Learning objectives
To describe the characteristic radiological signs of tuberculosis involving the musculoskeletal system.
To illustrate cases depicting tuberculous affliction of spine,
bones and joints.
To depict the complications and sequelae of tuberculosis.
To discuss the mimickers of tuberculosis.
Background
Tuberculosis (TB) has always been a major public health problem in developing countries.
The incidence had decreased with the introduction of antituberculous drugs but resurgence has been seen due to drug resistance.
Prevalence has increased in developed countries due to large population suffering from chronic diseases (e.g.,
diabetes mellitus,
chronic renal failure,
chronic obstructive disease,
liver cirrhosis,
lymphoproliferative disorders,
etc.),
a growing number of immunocompromised patients; the emergence of multidrug-resistant TB; and various socioeconomic factors (e.g.,
alcohol and drug abuse,
poverty,
homelessness,
etc.).
High prevalence...
Imaging findings OR Procedure details
TUBERCULAR
PLAIN RADIOGRAPH
USG
CT
MRI
SPONDYLITIS
(fig 1-6)
indistinct end plates
loss of vertebral height
narrowing of disc space and collapse of vertebra with kyphotic deformity
lytic destruction(no reactive sclerosis or periosteal reaction)
Anterior erosions d/t subligamentous involvement
Fusiform abscess(bird’s nest appearance)in thoracic spine,
Converging lower border of abscess at thoracolumbar junction(petering abscess)
In the lumbar region: bulging or indistinct psoas outline
Radiological changes evident with more than 50% bone loss.
Paravertebral abscess
end plate destruction
fragmentation of the vertebrae
pre- and paravertebral abscesses...
Conclusion
Tuberculosis is endemic in the Indian subcontinent and has also made a comeback in the industrialized nations with the rise in immunosuppressed population and drug resistance.
Radiologists should be familiar with the imaging spectrum of musculoskeletal tuberculosis.
Timely diagnosis of tubercular infection in the musculoskeletal system can reduce the morbidity seen in the natural course of the disease.
References
1.De Backer AI,
Vanhoenacker FM,
Sanghvi DA (2009) Imaging
features of extraaxial musculoskeletal tuberculosis.
Indian J Radiol
Imaging 19:176–186.
2.Westall J (1997) Tuberculosislevelling off worldwide.
BMJ
314:921.
3.Sharif HS,
Morgan JL,
Al Shahed MS et al (1995) Role of CT and
MR imaging in the management of tuberculous spondylitis.
Radiol
Clin North Am 33:787–804.
4.Kumar R (2005) Spinal tuberculosis: with reference to the children
of Northern India.
Childs Nerv Syst 21:19–26.
5.Teo HE,
Peh WC (2004) Skeletal tuberculosis in children.
Pediatr
Radiol 34:853–860.
Personal Information
AUTHORS:
Smita Manchanda
Assistant Professor
Radiodiagnosis
UCMS and GTB hospital
New Delhi
India
Sakshi Khurana: Presenting author
Resident
Radiodiagnosis
UCMS and GTB hospital
New Delhi
India
Nipun Rajpal
Resident
Radiodiagnosis
UCMS and GTB hospital
New Delhi
India
Sachin Agrawal
Resident
Radiodiagnosis
UCMS and GTB hospital
New Delhi
India
Swati Gupta
Resident
Radiodiagnosis
UCMS and GTB hospital
New Delhi
India
Naveen Bhardwaj
Resident
Radiodiagnosis
UCMS and GTB hospital
New Delhi
India
Anupama Tandon
Reader
Radiodiagnosis
UCMS and GTB hospital
New Delhi
India
Shuchi Bhatt
Associate professor...