Learning objectives
Our aim is to shift the focus from well-known pulmonary TB infection onto less commonly-encountered extra-pulmonary disease,
that tends to present atypically and late.
In this presentation,
the radiologic manifestations of some cases of extrapulmonary tuberculosis are reviewed.
Imaging of central nervous system,
head and neck,
musculoskeletal,
abdominal,
genitourinary and lymphatic systems will be discussed.
Background
Our local incidence of Mycobacterium tuberculosis infection has been increasing paralleling what is happening in mainland Europe in view of immigartion of populations where Tuberculosis,
(TB) is endemic.
Dissemination ofTB occurs by haematological or local spread.
The patient tends to present with non- specific symptoms of:
fever
lethargy
anorexia
In addition,
patients present with complications from the affected site like:
neck stiffness and vomiting in tubreculous meningitis;
change in bowel habits in intestinal TB;
haematuria inrenal tuberculosis;
bone pains with pathological fracture in skeletal infection....
Findings and procedure details
Case 1: Tuberculous meningitis
A 38 year old man of Middle Eastern origin presented to the Emergency departmentwith:
severe periorbital and occipital headaches
5 episodes of vomiting
acute confusional state
neck stiffness
On examination,
he was neurologically intact.
His CXR and CT Trunk were unremarkable.
Unenhanced CT scan of the brain showed mild diffuse cerebral oedema.
MRI of the brain demonstrated:
Pathological high-signal on FLAIR along thecerebral sulci and the ependymal layer of the lateral ventricles with leptomeningeal enhancement following contrast administration.
Appearances were consistent...
Conclusion
This poster highlights to the radiologist the revival of extra- pulmonary manifestations of TB which tend to present atypically making it a difficult diagnostic challenge and requires professional skepticism to report.
Personal information
Dr Lara Maria Zammit,
MD
Radiology Resident,
BST,
Medical Imaging Deprtment,
Mater Dei Hospital,
Msida,
Malta,
EU.
[email protected]
Dr Nathania Bonanno,
MD,
MRCS
Radiology Resident,
HST,Medical Imaging Deprtment,
Mater Dei Hospital,
Msida,
Malta,
EU.
[email protected]
Dr Gabriel Galea,
MD,
MRCP
Radiology Resident,
HST,Medical Imaging Deprtment,
Mater Dei Hospital,
Msida,
Malta,
EU.
[email protected]
Dr Adrian Mizzi,
MD,
MRCP,
FRCR,
EDiR
Consutant Thoracic and Interventional Radiologist,
Medical Imaging Deprtment,
Mater Dei Hospital,
Msida,
Malta,
EU.
[email protected]
References
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Harrington TA,
LoBue PA,
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Clin Infect Dis.
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Pubmed.
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Lucey,
MD,
Joshua W.
Stuhlfaut,
MD,
and Jorge A.
Soto,
MD,
Radiographics,
March-April 2005 Volume 25,
Issue 2
http://pubs.rsna.org/doi/full/10.1148/rg.252045108
3.
“Tuberculous cervical lymphadenitis”,
A.Prof Frank Gaillard,
et al.
https://radiopaedia.org/articles/tuberculous-cervical-lymphadenitis
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CornelisJ.P.Thijn,
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MBBS,
FRACP,
FRCPA,
MPH...