and maintained by K-wires and external fixators. At the second stage, autologous iliac and allogeneic bone graft were used to replace bone cement and by fixed by locking plates. American Orthopaedic Foot and Ankle Society (AOFAS), SF-36 and visual analogue scale (VAS) pain score were recorded at the last follow-up. RESULTS The average bone union time was 3.8 (range 3-6) months. There is no case of local recurrence or skin sinus. Neither implant broken nor screw loosen was present in this study. The AOFAS score was increased from 51.7±6.8 (range 43-61) preoperatively to 82.9±3.9 (range 76-90) postoperatively (P<0.001). The SF-36 score increased from 46.1±6.1 preoperatively to 83.1±5.4 postoperatively (P<0.001). The VAS score decreased from 6.1±1.1 preoperatively to 1.4±0.9 points postoperatively (P<0.001). DISCUSSION Stage operation is an effective treatment to stage III, IV midfoot tuberculosis. LEVELS OF EVIDENCE Level IV, retrospective.
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Affiliation(s)
- J Zou
- Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
| | - Z Shi
- Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China.
| | - G Mei
- Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
| | - J Xue
- Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
| | - W Gu
- Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
| | - X Li
- Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
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Abstract
Sternal mycobacterial infections are rare. Due to the rarity, its clinical characteristics, diagnoses, and regular management strategies are still scanty. A total of 76 articles on this topic were obtained by a comprehensive literature collection. The clinical features, diagnosis, management strategies and prognosis were carefully analyzed. There were totally 159 patients including 152 (95%) cases of tuberculosis (TB) and seven (5%) cases of non-TB sternal infections. Sternal mycobacterial infections can be categorized into three types: Primary, secondary, and postoperative, according to the pathogenesis; and categorized into isolated, peristernal, and multifocal, according to the extent of the lesions. Microbiological investigation is more sensitive than medical imaging and Mantoux tuberculin skin test in the diagnosis of sternal infections. Most patients show good responses to the standard four-drug regimen and a surgical intervention was necessary in 28.3% patients. The prognoses of the patients are good with a very low mortality. A delayed diagnosis of sternal mycobacterial infections may bring about recurrent sternal infections and sustained incurability. An early diagnosis and prompt antibiotic regimens may significantly improve the patients' outcomes.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, People's Republic of China
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20
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Mikawa T, Miyoshi K, Fujita K, Hase R, Hosokawa N. [The Great Imitator; Clavicular Tuberculosis Mimics a Metastatic Neoplasm]. ACTA ACUST UNITED AC 2016; 89:588-91. [PMID: 26630791 DOI: 10.11150/kansenshogakuzasshi.89.588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In the same manner as syphilis, tuberculosis (TB) was often called "The Great Imitator". We have to consider not only malignancies but also TB as a differential diagnosis when we find any tumorous regions. We report herein on a rare case, clavicular osteomyelitis due to TB. A 72-year-old female, with diabetic nephropathy, was on maintenance hemodialysis. She had a fall 2 months prior to admission followed by pain around her right clavicle. Ulceration occurred in that region a month prior to admission, and CT scan revealed a fracture of the right clavicle with a tumor surrounding that area. Seven days prior to admission, she went to a neurologist because of dizziness. MRI of the brain revealed a tumor in her pons. The physician suspected the tumor was metastasis. Needle biopsies revealed only necrotic tissue so the medical oncologist consulted us because they suspected it was caused by infection of some kind. From the patient's history and the physical examination, we suspected TB osteomyelitis and grew some more cultures, but only MRSA and E. coli were detected. We administered vancomycin and cefmetazole for the secondary bacterial osteomyelitis. After a month of hospitalization, we found miliary regions on her chest CT and Mycobacterium tuberculosis was grown from the needle biopsy specimen. We started multi-antituberculosis therapy and the patient had a good prognosis. We report herein on a rare case of clavicular osteomyelitis due to TB, together with a review of the literature.
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21
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Rabiou S, Issoufou I, Ammor FZ, Belliraj L, Ghalimi J, Ouadnouni Y, Lakranbi M, Smahi M. [Primitive sternoclavicular septic arthritis]. Rev Mal Respir 2016; 33:630-3. [PMID: 26827105 DOI: 10.1016/j.rmr.2015.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 11/01/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Sternoclavicular infections are unusual, and it even more unusual for infection to occur here as a primary site. CASE REPORT We report the case of a 53-year-old patient with no prior medical history or risk factor who consulted because of sternal swelling of inflammatory character. CT-scan, bacteriological and histological analysis of samples concluded the diagnosis of primary sternoclavicular staphylococcal septic arthritis. Management consisted of antibiotics and was associated with a flattening of the lesion. The outcome at 6 months was favorable. CONCLUSION Sternoclavicular infections should be evoked early in the course of sternoclavicular pain in order to avoid any locoregional complications and mostly mediastinitis.
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Affiliation(s)
- S Rabiou
- Service de chirurgie thoracique, CHU Hassan II, Fès, Maroc.
| | - I Issoufou
- Service de chirurgie thoracique, CHU Hassan II, Fès, Maroc
| | - F Z Ammor
- Service de chirurgie thoracique, CHU Hassan II, Fès, Maroc
| | - L Belliraj
- Service de chirurgie thoracique, CHU Hassan II, Fès, Maroc
| | - J Ghalimi
- Service de chirurgie thoracique, CHU Hassan II, Fès, Maroc
| | - Y Ouadnouni
- Service de chirurgie thoracique, CHU Hassan II, Fès, Maroc; Faculté de médecine et pharmacie, université Sidi Mohamed Ben Abdellah, Fès, Maroc
| | - M Lakranbi
- Service de chirurgie thoracique, CHU Hassan II, Fès, Maroc
| | - M Smahi
- Service de chirurgie thoracique, CHU Hassan II, Fès, Maroc; Faculté de médecine et pharmacie, université Sidi Mohamed Ben Abdellah, Fès, Maroc
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Pal CP, Kumar H, Kumar S, Hussain A. Tubercular osteomyelitis of the lateral-third of the clavicle. BMJ Case Rep 2016; 2016:bcr-2015-213636. [PMID: 26768706 DOI: 10.1136/bcr-2015-213636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An elderly women with a chronic history of pain and swelling of the right clavicle was investigated. She also had constitutional symptoms. Clinical examination showed mild inflammatory signs over the lateral one-third of the clavicle and the swelling was hard. Clavicle X-ray showed a lytic lesion in the lateral-third of the clavicle and MRI revealed a focal hyperintense area with cortical breach involving the superior cortex of the clavicle. The diagnosis was confirmed as tubercular osteomyelitis after the biopsy, which showed chronic granulomatous inflammation, and the culture was positive for Mycobacterium tuberculosis. Pain resolved by 6 weeks, swelling by 4 months and complete radiological resolution was seen at 15 months after the initiation of antitubercular therapy. No deficit in function was seen. No relapse was noted at 1-year follow-up.
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Affiliation(s)
| | - Harish Kumar
- Department of Orthopaedics, S N Medical College, Agra, Uttar Pradesh, India
| | - Suneel Kumar
- Department of Orthopaedics, S N Medical College, Agra, Uttar Pradesh, India
| | - Asif Hussain
- Department of Orthopaedics, S N Medical College, Agra, Uttar Pradesh, India
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23
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Akhtar MN, Agarwal S, Athar R. Clinico-radiological Approach to a Rare Case of Early Clavicle Tuberculosis: A Case Discussion Based Review of Differential Diagnosis. J Clin Diagn Res 2015; 9:RE01-5. [PMID: 26266175 DOI: 10.7860/jcdr/2015/11971.6079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 04/28/2015] [Indexed: 11/24/2022]
Abstract
A patient of 41 years of age presented with insidious onset atraumatic swelling arising from medial end of right clavicle with apparently normal radiograph. Initial computed tomography ascribed it to benign bony pathology requiring no specific treatment but patient did not respond to symptomatic management. FNAC done elsewhere was inconclusive, with no bacteria on Gram's staining and negative bacterial culture and AFB smear examinations. Patient had possible exposure to tuberculosis and Mantoux skin test done which showed significant induration. Possible differential diagnoses related to clavicle including infective, neoplastic, rheumatological, degenerative and idiopathic conditions considered. Magnetic resonance imaging (MRI) showed focal periosteal reaction with marrow signal changes with sparing of sternoclavicular joint. Correlation between patient's history, clinical findings and investigations done and diagnosis of isolated clavicle tuberculosis was made. Patient showed good response to anti-tubercular chemotherapy. Repeat MRI showed resolution of initial imaging findings. At the end of 2 years patient was completely symptom free.
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Affiliation(s)
- Mohammad Nasim Akhtar
- Assistant Professor, Department of Orthopaedics, ESI PGIMSR, ESIC Medical College and ESIC Hospital , The West Bengal University of Health Sciences, Kolkata (W.B.), India
| | - Sharat Agarwal
- Associate Professor, Department of Orthopaedics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences , Shillong (Meghalaya), India
| | - Rizwan Athar
- Consultant Pathologist, Haji Abdul Majid Memorial Hospital , Hojai (Assam), India
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Epperla N, Kattamanchi S, Fritsche TR. Appearances are Deceptive: Staphylococcus Superinfection of Clavicular Tuberculous Osteomyelitis. Clin Med Res 2015; 13:85-8. [PMID: 25487239 PMCID: PMC4504661 DOI: 10.3121/cmr.2014.1247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 07/24/2014] [Indexed: 11/18/2022]
Abstract
A man, aged 25 years, presented with pain, swelling, and drainage from the right clavicular area. He had a past history of abscess at the sternoclavicular joint. The cultures from the drainage site grew methicillin-sensitive Staphylococcus aureus, and he was placed on appropriate antibiotics. As S. aureus infection of the clavicle is often secondary in nature, particularly in adults, a thorough workup was done to identify the underlying cause. Quantiferon gold, done as a part of the workup, came back positive, while the bone cultures grew S. aureus and Mycobacterium tuberculosis. He was placed on 9 months of combination therapy for tuberculosis osteomyelitis with a good clinical outcome.
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Affiliation(s)
- Narendranath Epperla
- Department of Internal Medicine, Marshfield Clinic, Marshfield WI, USA Department of Laboratory Medicine, Marshfield Clinic, Marshfield WI, USA
| | | | - Thomas R Fritsche
- Department of Laboratory Medicine, Marshfield Clinic, Marshfield WI, USA
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25
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Gorospe L, Ayala-Carbonero AM, Rodríguez-Díaz R, García Latorre R, Muñoz-Molina GM, Cabañero-Sánchez A. Tuberculosis of the manubriosternal joint and concurrent asymptomatic active pulmonary tuberculosis in a patient presenting with a chest wall mass. Clin Imaging 2015; 39:311-4. [DOI: 10.1016/j.clinimag.2014.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 08/17/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
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Abstract
The magnetic resonance (MR) imaging presentations of arthritis of the knee are important for radiologists to recognize because these disorders are often clinically unsuspected. When they are known or clinically suspected, knowledge of imaging features allows for the confirmation and characterization of the extent of disease. This article reviews the fundamental MR imaging manifestations of rheumatologic disorders of the knee and their presentation in specific arthropathies.
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27
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Prakash J, Aggarwal S, Mehtani A. Primary tuberculosis of the clavicle. Orthopedics 2014; 37:e879-84. [PMID: 25275974 DOI: 10.3928/01477447-20140924-53] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 02/20/2014] [Indexed: 02/03/2023]
Abstract
Tuberculosis of the clavicle is a rare lesion, accounting for less than 1% of all osteoarticular tuberculosis. The lesion has been described in a few case reports. The lesion can have a varied presentation, ranging from dull, aching pain to bony swelling and a draining sinus. The rarity of the lesion, its nonspecific symptoms, and its striking resemblance to common cystic conditions such as bone tumors and metabolic conditions such as rickets make diagnosis difficult. The authors describe a series of 17 patients with primary tuberculosis of the clavicle. Radiographs and magnetic resonance images were obtained for all patients, and a preliminary diagnosis was made on the basis of clinical features and the results of erythrocyte sedimentation rate, C-reactive protein, and Mantoux tests. Erythrocyte sedimentation rate was uniformly elevated. Radiographs showed diffused thickening and honeycombing, eccentric expansile lytic lesions with surrounding osteopenia, or sequestration not unlike pyogenic infection. Magnetic resonance imaging is useful for determining the extent of the lesion and soft tissue involvement. The radiological and laboratory findings provided complementary information. The diagnosis was confirmed on biopsy material that was analyzed with histopathology, pus culture and sensitivities, gram stain, acid-fast stain, and cultures on Löwenstein-Jensen medium. Patients were treated with multidrug antitubercular chemotherapy for 18 months and were assessed on pre- and posttreatment radiology, erythrocyte sedimentation rate, and University of California, Los Angeles (UCLA) shoulder rating scale. The results of conservative management of tubercular osteomyelitis were uniformly good, and all patients recovered well.
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Abstract
INTRODUCTION Osteomyelitis of the clavicle is a rare entity particularly in adults. Most infective lesions of the clavicle are traumatic and are not difficult to diagnose. Nontraumatic clavicular lesions, on the other hand, are rare and are difficult to diagnosis. It can also occur as a complication of head and neck surgery and subclavian catheter placement. CASE REPORT We describe this case in a 61-year-old male who presented with a discharging sinus since 2 years at his left shoulder tip with purulent discharge. Clinicoradiologically, patient was diagnosed as a case of pyogenic osteomyelitis of the lateral end of the clavicle. However, biopsy proved it to be a tubercular osteomyelitis. CONCLUSION Discharging sinus along with secondary infection made diagnosis difficult and delayed appropriate treatment. Thus, as skeletal tuberculosis (TB) can mimic any bony pathology, TB has to be included in the differential diagnosis especially at unusual sites.
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Affiliation(s)
- Archit Agarwal
- Department of Orthopaedics, Himalayan Institute of Medical Sciences, Dehradun, uttrakhand, India
| | - Rajesh Maheshwari
- Department of Orthopaedics, Himalayan Institute of Medical Sciences, Dehradun, uttrakhand, India
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Pratima K, Vijay S, Shailendra K. Tuberculosis of the Sternoclavicular Joint. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2013. [DOI: 10.1016/j.jotr.2013.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Tuberculosis may affect almost every part of the body. However, it is very uncommon for tuberculosis to involve the sternoclavicular joint. Demonstration of acid-fast bacilli, which is the gold standard for diagnosis, is extremely rare in these lesions. Diagnosis is usually based on demonstration of granulomas on histopathology. Good radiographs and imaging studies are supportive for diagnosis. We report a case of 32-year-old male who presented with a tender swelling over the medial end of the clavicle with a sinus and signs of inflammation. The fine needle aspiration of the lesion demonstrated acid-fast bacilli on Ziehl—Neelsen staining. The patient was put on antitubercular chemotherapy for 1 year and made an uneventful recovery.
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Affiliation(s)
- Khare Pratima
- Central Institute of Orthopedics, Safdarjung Hospital and Associated V.M. Medical College, New Delhi 110029, India
| | - Sharma Vijay
- Central Institute of Orthopedics, Safdarjung Hospital and Associated V.M. Medical College, New Delhi 110029, India
| | - Khare Shailendra
- Central Institute of Orthopedics, Safdarjung Hospital and Associated V.M. Medical College, New Delhi 110029, India
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30
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Dugg P, Shivhare P, Mittal S, Singh H, Tiwari P, Sharma A. Clavicular osteomyelitis: a rare presentation of extra pulmonary tuberculosis. J Surg Case Rep 2013; 2013:rjt030. [PMID: 24964439 PMCID: PMC3813558 DOI: 10.1093/jscr/rjt030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Clavicular tuberculosis is a rare entity, an unusual case of skeletal tuberculosis. We report a case of rare presentation of clavicular tuberculosis as a non-healing ulcer in the medial two-third and lateral one-third of the clavicle. The clinical picture was confusing because of the development of foul-smelling discharge due to secondary infection. The diagnosis is rarely suspected before biopsies because tumours are much more frequent than infections in this bone. With worldwide resurgence of tuberculosis, clinicians should maintain a high index of suspicion as more infection at unusual sites is being reported.
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Affiliation(s)
- Pankaj Dugg
- Department of General Surgery, Government Medical College, Patiala, India
| | - Pankaj Shivhare
- Department of General Surgery, Government Medical College, Patiala, India
| | - Sushil Mittal
- Department of General Surgery, Government Medical College, Patiala, India
| | - Harnam Singh
- Department of General Surgery, Government Medical College, Patiala, India
| | - Punit Tiwari
- Department of Orthopaedics, Government Medical College, Patiala, India
| | - Ankur Sharma
- Department of General Surgery, Government Medical College, Patiala, India
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Cherif E, Ben Hassine L, Boukhris I, Khalfallah N. Sternal tuberculosis in an immunocompetent adult. BMJ Case Rep 2013; 2013:bcr2013008810. [PMID: 23580679 PMCID: PMC3645650 DOI: 10.1136/bcr-2013-008810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Skeletal tuberculosis accounts for 1-3% of patients with mycobacterial infection. Any bone can be a site for tuberculosis, but sternum involvement is quite rare. We report the case of a 37-year-old woman admitted because of chest pain and increased swelling over the anterior chest. She was immunocompetent and had no systemic features. She was diagnosed with tuberculosis of the sternum without active pulmonary disease. Conservative management with oral multidrug antituberculous therapy completely cured the patient.
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Affiliation(s)
- Eya Cherif
- Department of Internal Medicine, Charles Nicolle's Hospital, Tunis, Tunisia.
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32
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Hegazi A, Dragovic B. Tuberculous osteomyelitis of the sternum in a patient with well controlled HIV infection and undetectable vitamin D levels. HIV & AIDS REVIEW 2012. [DOI: 10.1016/j.hivar.2012.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Aghoutane EM, Fezzazi R. [Isolated tuberculosis of the sternum in children: case report]. REVUE DE PNEUMOLOGIE CLINIQUE 2011; 67:322-324. [PMID: 22017954 DOI: 10.1016/j.pneumo.2010.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 09/17/2010] [Accepted: 09/20/2010] [Indexed: 05/31/2023]
Abstract
Tuberculosis of the sternum is rare in children, and is often difficult to diagnose, however its prognosis remains good following treatment. Here we have the case of a young 14-year-old girl, who over the past 1 month has had swelling of the sternum combined with a fever of 38.5°C. Computed tomography revealed sternal lysis and swelling of the soft tissue. The histopathological examination of the bone harvesting confirmed the diagnosis of tuberculous osteitis. Anti-bacillary treatment permitted favorable progression. Tuberculous osteitis of the sternum is a rare condition. Contamination can occur through contiguity or reactivation of a latent focus. Confirmation is established by histopathological and/or bacteriological sampling. Treatment is essentially medical.
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Affiliation(s)
- E M Aghoutane
- Service de chirurgie pédiatrique A, hôpital Arrazi, BP 3939, avenue Ibn Sina Ammerchich, Marrakech, Morocco.
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De Backer AI, Vanhoenacker FM, Sanghvi DA. Imaging features of extraaxial musculoskeletal tuberculosis. Indian J Radiol Imaging 2011; 19:176-86. [PMID: 19881081 PMCID: PMC2766888 DOI: 10.4103/0971-3026.54873] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tuberculosis (TB) continues to be a public health problem in both developing and industrialized countries. TB can involve pulmonary as well as extrapulmonary sites. The musculoskeletal system is involved in 1–3% of patients with tuberculosis. Although musculoskeletal TB has become uncommon in the Western world, it remains a huge problem in Asia, Africa, and many developing countries. Tuberculous spondylitis is the most common form of musculoskeletal TB and accounts for approximately 50% of cases. Extraspinal musculoskeletal TB shows a predilection for large joints (hip and knee) and para-articular areas; isolated soft tissue TB is extremely rare. Early diagnosis and prompt treatment are mandatory to prevent serious destruction of joints and skeletal deformity. However, due to the nonspecific and often indolent clinical presentation, the diagnosis may be delayed. Radiological assessment is often the first step in the diagnostic workup of patients with musculoskeletal TB and further investigations are decided by the findings on radiography. Both the radiologist and the clinician should be aware of the possibility of this diagnosis. In this manuscript we review the imaging features of extraspinal bone, joint, and soft tissue TB.
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Affiliation(s)
- Adelard I De Backer
- Department of Radiology, Antwerp University Hospital, UZA, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem and Department of Radiology, AZ Sint-Maarten, Duffel-Mechelen, Rooienberg 25, B-2570 Duffel, Belgium
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Grover SB, Jain M, Dumeer S, Sirari N, Bansal M, Badgujar D. Chest wall tuberculosis - A clinical and imaging experience. Indian J Radiol Imaging 2011; 21:28-33. [PMID: 21431030 PMCID: PMC3056366 DOI: 10.4103/0971-3026.76051] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIMS Tuberculous infection of the thoracic cage is rare and is difficult to discern clinically or on radiographs. This study aims to describe the common sites and the imaging appearances of chest wall tuberculosis. MATERIALS AND METHODS A retrospective review of the clinical and imaging records of 12 confirmed cases of thoracic cage tuberculosis (excluding that of the spine), seen over the last 7 years, was performed. Imaging studies available included radiographs, ultrasonographies (USGs), and computed tomography (CT) scans. Pathological confirmation was obtained in all cases. RESULTS All patients had clinical signs and symptoms localized to the site of involvement, whether it was the sternum, sternoclavicular joints, or ribs. CT scan revealed sternal destruction in three patients and osteolytic lesions with sclerosis of the articular surfaces of the sternoclavicular joints in two patients. In five patients with rib lesions, USG elegantly demonstrated the bone destruction underlying the cold abscess. All cases were confirmed to be of tuberculous origin by pathology studies of the aspirated/curetted material, obtained by CT / USG guidance. CONCLUSIONS Tuberculous etiology should be considered for patients presenting with atypical sites of skeletal inflammation. CT scan plays an important role in the evaluation of these patients. However, the use of USG for demonstrating rib destruction in a chest wall cold abscess has so far been under-emphasized, as has been the role of CT and USG guided aspiration in confirming the aetiology.
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Affiliation(s)
- Shabnam Bhandari Grover
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
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de Carli DM, Severo MD, Haygert CJP, Guollo M, Omairi A, Pedro VD, Silva EP, Rodrigues AT. Sternal osteomyelitis caused by infection with Mycobacterium tuberculosis. J Bras Pneumol 2010; 35:709-12. [PMID: 19669010 DOI: 10.1590/s1806-37132009000700013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 01/12/2009] [Indexed: 11/21/2022] Open
Abstract
We report the case of a 74-year-old male patient with a one-year history of chest pain in the suprasternal notch associated with erythema, edema and drainage of purulent material from a fistulous lesion. The patient was HIV-negative with no history of TB. A CT scan of the chest showed an osteolytic lesion in the sternum, and a biopsy revealed caseous granuloma, which, in the microbiological evaluation, was negative for fungi and acid-fast bacilli. The diagnosis of sternal osteomyelitis caused by Mycobacterium tuberculosis was confirmed using PCR.
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Abstract
Tuberculosis of the clavicular bone is a very rare clinical entity, with limited cases reported in the United States. Furthermore, sparing of the sternoclavicular joint is exceedingly unusual. A literature review of the prevalence of clavicular tuberculosis identified fewer than 80 cases reported since the discovery of the tubercular bacillus, over a century ago. To our knowledge, there have been no cases reported over the last decade in the United States. A rare case of tuberculous osteomyelitis of the clavicle in an immunocompetent patient who presented with swelling of the upper chest is reported.
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Restrepo CS, Martinez S, Lemos DF, Washington L, McAdams HP, Vargas D, Lemos JA, Carrillo JA, Diethelm L. Imaging appearances of the sternum and sternoclavicular joints. Radiographics 2009; 29:839-59. [PMID: 19448119 DOI: 10.1148/rg.293055136] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The sternum and sternoclavicular joints--critical structures of the anterior chest wall--may be affected by various anatomic anomalies and pathologic processes, some of which require treatment. Pectus excavatum and pectus carinatum are common congenital anomalies that are usually benign but may warrant surgical treatment if they cause compression of vital internal structures. By contrast, developmental variants such as the sternal foramen are asymptomatic and do not require further evaluation or treatment. Arthritides of the sternoclavicular joint (osteoarthritis, septic arthritis, and seronegative arthropathies) are common and must be differentiated before an appropriate management method can be selected. The recognition of complications of sternotomy (eg, sternal dehiscence, secondary osteomyelitis) is critical to avoid life-threatening sequelae such as acute mediastinitis. Likewise, the detection of sternal fractures and sternoclavicular dislocations is important, especially where they impinge on vital structures. In addition, sternal malignancies (most commonly, metastases and chondrosarcoma) must be distinguished from benign neoplasms. To achieve accurate and timely diagnoses that facilitate appropriate treatment, radiologists must be familiar with the appearances of these normal anatomic variants and diseases of the sternum.
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Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex., USA
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39
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Mohammadi A, Howell JM. Sternal Tuberculosis. J Emerg Med 2009; 36:342-4. [DOI: 10.1016/j.jemermed.2007.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Revised: 01/30/2007] [Accepted: 02/11/2007] [Indexed: 10/22/2022]
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Sternal Tuberculosis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2009. [DOI: 10.1097/ipc.0b013e3181841f97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aggarwal AN, Dhammi IK, Singh AP, Kumar S, Goyal MK. Tubercular osteomyelitis of the clavicle: a report of four cases. J Orthop Surg (Hong Kong) 2009; 17:123-6. [PMID: 19398810 DOI: 10.1177/230949900901700128] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report the clinicoradiological features of tuberculosis in the clavicle in 4 patients. The patients' ages ranged from 9 months to 29 years. All patients were managed with antitubercular drug therapy for one year and one underwent surgical debridement and curettage as well. Clinicians should be aware of the varied presentation (pain, non-healing ulcer, abscess, multifocal osteoarticular tuberculosis) of this condition. With the worldwide resurgence of tuberculosis, clinicians should maintain a high index of suspicion. The diagnosis of osteoarticular tuberculosis is usually made on clinico-radiological features.
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Affiliation(s)
- A N Aggarwal
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
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Gözübüyük A, Ozpolat B, Gürkök S, Caylak H, Yücel O, Kavakli K, Dakak M, Genç O. Surgical management of chest wall tuberculosis. J Cutan Med Surg 2009; 13:33-9. [PMID: 19298769 DOI: 10.2310/7750.2008.07084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Tuberculosis remains one of the most fatal diseases in the world. Extrapulmonary tuberculosis increases in parallel fashion with the rise of incidence of pulmonary tuberculosis. Tuberculosis of the chest wall is rare. METHODS Our study retrospectively evaluated 10 patients with tuberculosis of the chest wall who were treated with surgery in addition to antituberculous chemotherapy in the last 8 years. Seven of the lesions were located on the anterior chest wall, and three of the lesions were on the lateral chest wall. RESULTS Surgical therapy consisted of evacuation of the cold abscess material from the cavities and wide débridement of the soft tissue planes in all patients. Partial rib resections were performed in six patients owing to costal or chondral involvement. CONCLUSIONS Chest wall tuberculosis must be considered in the differential diagnosis of chest wall lesions, especially in endemic areas.
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Affiliation(s)
- Alper Gözübüyük
- Department of Thoracic Surgery, Gülhane Military Medical Academy, Ankara, Turkey.
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Sanghvi DA, Iyer VR, Deshmukh T, Hoskote SS. MRI features of tuberculosis of the knee. Skeletal Radiol 2009; 38:267-73. [PMID: 19050872 DOI: 10.1007/s00256-008-0617-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Revised: 10/06/2008] [Accepted: 10/28/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this study was to describe the magnetic resonance imaging (MRI) features of tuberculosis (TB) of the knee joint. MATERIALS AND METHODS The MRI features in 15 patients with TB of the knee, as confirmed by histology of the biopsied joint synovium, were reviewed retrospectively. The images were assessed for intra-articular and peri-articular abnormalities. RESULTS All patients had florid synovial proliferation. The proliferating synovium showed intermediate to low T2 signal intensity. In the patients who were administered intravenous contrast, the hypertrophic synovium was intensely enhancing. Marrow edema (n = 9), osteomyelitis (n = 4), cortical erosions (n = 5), myositis (n = 6), cellulitis (n = 2), abscesses (n = 3), and skin ulceration/sinus formation (n = 2) were seen in the adjacent bone and soft tissue. CONCLUSION Synovial proliferation associated with tuberculous arthritis is typically hypointense on T2-weighted images. This appearance, in conjunction with other peri-articular MRI features described, can help in distinguishing TB arthritis from other proliferating synovial arthropathies.
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Affiliation(s)
- Darshana A Sanghvi
- Department of Radiology, Seth GS Medical College and KEM Hospital, Parel, Mumbai 400012, India
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Sahu S. Sternoclavicular Tuberculosis. Med J Armed Forces India 2008; 64:373-4. [PMID: 27688583 DOI: 10.1016/s0377-1237(08)80031-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Accepted: 11/28/2007] [Indexed: 11/19/2022] Open
Affiliation(s)
- S Sahu
- Graded Specialist (Radiodiagnosis & Imaging), No 7 AFH, Kanpur Cantt, UP 208004
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Abstract
BACKGROUND Isolated involvement of bone in tuberculous infection is uncommon, and the variable clinical and radiological features may mimic pyogenic osteomyelitis, bone tumor or other inflammatory and neoplastic processes of the synovium. We have reported our experiences with the diagnosis of tuberculosis infection in the ankle and foot with the hope of providing sufficient information about these cases to lead to early diagnosis. MATERIALS AND METHODS We treated 15 patients with tuberculosis involving the foot and ankle between 1995 and 2005. They were followed for a minimum of 24 months, and the average duration of symptoms was 23 months. All patients underwent a physical examination, routine laboratory tests, plain radiographs, and a biopsy of the infection site. MRI studies were performed in 10 patients and a CT scan was done in one patient. RESULTS The lesions were located in the forefoot (2), midfoot (3) and ankle (10). From the imaging studies, the presumptive preoperative diagnoses were tuberculous osteomyelitis (7), pyogenic osteomyelitis (4), pigmented villonodular synovitis (2), amyloidosis (1), and avascular necrosis of the talus (1). These diagnoses were verified by granulomatous inflammation with or without caseous necrosis on histology and tubercle bacilli were cultured in four cases. In three cases the diagnosis was made by polymerase chain reaction (PCR). CONCLUSION When a patient presents with a localized, painful swelling and a persistent draining sinus of the foot and ankle, tuberculosis should be considered in the differential diagnosis. Additionally, we highly recommend taking a biopsy of the site of suspected infection because an early diagnosis is the key to successful treatment.
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Affiliation(s)
- Woo Jin Choi
- Department of Orthopaedic Surgery-29, Yonsei University College of Medicine, Seoul 120-752, South Korea
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Park JY, Kim JW, Chun CH, Kwon SH, Choi YH, Lee SJ. Operative Treatment of the Tuberculous Arthritis on the Sternoclavicular Joint - A Report of Two Cases-. Clin Shoulder Elb 2008. [DOI: 10.5397/cise.2008.11.1.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Guillemot N, Chadelat K, Nathan N, Aubertin G, Ducou le pointe H, Clément A, Fauroux B, Epaud R. Tuméfaction sternale chez un enfant de neuf ans. Med Mal Infect 2008; 38:278-80. [DOI: 10.1016/j.medmal.2007.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 11/11/2007] [Indexed: 10/22/2022]
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Abstract
A series of 14 patients suffering from tuberculosis of the sternum with a mean follow-up of 2.8 years (2 to 3.6) is presented. All were treated with antitubercular therapy: ten with primary therapy, two needed second-line therapy, and two required surgery (debridement). All showed complete healing and no evidence of recurrence at the last follow-up. MRI was useful in making the diagnosis at an early stage because atypical presentations resulting from HIV have become more common. Early adequate treatment with multidrug antitubercular therapy avoided the need for surgery in 12 of our 14 patients.
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Affiliation(s)
- S A Khan
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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Wang TK, Wong CF, Au WK, Cheng VC, Wong SS. Mycobacterium tuberculosis sternal wound infection after open heart surgery: a case report and review of the literature. Diagn Microbiol Infect Dis 2007; 58:245-9. [PMID: 17300911 DOI: 10.1016/j.diagmicrobio.2006.11.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Revised: 11/28/2006] [Accepted: 11/28/2006] [Indexed: 11/29/2022]
Abstract
Tuberculous osteomyelitis of sternum after open heart surgery is a rare disease entity. We report a case of wound infection with osteomyelitis caused by Mycobacterium tuberculosis in a patient with diabetic nephropathy, requiring peritoneal dialysis after coronary artery bypass grafting, who was successfully treated with antituberculous agents and surgical debridement. In addition, we provide a literature review on reported cases of tuberculous sternal osteomyelitis and mediastinitis after open heart surgery, and discuss about the risk factors, clinical features, and treatment of this infection.
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Affiliation(s)
- Teresa K Wang
- Department of Microbiology, Research Centre of Infection and Immunology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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Szentkereszty Z, Pósán J, Petö K, Sápy P, Boros M, Takács I, Sz Kiss S. [Surgical management of sternoclavicular joint infections]. Magy Seb 2007; 60:514-7. [PMID: 17474306 DOI: 10.1556/maseb.60.2007.1.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
AIMS The pyogenic infection of the sternoclavicular joint is a rare disease. The treatment can be conservative (antibiotics) or surgical (exposure and drainage of the joint or its resection). The authors analyze the causative and predisposing factors, the symptoms, the diagnosis, the questions of the therapy and its efficiency. PATIENTS AND METHODS In the 6 cases (5 male, 1 female, average age: 56.8 years) the cause of the disease were trauma or metastatic septic focus in 2-2 cases and intraarticular injection or preceding radiotherapy in 1-1 case. Predisposing diseases (diabetes mellitus, gout, chronic alcoholism, liver cirrhosis) could be proved in two cases. The most frequent symptoms were the swelling and erythema of the joint, fever, pain and limitation of motion. In all cases the CT scan proved the destruction of the joint. In one case after unsuccessful conservative therapy and in 1-1 case after debridement and drainage because of concomitant multiple septic focuses and mediastinitis resection of the sternoclavicular joint was applied in a later second step. In the other three patients primary resection of the joint was performed. RESULTS Both the conservative and drainage managements were insufficient. On the other hand the radical joint resection caused complete recovery in all cases. No intra and postoperative complications were observed. On an average 28.2 months after the radical operation the functional results were excellent. CONCLUSIONS Relying upon the results, radical resection is supposed to be the most effective method. Conservative treatment or drainage are recommended only for cases associated with severe complications. Resection is worthy performing after the recovery of the concomitant illnesses.
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