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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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Kouadio AF, Bravo-Tsri AEB, Tanoh KE, Kouassi KPB, Yao BL, Kouakou BDM, Sanogo SC, Soro M, Konate I. Incidental finding of Pott's disease with abscesses of the psoas simulating an appendicular syndrome. Radiol Case Rep 2023; 18:4115-4118. [PMID: 37720919 PMCID: PMC10504458 DOI: 10.1016/j.radcr.2023.08.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Pott's disease or tuberculous spondylodiscitis is the disco-vertebral localization of Koch's bacillus. It causes progressive spinal lesions, with abscesses forming in the perivertebral soft tissues and epidural spaces. Medical imaging plays an indisputable role in the diagnosis and management of Pott's disease. Magnetic resonance imaging (MRI) enables early positive diagnosis and assessment of spinal damage. Computed tomography (CT) is currently the best interventional imaging method for the drainage of soft tissue abscesses and disco-vertebral biopsies for bacteriological and histological purposes. We report a case of accidental discovery of Pott's disease with abscesses of the psoas simulating an appendicular syndrome and describe its epidemiological, clinical, and radiological aspects through a review of the literature.
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Affiliation(s)
- Allou Florent Kouadio
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
- Alassane Ouattara University of Bouaké, Bouaké, Ivory Coast
| | - Akoli Eklou Baudoin Bravo-Tsri
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
- Alassane Ouattara University of Bouaké, Bouaké, Ivory Coast
| | - Kesse Emile Tanoh
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
- Alassane Ouattara University of Bouaké, Bouaké, Ivory Coast
| | - Kouamé Paul Bonfils Kouassi
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
- Alassane Ouattara University of Bouaké, Bouaké, Ivory Coast
| | - Brou Lambert Yao
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
- Alassane Ouattara University of Bouaké, Bouaké, Ivory Coast
| | | | - Sara Carole Sanogo
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
| | - Malick Soro
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
| | - Issa Konate
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
- Alassane Ouattara University of Bouaké, Bouaké, Ivory Coast
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Darvishi M, Rashidi S, Abazari S. Tuberculous Sacroiliitis after a Penicillin Injection: A Case Report. Eur J Case Rep Intern Med 2020; 7:001495. [PMID: 32523913 PMCID: PMC7279915 DOI: 10.12890/2020_001495] [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: 01/15/2020] [Accepted: 02/13/2020] [Indexed: 12/04/2022] Open
Abstract
Tuberculosis is one of the major health problems in developing countries affecting different organs such as bone and joints. One of the most important involvements of osteoarticular tuberculosis is that of the sacroiliac joint. In addition, its incidence has increased over the past several years. Early diagnosis is necessary to prevent further disorders such as neurological and surgical complications. We report a tuberculous arthritis case in the right sacroiliac joint, which developed after penicillin injection. The patient was a 32-year-old man admitted to Besat hospital, Tehran, Iran. He complained of pain, erythema and swelling in his right buttock starting approximately 17 years previously, after a penicillin injection, which was followed by the emergence of an orifice with yellow secretions. Over the years, the secretions continued but the pain, swelling and erythema were resolved. At the time of admission, his vital signs were stable and normal. In the physical examination, an orifice with a small amount of yellow secretion was detected on the right buttock as claimed by the patient. Lung auscultation was clear. No lymphadenopathy was detected. Laboratory data were normal. During hospitalization, initial antibiotic therapy was prescribed. After Mycobacterium tuberculosis was detected in culture, a 4-drug anti-TB therapy encompassing rifampin, isoniazid, ethambutol and pyrazinamide was prescribed for 18–24 months, in addition to daily vitamin B6 and pantoprazole.
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Affiliation(s)
- Mohammad Darvishi
- Infectious Diseases and Tropical Medicine Research Center, Dept of Aerospace and Subaquatic Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Sana Rashidi
- Faculty of Medicine, Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | - Setayesh Abazari
- Faculty of Medicine, Tehran Medical Branch, Islamic Azad University, Tehran, Iran
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Djaja YP, Phedy P, Silitonga J, Librianto D, Saleh I. Submuscular gluteal abcess: An unusual presentation of rare sacral tuberculosis. Int J Surg Case Rep 2018; 54:55-59. [PMID: 30522080 PMCID: PMC6280601 DOI: 10.1016/j.ijscr.2018.11.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 11/15/2018] [Accepted: 11/20/2018] [Indexed: 11/11/2022] Open
Abstract
Gluteal abscess and sacral tuberculosis are rare entities in spine tuberculosis, as to our knowledge; this is the second case report about it. MRI has a great role to describe anatomical pathophysiology of the abscess dissemination from sacral tuberculosis. Sacral tuberculosis should be made as the main differential diagnosis for atypical sacral lesion that occurs with submuscular gluteal abscess.
Introduction Both gluteal abscess and sacral tuberculosis are rare entities in spinal tuberculosis cases. Even in endemic country, this atypical presentation may be the cause of delayed diagnosis and treatment. Presentation of case A 51-year-old woman was admitted with painless massive lump on both of her thighs that have been enlarging for the past 6 months. She had a history of previous tuberculosis treatment. From the MRI examination submuscular gluteal abscess, which was an extension of the sacral tuberculosis, were found. Open debridement and biopsy were performed, which confirmed the suspicion of tuberculosis. Oral anti tuberculosis drugs were administered after. There was no recurrence and complication at the final follow up. Discussion Cold abscess formation is common in spine tuberculosis however the formation of gluteal abscess as the extension of sacral tuberculosis is rare. Although MRI's specificity in determining the underlying cause is poor, it has a great role not only determining the location and size of the lesion, but also to describe anatomical pathophysiology of the abscess dissemination from sacral tuberculosis. Conclusion Despite the limitation of the study and the rarity of this case, tuberculosis should be made as the main differential diagnosis for atypical sacral lesion that occurs with submuscular gluteal abscess.
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Affiliation(s)
- Yoshi Pratama Djaja
- Department of Orthopaedic and Traumatology, Fatmawati General Hospital, Jl. RS Fatmawati No. 1, Cilandak, South Jakarta, 12430, Indonesia.
| | - Phedy Phedy
- Department of Orthopaedic and Traumatology, Fatmawati General Hospital, Jl. RS Fatmawati No. 1, Cilandak, South Jakarta, 12430, Indonesia.
| | - Jamot Silitonga
- Department of Orthopaedic and Traumatology, Fatmawati General Hospital, Jl. RS Fatmawati No. 1, Cilandak, South Jakarta, 12430, Indonesia.
| | - Didik Librianto
- Department of Orthopaedic and Traumatology, Fatmawati General Hospital, Jl. RS Fatmawati No. 1, Cilandak, South Jakarta, 12430, Indonesia.
| | - Ifran Saleh
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo General Hospital - Faculty of Medicine Universitas, Jl. Pangeran Diponegoro No. 71, Salemba, Central Jakarta, 10430, Indonesia.
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Okuyama Y, Baba A, Kobashi Y, Anazawa U. Sacral Tuberculosis. Intern Med 2016; 55:1939-40. [PMID: 27432110 DOI: 10.2169/internalmedicine.55.6500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yumi Okuyama
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, Japan
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Oniankitan O, Fianyo E, Kakpovi K, Agoda-Koussema LK, Mijiyawa M. Sacrum Pott’s disease: A rare location of spine tuberculosis. EGYPTIAN RHEUMATOLOGIST 2014. [DOI: 10.1016/j.ejr.2014.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lazrak F, Abourazzak FE, Elouzzani FE, Benzagmout M, Harzy T. A rare location of sacral tuberculosis: A report of three cases. Eur J Rheumatol 2014; 1:78-80. [PMID: 27708880 DOI: 10.5152/eurjrheumatol.2014.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 04/14/2014] [Indexed: 11/22/2022] Open
Abstract
Tuberculosis remains one of the most common infectious diseases in the world. Vertebral tuberculosis is the commonest form of bone and joint tuberculosis; however, isolated sacral tuberculosis is rare. This atypical presentation may lead to a delay in diagnosis and treatment. We report three cases of sacral tuberculosis diagnosed in young women, aged 30, 23, and 35 years old, respectively. Lombosciatic pain was the main symptom in all cases. All patients had a biological assessment, plain radiographs, and CT scan. However, magnetic resonance imaging was done in only two cases. All patients underwent surgical sacral biopsy, and the diagnosis of tuberculosis was confirmed by histology in all cases. The evolution was satisfactory with the adjunction of antituberculous chemotherapy in all cases. Spinal tuberculosis should be the first and foremost differential diagnosis in the presence of atypical clinical and radiological features of a sacral lesion, particularly in developing countries. Early diagnosis and treatment could prevent or minimize the neurological morbidity in such cases.
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Affiliation(s)
- Faiza Lazrak
- Department of Rheumatology, CHU Hassan II University Hospital, Fez, Morocco
| | | | | | | | - Taoufik Harzy
- Department of Rheumatology, CHU Hassan II University Hospital, Fez, Morocco
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Isolated tuberculosis of sacrum with monoparesis: an atypical presentation. Asian Spine J 2013; 7:351-4. [PMID: 24353854 PMCID: PMC3863663 DOI: 10.4184/asj.2013.7.4.351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 07/06/2012] [Accepted: 07/07/2012] [Indexed: 11/13/2022] Open
Abstract
Tuberculosis is a major health problem in developing nations. Spine is the most commonly affected site for skeletal tuberculosis but involvement of sacrum is rare. Isolated involvement of sacrum has been reported in literature but none of the reports has mentioned its clinical presentation as monoparesis. Our case presented with symptoms of sensory and motor deficit in right lower limb. The magnetic resonance imaging spine and non contrast computerized tomogram revealed a sacral lesion but were inconclusive of diagnosis. Histological examination after computed tomography guided biopsy revealed the condition as tuberculosis. Anti tubercular treatment was started after confirmation of diagnosis and continued for 18 months. Erythrocyte sedimentation rate and C-reactive protein drooped to normal range and patient was symptom free at two-year follow up. This case report intends to emphasize that sacral tuberculosis, being itself a rare condition, may present atypically as monoparesis.
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Kumar A, Varshney MK, Trikha V. Unusual Presentation of Isolated Sacral Tuberculosis. Joint Bone Spine 2006; 73:751-2. [PMID: 16996769 DOI: 10.1016/j.jbspin.2006.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2005] [Accepted: 01/30/2006] [Indexed: 11/20/2022]
Abstract
Tuberculosis is as old as mankind. Vertebral tuberculosis is fairly common form of bone and joint tuberculosis. However, isolated sacral tuberculosis is rare. It may present as an atypical sacral lesion having epidural granuloma without destruction of sacrum on MRI and plain X-rays. This atypical presentation may lead to delay in diagnosis and treatment. This case report intends to emphasize that spinal tuberculosis should be the first and foremost differential diagnosis in the presence of atypical clinical and radiological features of a sacral lesion particularly in developing countries. Early diagnosis and treatment can prevent or minimize the neurological morbidity in such cases.
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Affiliation(s)
- Ashok Kumar
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi 110029, India.
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Abstract
Vertebral disease constitutes approximately 50% of all skeletal tuberculosis. We describe a patient who developed a discharging sinus at the tip of the coccyx. Extensive examination revealed isolated tuberculosis of the coccyx. Although rare, the condition should be suspected in patients presenting with a chronic sinus in the sacrococcygeal area and a lytic lesion in the coccyx on CT or MRI, particularly in the developing world.
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Affiliation(s)
- A Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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Abstract
BACKGROUND Spinal tuberculosis (TB) is perhaps the most clinically important extrapulmonary form of the disease. Early recognition is therefore necessary to minimize residual spinal deformity and/or permanent neurological deficit. We defined the CT and MRI image morphology of spinal TB and correlated the imaging features of these two modalities. METHODS CT (29 patients) and MRI (11 patients) images were retrospectively analyzed in 30 patients with proved spinal TB. CT and MRI findings were compared in cases with both imaging tests (10 cases). The parameters assessed were the type and extent of bone and soft tissue involvement. RESULTS The majority of the 30 patients were males (n=18) in the 30-49 year age group (43%). The most common clinical presentation was backache (73.3%) followed by fever (63.3%) and malaise (36.6%). The lumbar spine was the commonest site of the disease (43.3%) followed by the thoracic region (36.6%). A fragmentary type of bone destruction was the most frequent CT feature of the disease (48.2%) followed by the lytic type (24.1%). Intervertebral disc destruction (72%) and paravertebral mass/abscess (65.5%) were other features. Of the 11 patients who had an MRI, contiguous vertebral disease with disc destruction was seen in 10 cases. In 4 patients, there was distant vertebral disease in addition to the disease at the symptomatic site. CONCLUSIONS MRI offers excellent visualization of the bone and soft tissue components of spinal tuberculosis and helps to identify disease at distant asymptomatic sites. CT is useful in assessing bone destruction, but is less accurate in defining the epidural extension of the disease and therefore its effect on neural structures. MR imaging clearly demonstrated the extent of soft tissue disease and its effect on the theca/cord and foramen in cases with doubtful CT findings.
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Affiliation(s)
- Tariq Sinan
- Department of Radiology, Faculty of Medicine, Kuwait University.
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Lobato Salinas Z, Artigas Rodríguez S, Séculi Palacios JL. Abscesos cutáneos como forma de presentación de la enfermedad de Pott. An Pediatr (Barc) 2004; 61:66-8. [PMID: 15228936 DOI: 10.1016/s1695-4033(04)78355-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Interest in skeletal tuberculosis has been growing in our environment due to the presence of patients with immunodeficiency and those from areas where tuberculosis is endemic. Clinical presentation in the form of skin abscesses with an osteoarticular focus is rare, hindering early diagnosis and treatment. We describe the case of an 8-year-old immigrant boy with a diagnosis of bone tuberculosis based on the presence of skin fistulas.
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Affiliation(s)
- Z Lobato Salinas
- Unidad Integrada de Pediatría, Hospitals Sant Joan de Déu-Clínic, Servicio de Pediatría, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.
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De Vuyst D, Vanhoenacker F, Gielen J, Bernaerts A, De Schepper AM. Imaging features of musculoskeletal tuberculosis. Eur Radiol 2003; 13:1809-19. [PMID: 12942283 DOI: 10.1007/s00330-002-1609-6] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2002] [Revised: 06/12/2002] [Accepted: 06/17/2002] [Indexed: 10/26/2022]
Abstract
The purpose of this article is to review the imaging characteristics of musculoskeletal tuberculosis. Skeletal tuberculosis represents one-third of all cases of tuberculosis occurring in extrapulmonary sites. Hematogenous spread from a distant focus elsewhere in the body is the cornerstone in the understanding of imaging features of musculoskeletal tuberculosis. The most common presentations are tuberculous spondylitis, arthritis, osteomyelitis, and soft tissue involvement. The diagnostic value of the different imaging techniques, which include conventional radiography, CT, and MR imaging, are emphasized. Whereas conventional radiography is the mainstay in the diagnosis of tuberculous arthritis and osteomyelitis, MR imaging may detect associated bone marrow and soft tissue abnormalities. MR imaging is generally accepted as the imaging modality of choice for diagnosis, demonstration of the extent of the disease of tuberculous spondylitis, and soft tissue tuberculosis. Moreover, it may be very helpful in the differential diagnosis with pyogenic spondylodiscitis, as it may easily demonstrate anterior corner destruction, the relative preservation of the intervertebral disk, multilevel involvement with or without skip lesions, and a large soft tissue abscess, as these are all arguments in favor of a tuberculous spondylitis. On the other hand, CT is still superior in the demonstration of calcifications, which are found in chronic tuberculous abscesses.
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Affiliation(s)
- Dimitri De Vuyst
- Department of Radiology, AZ Sint-Maarten, Campus Duffel, Rooienberg 25, 2570 Duffel, Belgium
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