Type:
Educational Exhibit
Keywords:
Tropical diseases, Infection, Diagnostic procedure, Digital radiography, CT, MR, Musculoskeletal spine, Musculoskeletal joint, Musculoskeletal bone
Authors:
C. Kakkar1, A. M. Polnaya2, C. M. shetty3, K. Rajagopal1, P. Koteshwara1, N. M. MULIMANI1, S. Sripathi4, V. R. K. Rao1; 1Manipal, Karnataka/IN, 2Mangalore, Karnataka/IN, 3manipal, ka/IN, 4Manipal/IN
DOI:
10.1594/ecr2011/C-0922
Background
Extra-pulmonary tuberculosis occurs in 20% cases of tuberculosis with musculoskeletal tuberculosis occurring in 1-3% of cases.
Spine is the most common site of skeletal tuberculosis accounting for 50% cases of skeletal tuberculosis followed by knee or hip in 30% cases.
Pubis,
wrist,
shoulder,
and sacroiliac joint are rarer sites.
Extra-axial manifestations:
1.Tubercular arthritis 2.
Osteomyelitis 3.Tenosynovitis and bursitis 4.Pyomyositis.
Multifocal skeletal tuberculosis is an even rarer entity accounting for 10% of total cases of skeletal tuberculosis and should suggest an immunocompromised status of the patient.
Active pulmonary focus in skeletal tuberculosis is seen in less than 50% of cases.
Imaging plays a significant role in diagnosis and knowing the extent of disease.
Radiography:
Insensitive to early changes of disease.
Late stages characteristic manifestations can be seen as Phemister's triad in tubercular arthritis,
spina ventosa in cases of tubercular dactylitis ,
spondylodiscitis with paraspinal abscesses especially with evidence of calcification.
Sonography useful for assessment of soft tissue involvement particularly tenosynovitis
Cross sectional imaging in the form of CT and MRI sensitive for detection of early disease.
Detection of marrow changes and better contrast makes MRI the modality of choice at various sites.
Final diagnosis requires either histopathology ,
culture or PCR assay.