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Pattnaik M, Tripathy D. Costal tubercular osteomyelitis presenting as an orbital abscess. Orbit 2020; 41:256-259. [PMID: 33050754 DOI: 10.1080/01676830.2020.1835995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Orbital abscesses are most commonly associated with co-existing active paranasal sinus infection. Herein, the authors present the case of an orbital abscess in the setting of costal tubercular osteomyelitis and an anterior chest wall abscess in the absence of any paranasal sinus pathology in an immunocompetent patient. Costal tuberculosis is a very rare form of extrapulmonary skeletal tuberculosis and is challenging to diagnose. Initial presentation as an orbital abscess remote from the site of the primary pathology is of extremely rare occurrence. In this instance, the diagnosis of tuberculous osteomyelitis was suspected primarily on the basis of clinicoradiological features. The patient was treated with, and responded well to, standard first-line anti-tubercular therapy (ATT) for extrapulmonary tuberculosis.
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Affiliation(s)
- Monalisha Pattnaik
- Ophthalmic Plastic Surgery Service, LV Prasad Eye Institute, Bhubaneswar, India
| | - Devjyoti Tripathy
- Ophthalmic Plastic Surgery Service, LV Prasad Eye Institute, Bhubaneswar, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kabiri EH, Alassane EA, Kamdem MK, Bhairis M, Amraoui M, El Oueriachi F, El Hammoumi M. Tuberculous cold abscess of the chest wall: A clinical and surgical experience. Report of 16 cases(Case series). Ann Med Surg (Lond) 2020; 51:54-58. [PMID: 32099646 PMCID: PMC7029049 DOI: 10.1016/j.amsu.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/22/2020] [Accepted: 02/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background Tuberculosis is a public health problem in developing countries. Tuberculosis of the chest wall is rare and often presents as cold abscess (to differentiate from pyogenic abscess) or pseudotumoral mass whose diagnosis is difficult and often requires a surgical biopsy. Patients and methods The medical series of 16 patients with cold chest wall abscess treated with surgery in association to anti-tubercular therapy were analysed retrospectively for the period of 7 years between January 2011 to December 2017 at Mohamed V Military Teaching Hospital – Rabat - Morocco. Results The clinical examination provided a correct preoperative diagnosis of the abscess in all cases. Five patients had a past history of pulmonary tuberculosis and three patients had concomitant active infection. There were 6 cases on the left side, 9 cases on the right side and one case on the anterior chest wall. All patients underwent surgical drainage and debridement with specimens for bacteriology and histology. It was not necessary to resect ribs or sternum in all cases (sample costal or sternal curettage in one case each). Anti-tubercular treatment was routinely administered (6–9 months) with drug combinations of Isoniaside, Rifampicin, Pyrazinamide and Ethambutol. The evolution was favorable in all cases without complications or recurrences. Conclusion Drainage of chest wall abscess and complete debridement provide adequate treatment. Post-operative anti-bacillary therapy should be combined with surgical procedures to minimize local complications and recurrence of infection. Tuberculous abscesses of the chest wall well be associated pulmonary disease or primary location. Chest CT scan is the best exam to diagnosis and the procedure to do. Debridement must be large and in association with antituberculosis chemotherapy.
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Affiliation(s)
- El Hassane Kabiri
- Department of Thoracic Surgery, Mohamed V Military Teaching Hospital, Morocco.,Faculty of medicine -Mohamed V University, Rabat, Morocco
| | | | | | - Mohamed Bhairis
- Department of Thoracic Surgery, Mohamed V Military Teaching Hospital, Morocco
| | - Mouad Amraoui
- Department of Thoracic Surgery, Mohamed V Military Teaching Hospital, Morocco
| | - Faycal El Oueriachi
- Department of Thoracic Surgery, Mohamed V Military Teaching Hospital, Morocco
| | - Massine El Hammoumi
- Department of Thoracic Surgery, Mohamed V Military Teaching Hospital, Morocco.,Faculty of medicine -Mohamed V University, Rabat, Morocco
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Quaglio G, Pizzol D, Isaakidis P, Bortolani A, Tognon F, Marotta C, Di Gennaro F, Putoto G, Olliaro PL. Breast Tuberculosis in Women: A Systematic Review. Am J Trop Med Hyg 2020; 101:12-21. [PMID: 31115305 DOI: 10.4269/ajtmh.19-0061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Breast tuberculosis (TB) is rarely reported and poorly described. This review aims to update the existing literature on risk factors, clinical presentations, constitutional symptoms, diagnostic procedures, and medical and surgical treatments for breast TB. In all, 1,478 cases of breast TB were collected. Previous history of TB was reported in 19% of cases. The most common clinical appearance of the lesion was breast lump (75%). The most common associated finding was axillary lymphadenitis (33%) followed by sinus or fistula (24%). The most common symptoms were pain and fever, reported in 42% and 28% of cases, respectively. The most used diagnostic method was fine-needle aspiration cytology (32%), followed by biopsy (27%), acid-fast bacteria Ziehl-Neelsen stain (26%), culture (13%), and polymerase chain reaction (2%). These tested positive in 64%, 93%, 27%, 26%, and 58% of cases, respectively. The majority (69%) of patients received a 6-month anti-TB treatment (isoniazid, rifampicin, pyrazinamide, and ethambutol). Surgery consisted of excision in 39% of cases, drainage in 23%, and mastectomy in 5%. The great majority of patients had a positive outcome. It often mimics breast cancer, which makes it difficult to diagnose. Most patients, when diagnosed in time, respond to antitubercular therapy alone.
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Affiliation(s)
- Gianluca Quaglio
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine, and Life Sciences, University of Maastricht, Maastricht, The Netherlands.,Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy.,European Parliamentary Research Services (EPRS), European Parliament, Brussels, Belgium
| | - Damiano Pizzol
- Operational Research Unit, Doctors with Africa CUAMM, Beira, Mozambique
| | - Petros Isaakidis
- Médecins Sans Frontières, Southern Africa Medical Unit (SAMU), Cape Town, South Africa
| | - Arianna Bortolani
- Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy
| | - Francesca Tognon
- Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy
| | - Claudia Marotta
- Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy
| | | | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy
| | - Piero L Olliaro
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Special Programme for Research and Training in Tropical Diseases, World Health Organization (WHO/TDR), Geneva, Switzerland
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Abstract
La localisation pariétale thoracique chez l'enfant est une forme très rare de tuberculose. Son diagnostic est souvent difficile nécessitant le recours à la biopsie chirurgicale. Nous rapportons le cas d'une jeune fille de 14 ans, présentant depuis un mois et demi une tuméfaction de la paroi thoracique antérieure. La tomodensitométrie thoracique a objectivé un processus lésionnel pariétal para-sternal droit à limites imprécises responsable d'une érosion du sternum. L'examen anatomo-pathologique des biopsies de la coque d'abcès a confirmé le diagnostic de tuberculose caséo-folliculaire. Le traitement anti-bacillaire a permis une évolution favorable.
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Affiliation(s)
- Rachid El Barni
- Service de chirurgie générale, Hôpital militaire Avicenne, Marrakech, Morocco
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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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Ka AS, Brousse V, Diakhaté I, Sermet-Gaudelus I, Lenoir G, Imbert P. [Tuberculous cold abscess of the chest wall in children: A report of 3 cases]. Arch Pediatr 2006; 13:1265-6. [PMID: 16860543 DOI: 10.1016/j.arcped.2006.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Accepted: 06/21/2006] [Indexed: 11/28/2022]
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Madkour MM, Kudwah AJ, Abd El Bagi M. Extraspinal Musculoskeletal Tuberculosis. Tuberculosis (Edinb) 2004. [DOI: 10.1007/978-3-642-18937-1_34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
The authors present a case of progressive unilateral proptosis caused by tuberculous osteoperiostitis of the orbital walls and sphenoid bone with extraconal orbital and extradural intracranial cold abscess formation. The patient responded well to surgical evacuation and antituberculous medical therapy.
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Affiliation(s)
- Deepak Aggarwal
- Department of Neurosurgery, C.N. Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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