Scapular mass in an adolescent

Isolated scapular involvement: uncommon presentation of childhood tuberculosis

Scapular involvement in childhood tuberculosis (TB) is rare. To date, only eight cases are reported in the literature in children aged <18 years. We report a case of isolated scapular TB in a 7-year-old boy who presented with swelling and pain over right shoulder and was suspected to have malignancy based on the X-ray findings. Magnetic resonance imaging was suggestive of erosive lesion of whole scapula with normal shoulder joint, humerus and spine and conglomerate axillary lymph nodes. Histopathology and TB culture were diagnostics of TB. Patient was started on anti-TB treatment and doing well on follow-up.

Isolated tubercular osteomyelitis of acromion: A case report and review of literature

Tuberculosis is an infectious disease of public health interest, infecting one-third of the world population. Up to 3% of all Tubercular cases have musculoskeletal involvement with less than 1% involving the scapular. To the best of our knowledge, we present the third case of acromion involvement in reported literature. An adolescent female with complains of shoulder pain with no restriction of movements, no local symptoms, no fever, no history of tuberculosis was being treated on analgesics for three months at a primary health centre. With a provisional diagnosis of Chondroblastoma, surgical exploration was done, but pus was drained. It was realized in retrospect that tuberculosis needs to be considered as a differential diagnosis for any undefined bony pain, however uncommon the site of involvement may be, especially in Indian subcontinent.

Scapular bone destruction: do not forget to think of tuberculosis in endemic areas

Tuberculosis is an endemic disease of worldwide concern. The most common involvement is in the form of pulmonary tuberculosis. Musculoskeletal system is involved in 20-30% of cases of extrapulmonary tuberculosis. Among these cases of musculoskeletal tuberculosis, vertebral column is most commonly involved followed by long bones. However, tuberculosis of flat bones like scapula is very rare. We present a case of a 56-year-old woman with painless swelling in the right lower back of chest. Ultrasonography suggested abscess formation. A chest X-ray and CT scan suggested coexisting pulmonary tuberculosis. CT revealed abscess with osteomyelitis of inferior angle of scapula. The abscess was aspirated and histopathological examination confirmed tubercular pathology. A 6-month course of antitubercular treatment resulted in complete resolution of symptoms.

Isolated tuberculous osteomyelitis of the scapula

Isolated tuberculous osteomyelitis involving flat bones such as the scapula is extremely rare. The diagnosis is generally delayed due to non-specific complaints and radiographs mimicking pyogenic osteomyelitis, especially in those with no lung involvement. The authors report a case of isolated tuberculous osteomyelitis of the scapula in a 44-year-old woman. A review of the English literature revealed only 11 cases of isolated tuberculous osteomyelitis involving the scapula. The management is outlined and the difficulties in diagnosis are highlighted.

Isolated cystic tuberculosis of scapula; case report and review of literature

Tubercular osteomylitis of scapula is extremely rare. The isolated involvement of this flat bone without any primary focus confuses the surgeon with other pathology and as a result there is always delay in diagnosis. This article discusses about an isolated multicystic tubercular lesion of scapula which remained untreated for about two years as the primary physician biased with the history of trauma and suspected it to be a post-traumatic hematoma. MRI picture was deceptive. Finally, diagnosis was established by fine needle aspiration which showed typical epitheloid granuloma on histology. Lack of awareness and nonspecific radiological picture may cause delay in diagnosis of scapular tuberculosis. Tuberculosis is an important consideration in isolated scapular swelling particularly in endemic regions and the histological diagnosis by fine needle aspiration may be helpful in cases of doubtful radiological pictures.

Cystic tuberculosis of the scapula in a young boy: a case report and review of the literature

INTRODUCTION

Tuberculosis of the flat bones is rare and only a small percentage involves the scapular bone.

CASE PRESENTATION

We report a rare case of tuberculosis of the scapula in a 14-year-old. Diagnostic clues include lytic areas with low density seen in the body of the scapula involving a glenoid margin associated with typical clinical features. Treatment should include a regimen of four antitubercular drugs along with surgical debridement if required.

CONCLUSION

Although rare, tuberculosis should be suspected in patients presenting with a chronic sinus in the scapular region, particularly in the developing world.