1
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Yunus RE, Sriyana AA. Unusual presentation of bilateral tuberculous otomastoiditis with tuberculous spondylitis in a 14-year-old child: A case report. Radiol Case Rep 2024; 19:2679-2683. [PMID: 38645953 PMCID: PMC11033114 DOI: 10.1016/j.radcr.2024.03.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/24/2024] [Indexed: 04/23/2024] Open
Abstract
Tuberculous otomastoiditis, a rare manifestation of tuberculosis in the head and neck region, poses diagnostic and therapeutic challenges due to its non-specific clinical features and potential debilitating complications. While typically arising from direct spread from adjacent organs, the coexistence of tuberculous otomastoiditis and cervical spondylitis is rarely reported. We present the case of a 14-year-old male with a 3-month history of painless bilateral ear discharge resistant to antibiotic therapy. The clinical and radiological findings raised suspicions of tuberculous otomastoiditis and spondylitis, which was later confirmed by histopathological examination despite negative microbiological cultures. This case underscores the significance of considering tuberculosis in conditions involving multiple organs, especially when persistent extensive damage is observed despite optimal initial treatments.
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Affiliation(s)
- Reyhan E. Yunus
- Department of Radiology, Dr. Cipto Mangunkusumo General Hospital-Faculty of Medicine University of Indonesia, Jakarta, Indonesia
| | - Ayu A. Sriyana
- Department of Otorhinolaryngology, Head and Neck Surgery, Dr. Cipto Mangunkusumo General Hospital-Faculty of Medicine University of Indonesia, Jakarta, Indonesia
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2
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Banik S, Madavi S. Navigating Perioperative Challenges in Pott's Spine: A Comprehensive Review. Cureus 2024; 16:e59871. [PMID: 38854265 PMCID: PMC11157990 DOI: 10.7759/cureus.59871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 05/08/2024] [Indexed: 06/11/2024] Open
Abstract
Pott's spine, or tuberculous spondylitis, remains a significant public health concern in regions where tuberculosis is endemic. The management of Pott's spine poses unique perioperative challenges due to the complexity of the disease process, including vertebral destruction, spinal instability, and neurological compromise. This comprehensive review explores the intricacies of navigating perioperative challenges in Pott's spine surgery. Beginning with an overview of Pott's spine, including its etiology, clinical presentation, and classification, the review delves into the significance of perioperative challenges in this condition. Emphasis is placed on the need for multidisciplinary collaboration, meticulous preoperative assessment, and tailored surgical planning to optimize outcomes while minimizing the risk of complications. Critical considerations in the preoperative, intraoperative, and postoperative phases of care are discussed in detail, including patient assessment, imaging modalities, surgical techniques, anesthesia considerations, and postoperative rehabilitation. Special considerations such as pediatric Pott's spine and multidrug-resistant tuberculosis are also addressed. The review concludes by summarizing key points, highlighting implications for clinical practice, and providing recommendations for future research. By synthesizing current evidence and clinical expertise, this review offers valuable insights into the optimal management of perioperative challenges in Pott's spine, ultimately aiming to improve patient outcomes and reduce the burden of this debilitating condition.
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Affiliation(s)
- Souvik Banik
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sheetal Madavi
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Pattamapaspong N, Kanthawang T, Bouaziz MC, Ladeb MF, Hammami N, Peh WCG. Imaging of musculoskeletal tuberculosis. Br J Radiol 2024; 97:1-12. [PMID: 38263840 PMCID: PMC11027299 DOI: 10.1093/bjr/tqad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/23/2023] [Accepted: 10/06/2023] [Indexed: 01/25/2024] Open
Abstract
Extra-pulmonary tuberculosis (TB) of the musculoskeletal system usually manifests with non-specific clinical features, mimicking a variety of diseases. Diagnosis and treatment of spinal and extra-spinal musculoskeletal TB are often challenging. Imaging has an important role in detecting this disease, aiding diagnosis, identifying complications, and monitoring disease progression. Radiographs and magnetic resonance imaging are the key imaging modalities utilized. Radiologists should aim to be familiar with the spectrum of imaging features of TB affecting spinal and extra-spinal locations in the musculoskeletal system.
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Affiliation(s)
- Nuttaya Pattamapaspong
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Thanat Kanthawang
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Mouna Chelli Bouaziz
- Department of Radiology, MT Kassab Institute of Orthopaedics, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis-El Manar University, Tunis, Tunisia
| | - Mohamed Fethi Ladeb
- Department of Radiology, MT Kassab Institute of Orthopaedics, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis-El Manar University, Tunis, Tunisia
| | - Nadia Hammami
- Department of Neuroradiology, National Institute of Neurology Mongi Ben Hamida, Tunis, Tunisia
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore
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4
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Abid W, Ladeb MF, Chidambaranathan N, Peh WCG, Vanhoenacker FM. Imaging of musculoskeletal tuberculosis. Skeletal Radiol 2024:10.1007/s00256-023-04556-5. [PMID: 38231262 DOI: 10.1007/s00256-023-04556-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
Tuberculosis (TB) represents a major public health problem worldwide. Any tissue may be infected. Involvement of the musculoskeletal (MSK) system account for 1-3% of all tuberculous infections. MSK TB may manifest as tuberculous spondylitis, arthritis, osteomyelitis, and soft tissue infections. Although TB spondylitis may present with distinctive imaging features compared to pyogenic infections of the spine, the imaging semiology of extra-spinal TB infections is mostly nonspecific and may mimic other lesions. TB infections should therefore always be considered in the differential diagnosis, particularly in immunocompromised patients. The aim of this article is to review the imaging features of spinal and extra-spinal MSK TB. Magnetic resonance imaging is considered the modality of choice to make the diagnosis and to evaluate the extent of the disease.
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Affiliation(s)
- Wiem Abid
- Department of Radiology, (Vrije Universiteit Brussel), University Hospital Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Mohamed F Ladeb
- Department of Radiology, MT Kassab Institute of Orthopaedics, Tunis, Tunisia
| | - Natesan Chidambaranathan
- Department of Radiology & Imaging Sciences, Apollo Hospitals, 21, Greams Lane, Chennai, 600 006, India
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Republic of Singapore
| | - Filip M Vanhoenacker
- General Hospital Sint-Maarten Mechelen, Liersesteenweg 435, 2800, Mechelen, Belgium.
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat, 655, B-2650, Edegem, Belgium.
- Faculty of Medicine and Health Sciences, University of Antwerp, Ghent and KU Leuven, Belgium.
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5
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Spekker O, Kiss P. A, Kis L, Király K, Varga S, Marcsik A, Schütz O, Török T, Hunt DR, Tihanyi B. White plague among the "forgotten people" from the Barbaricum of the Carpathian Basin-Cases with tuberculosis from the Sarmatian-period (3rd-4th centuries CE) archaeological site of Hódmezővásárhely-Kenyere-ér, Bereczki-tanya (Hungary). PLoS One 2024; 19:e0294762. [PMID: 38198442 PMCID: PMC10781108 DOI: 10.1371/journal.pone.0294762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/07/2023] [Indexed: 01/12/2024] Open
Abstract
Tuberculosis (TB) is a bacterial infection that is well-known in the palaeopathological record because it can affect the skeleton and consequently leaves readily identifiable macroscopic alterations. Palaeopathological case studies provide invaluable information about the spatio-temporal distribution of TB in the past. This is true for those archaeological periods and geographical regions from when and where no or very few TB cases have been published until now-as in the Sarmatian period (1st-5th centuries CE) in the Barbaricum of the Carpathian Basin. The aim of our paper is to discuss five newly discovered TB cases (HK199, HK201, HK225, HK253, and HK309) from the Sarmatian-period archaeological site of Hódmezővásárhely-Kenyere-ér, Bereczki-tanya (Csongrád-Csanád county, Hungary). Detailed macromorphological evaluation of the skeletons focused on the detection of bony changes likely associated with different forms of TB. In all five cases, the presence of endocranial alterations (especially TB-specific granular impressions) suggests that these individuals suffered from TB meningitis. Furthermore, the skeletal lesions observed in the spine and both hip joints of HK225 indicate that this juvenile also had multifocal osteoarticular TB. Thanks to the discovery of HK199, HK201, HK225, HK253, and HK309, the number of TB cases known from the Sarmatian-period Carpathian Basin doubled, implying that the disease was likely more frequent in the Barbaricum than previously thought. Without the application of granular impressions, the diagnosis of TB could not have been established in these five cases. Thus, the identification of TB in these individuals highlights the importance of diagnostics development, especially the refinement of diagnostic criteria. Based on the above, the systematic macromorphological (re-)evaluation of osteoarchaeological series from the Sarmatian-period Carpathian Basin would be advantageous to provide a more accurate picture of how TB may have impacted the ancestral human communities of the Barbaricum.
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Affiliation(s)
- Olga Spekker
- Ancient and Modern Human Genomics Competence Centre, University of Szeged, Szeged, Hungary
- Institute of Archaeological Sciences, Eötvös Loránd University, Budapest, Hungary
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
| | - Attila Kiss P.
- Department of Early Hungarian and Migration Period Archaeology, Pázmány Péter Catholic University, Budapest, Hungary
| | - Luca Kis
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
- Department of Archaeogenetics, Institute of Hungarian Research, Budapest, Hungary
| | - Kitty Király
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
- Department of Archaeology, Móra Ferenc Museum, Szeged, Hungary
| | - Sándor Varga
- Department of Archaeology, Móra Ferenc Museum, Szeged, Hungary
| | - Antónia Marcsik
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
| | - Oszkár Schütz
- Department of Archaeogenetics, Institute of Hungarian Research, Budapest, Hungary
- Department of Genetics, University of Szeged, Szeged, Hungary
| | - Tibor Török
- Ancient and Modern Human Genomics Competence Centre, University of Szeged, Szeged, Hungary
- Department of Archaeogenetics, Institute of Hungarian Research, Budapest, Hungary
- Department of Genetics, University of Szeged, Szeged, Hungary
| | - David R. Hunt
- Virginia Office of the Chief Medical Examiner, Northern District, Manassas, Virginia, United States of America
| | - Balázs Tihanyi
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
- Department of Archaeogenetics, Institute of Hungarian Research, Budapest, Hungary
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6
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Bhagwatkar S, Harjpal PL, Koul P, Ankar P. Pott's Spine Leading to Compressive Myelopathy. Neurol India 2024; 72:207-208. [PMID: 38443044 DOI: 10.4103/neurol-india.neurol-india-d-24-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/02/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Sawari Bhagwatkar
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, DMIHER, Sawangi Meghe, Wardha, Maharashtra, India
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7
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Garg B, Mehta N, Mukherjee RN, Aryal A, Kandasamy D, Sharma R. Unmasking the great imitators-noninfectious conditions masquerading as spinal tuberculosis in a developing country: A single-center case series analysis. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100245. [PMID: 37664824 PMCID: PMC10472297 DOI: 10.1016/j.xnsj.2023.100245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/06/2023] [Accepted: 07/23/2023] [Indexed: 09/05/2023]
Abstract
Background The diagnosis of spinal tuberculosis often relies on clinical, radiological, and laboratory findings, particularly in resource-constrained settings. However, numerous noninfectious conditions exhibit similar clinical and radiological features to spinal tuberculosis, leading to potential misdiagnosis in the absence of microbiological or histopathological confirmation. This study aims to present a case series from a developing country, highlighting noninfectious conditions that mimic spinal tuberculosis. Methods A retrospective analysis was conducted on hospital records and imaging of patients diagnosed with spinal tuberculosis, lacking microbiological or histopathological evidence, and unresponsive to empirical antitubercular treatment. Patients displaying noninfectious conditions resembling spinal tuberculosis upon further investigation were included. Clinical and radiological findings of these patients were thoroughly analyzed. Results Among a total of 23 patients observed over a 6-year period (2015-2020), various noninfectious conditions were identified as mimickers of spinal tuberculosis. These conditions included vertebral body haemangioma, ankylosing spondylitis (with or without Andersson lesion), rheumatoid pannus, osteoid osteoma, cystic hygroma, multiple myeloma, vertebral metastasis, malignant small round-cell tumor, pancreatic pseudocyst, esophageal duplication cyst, Modic changes in degenerative disc disease, Paget's disease, and psoas hematoma. Conclusion Noninfectious spinal conditions can masquerade as spinal tuberculosis, underscoring the importance of obtaining a definitive tissue diagnosis before initiating antitubercular treatment. Particular attention should be given to features such as central lesions and the absence of soft tissue involvement in suspected cases of spinal tuberculosis, warranting a careful reconsideration of the diagnosis.
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Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Nishank Mehta
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Rudra Narayan Mukherjee
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Aayush Aryal
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Devasenathipathy Kandasamy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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8
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Mertens K, Vanhoenacker FM. Imaging of the Craniocervical Junction: A Pictorial Review. Semin Musculoskelet Radiol 2023; 27:499-511. [PMID: 37816358 DOI: 10.1055/s-0043-1772190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
The craniocervical junction (CCJ) is a complex anatomical structure comprising the occiput, the atlas, and the axis. The CCJ plays an important role in maintaining stability, providing protection, and supporting neurovascular structures. The CCJ can be affected by a wide range of congenital variants and traumatic, degenerative, inflammatory, and tumoral pathologies. This pictorial review the normal anatomy of the CCJ and presents the most common anatomical variants and pathologic conditions affecting the CCJ.
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Affiliation(s)
- Kris Mertens
- Department of Radiology, UZ Leuven, University of Leuven, Leuven, Belgium
- Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium
| | - Filip M Vanhoenacker
- Department of Radiology, UZ Leuven, University of Leuven, Leuven, Belgium
- Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium
- Department of Diagnostic Sciences, UZ Gent, Faculty of Medicine and Health Sciences, Ghent, Belgium
- Department of Radiology, UZ Antwerpen, University of Antwerp, Edegem, Belgium
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9
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Vlok M. Technical note: The use and misuse of threshold diagnostic criteria in paleopathology. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023; 181:326-335. [PMID: 36866523 DOI: 10.1002/ajpa.24721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/16/2022] [Accepted: 02/19/2023] [Indexed: 03/04/2023]
Abstract
Weighted threshold diagnostic criteria approaches have emerged for diseases that involve skeletal/bony tissue that are readily diagnosed in the field of paleopathology such as Vitamin C deficiency (scurvy), Vitamin D deficiency (rickets) and treponemal disease. These criteria differ from traditional differential diagnosis in that they involve standardized inclusion criteria based on the lesion's specificity to the disease. Here I discuss the limitations and benefits of threshold criteria. I argue that while these criteria will benefit from further revision such as inclusion of lesion severity, and the incorporation of exclusion criteria, threshold diagnostic approaches have considerable value in the future of diagnosis in the field.
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Affiliation(s)
- Melandri Vlok
- Sydney Southeast Asia Centre, University of Sydney, Sydney, New South Wales, Australia
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10
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Na S, Lyu Z, Zhang S. Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions. Orthop Surg 2023. [PMID: 37186216 DOI: 10.1111/os.13744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/04/2023] [Accepted: 03/24/2023] [Indexed: 05/17/2023] Open
Abstract
Spinal tuberculosis, also known as Pott's disease or tuberculous spondylitis, is usually secondary to primary infection in the lungs or other systems, and in most instances, is thought to be transmitted via blood. Typical manifestations of infection include narrowing of the intervertebral disc by erosion and bone destruction of adjacent vertebrae. Atypical spinal tuberculosis is a specific type of spinal tuberculosis. It mainly consists of single vertebral lesions, single posterior structure lesions, multiple vertebral lesions, and intra-spinal lesions. Skipped multifocal spinal tuberculosis is one of these types and is characterized by two or more vertebral lesions without the involvement of the adjoining intervertebral discs, regardless of their location. To date, only a few cases have been reported. Upon clinical admission, it can be treated conservatively or surgically, depending on the patient's symptoms. In addition, gene or biological therapies are being investigated. However, because of the exceptional imaging findings and insidious symptoms, it is often misdiagnosed as a neoplastic lesion, osteoporotic fracture, or other infectious spondylitis, increasing the risk of neurological deficit and kyphotic deformity, and delaying the optimal treatment window. In this study, we review the diagnosis and treatment strategies for skipped multifocal spinal tuberculosis lesions and enumerate the common differential diagnoses, to provide reference and guidance for clinical treatment and diagnosis direction.
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Affiliation(s)
- Shibo Na
- Department of Spinal Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun City, China
| | - ZhenShan Lyu
- Department of Spinal Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun City, China
| | - Shaokun Zhang
- Department of Spinal Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun City, China
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Zanon IDB, Meves R, Klautau GB. The Relative Lymphocyte Count is Lower when the Etiological Agent in Pott Disease is Successfully Isolated
*. Rev Bras Ortop 2023; 58:92-100. [PMID: 36969768 PMCID: PMC10038726 DOI: 10.1055/s-0042-1756638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 07/18/2022] [Indexed: 03/26/2023] Open
Abstract
Objective
To describe the clinico-epidemiological, laboratory, and radiological characteristics of tuberculous spondylodiscitis in the Brazilian population, and to assess whether there are differences between patients in whom the etiological agent in Pott disease was isolated or not.
Methods
Patients diagnosed with tuberculosis (TB) of the spine (Pott disease) underwent follow-up between 2009 and 2019 at a quaternary hospital and were divided into 2 groups: successful isolation (SI) of the etiological agent (through bacilloscopy, culture, or positive molecular rapid test) and unsuccessful isolation (UI) of the etiological agent.
Results
From a total of 26 patients diagnosed with TB of the spine, 21 (80.7%) were male, with a mean age of 40 ± 22.5 years. The average lymphocyte counts were higher in the UI group (25.35 ± 13.08;
p
= 0.025) compared to the SI group (14.18 ± 7.48). Moreover, the monocyte/lymphocyte ratio was lower in the UI group (0.39 ± 0.22;
p
= 0.009) than in the SI group (0.89 ± 0.65). Relative lymphocyte counts higher than or equal to 16.7 had a sensitivity of 76.9% and specificity of 62.5% in the UI group. Values higher than or equal to 0.58 for the monocyte/lymphocyte ratio showed a sensitivity of 84.6% and specificity of 75.0% in the UI group.
Conclusion
No differences were observed regarding the clinico-epidemiological and radiological characteristics of the two experimental groups. However, the UI group had higher lymphocyte counts and a lower monocyte/lymphocyte ratio.
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Affiliation(s)
- Igor de Barcellos Zanon
- Grupo de Afecções da Coluna Vertebral, Departamento de Ortopedia e Traumatologia, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
- Endereço para correspondência Igor de Barcellos Zanon, MD, MSc Rua Doutor Cesário Motta Júnior112, Vila Buarque, São Paulo, SPBrasil
| | - Robert Meves
- Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
| | - Giselle Burlamaqui Klautau
- Grupo de Afecções da Coluna Vertebral, Departamento de Ortopedia e Traumatologia, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
- Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
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Miyamoto K, Imada H, Yoshida S, Oka H, Iida S, Saita K, Ogihara S. Atypical clinical and radiological presentations of lumbar spinal tuberculosis mimicking a spinal tumor: A case report. Medicine (Baltimore) 2023; 102:e32730. [PMID: 36701731 PMCID: PMC9857248 DOI: 10.1097/md.0000000000032730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Tuberculosis (TB) is an important infectious disease worldwide. Classical spinal TB has specific radiological findings involving adjacent vertebral bodies with destruction of the intervertebral disc and involvement of paravertebral soft tissues with cold abscess formation. However, a few cases not exhibiting the radiological characteristics of TB spondylitis have been reported. We report a rare case of lumbar spinal TB with atypical clinical and radiological presentations that was difficult to differentiate from a malignant spinal tumor. PATIENT CONCERNS A 21-year-old man, who had immigrated to Japan from the Philippines 5 years ago, without a significant medical history, presented with back pain lasting 1 month and progression of gait disturbance 2 weeks prior to presentation. DIAGNOSIS Laboratory tests showed normal blood cell counts and normal value of C-reactive protein levels. Preoperative imaging studies indicated a possible spinal tumor. However, histopathologic findings of the epidural soft tissues at the first surgery led to the diagnosis of spinal mycobacterial infection. The diagnosis of spinal TB was confirmed by a positive culture of Mycobacterium tuberculosis obtained at the second surgery. INTERVENTIONS Given the progressive nature of neurologic deterioration, instead of needle biopsy, we proceeded with surgical intervention 8 days after admission; simultaneous neural decompression and open biopsy. Histological findings of the excised epidural soft tissues led to the diagnosis of spinal mycobacterial infection. We performed the second surgery involving additional resection of epidural soft tissues for further dural decompression and to obtain specimens for mycobacterial culture. Immediately after the second surgery, the patient commenced combination therapy with anti-tuberculous drugs. OUTCOMES The patient demonstrated significant recovery of motor function in the lower extremities, and was able to run at 2 months after the second surgery. The epidural granulomas completely disappeared on magnetic resonance imaging 3 months postoperatively. CONCLUSION Atypical clinical and radiological presentations of spinal TB present a challenge for appropriate diagnosis and early treatment. Even in developed countries where there are very few spinal TB patients, clinicians should be aware that spinal TB is an important differential diagnosis, especially in elderly patients or patients coming from countries with a middle-high prevalence of TB.
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Affiliation(s)
- Kodai Miyamoto
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Hiroki Imada
- Department of Pathology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Shinsuke Yoshida
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Hideaki Oka
- Department of General Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shunpei Iida
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kazuo Saita
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Satoshi Ogihara
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
- * Correspondence: Satoshi Ogihara, Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan (e-mail: )
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13
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Spekker O, Hunt DR, Király K, Kis L, Madai Á, Szalontai C, Molnár E, Pálfi G. Lumbosacral tuberculosis, a rare manifestation of Pott's disease - How identified human skeletons from the pre-antibiotic era can be used as reference cases to establish a palaeopathological diagnosis of tuberculosis. Tuberculosis (Edinb) 2023; 138:102287. [PMID: 36450192 DOI: 10.1016/j.tube.2022.102287] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
The macromorphological examination of identified human osteological collections from the pre-antibiotic era (e.g., Terry Collection) can provide invaluable information about the skeletal manifestations of tuberculosis (TB) in individuals who did not receive pharmaceutical therapy. With analysis of such collections, new diagnostic criteria for TB can be recognised which can be used in palaeopathological interpretation. The aim of our paper is to provide a reference and aid for the identification of TB in past populations by demonstrating and discussing in detail the vertebral alterations indicative of one of its rare skeletal manifestations, lumbosacral TB. These changes were detected in two individuals from the Terry Collection (Terry No. 760 and Terry No. 1093). These two case studies furnish palaeopathologists with a stronger basis for diagnosing lumbosacral TB in skeletons which exhibit similar vertebral lesions from osteoarchaeological series. To illustrate this, an archaeological case from Hungary (KK146) is also presented, displaying vertebral alterations resembling that of the two cases from the Terry Collection. Through the demonstrated case studies, we can derive a better insight into the disease experience of people who lived in the past and suffered from TB.
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Affiliation(s)
- Olga Spekker
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Institute of Archaeological Sciences, Eötvös Loránd University, Múzeum körút 4/B, H-1088, Budapest, Hungary.
| | - David R Hunt
- Northern Virginia District Office of the Chief Medical Examiners, 10850 Pyramid Place, Manassas, VA, 20110, USA.
| | - Kitty Király
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Móra Ferenc Museum, Roosevelt tér 1-3, H-6720, Szeged, Hungary.
| | - Luca Kis
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Department of Archaeogenetics, Institute of Hungarian Research, Úri utca 54-56, H-1014, Budapest, Hungary.
| | - Ágota Madai
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Department of Anthropology, Hungarian National History Museum, Ludovika tér 2-6, H-1083, Budapest, Hungary.
| | - Csaba Szalontai
- National Institute of Archaeology, Hungarian National Museum, Múzeum körút 14-16, H-1088, Budapest, Hungary.
| | - Erika Molnár
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
| | - György Pálfi
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
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14
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Datta D, Ravichandran T, Kumar R, Sharma R, Vedant D. Necrotizing granulomatous inflammation mimicking skeletal metastasis: a possible differential diagnosis. Eur J Hybrid Imaging 2022; 6:30. [PMID: 36303099 PMCID: PMC9613828 DOI: 10.1186/s41824-022-00151-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/06/2022] [Indexed: 11/21/2022] Open
Abstract
Tuberculosis is an endemic disease in India for decades, and its coexistence in the patients with malignancy cannot be ignored. The non-specific uptake of 2-deoxy-2-[fluorine-18] fluoro-d-glucose in active infection and malignancy can affect the diagnosis and management of patients. However, characteristic anatomical features of the lesion aid not only in its localization but also in diagnosis. We share an interesting case of necrotizing granulomatous inflammation of dorsal spine mimicking skeletal metastases in a treated case of carcinoma cervix.
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Affiliation(s)
- Deepanksha Datta
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - T Ravichandran
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Rajesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Jodhpur, India.
| | - Rashim Sharma
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Deepak Vedant
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
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15
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Qu J, Xu H, Lv X. Disseminated alveolar echinococcosis in a patient diagnosed by metagenomic next-generation sequencing: A case report. Front Public Health 2022; 10:972619. [PMID: 36091563 PMCID: PMC9454002 DOI: 10.3389/fpubh.2022.972619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/29/2022] [Indexed: 01/25/2023] Open
Abstract
Background Alveolar echinococcosis (AE) is a parasitic zoonosis with high mortality and disability rates. Diverse clinical manifestations and mimicking of differential diagnoses such as tuberculosis and malignancy pose a diagnostic dilemma. With the rapid development of molecular diagnostic techniques in recent years, metagenomic next-generation sequencing (mNGS) has become an attractive approach for the etiological diagnosis of infectious diseases. Case presentation we report a case of 51-year-old Chinese Tibetan male presented with 3-year low-back pain and 4-month discomfort in the right upper quadrant of the abdomen. He had been in good health. He was diagnosed with tuberculosis and was given anti-tuberculosis treatment a month prior to the visit, but the symptoms were not relieved. Abdominal computerized tomography (CT) revealed a hypodense lesion with uneven enhancement in the liver, and two ring-enhancing cystic lesions in the right abdominal wall. Lumbar spine enhanced MRI showed lesions of mixed density with uneven enhancement in the L1 vertebra and paraspinal tissue. The pathological results of the liver biopsy revealed parasitic infection and possibly echinococcosis. The metagenomic next-generation sequencing (mNGS) of the puncture fluid of abdominal cysts using Illumina X10 sequencer revealed 585 sequence reads matching Echinococcus multilocularis. Disseminated AE was diagnosed. Albendazole (400 mg, twice daily) was used, and the patient was in stable condition during follow-up. Conclusions mNGS may be a useful tool for the diagnosis of AE. The case would help clinicians to improve their diagnostic skills.
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Affiliation(s)
- Junyan Qu
- Center of Infectious Disease, West China Hospital of Sichuan University, Chengdu, China
| | - Huan Xu
- Pathology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoju Lv
- Center of Infectious Disease, West China Hospital of Sichuan University, Chengdu, China,*Correspondence: Xiaoju Lv
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16
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Chianca V, Chalian M, Harder D, Del Grande F. Imaging of Spine Infections. Semin Musculoskelet Radiol 2022; 26:387-395. [PMID: 36103882 DOI: 10.1055/s-0042-1749619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The incidence of spondylodiskitis has increased over the last 20 years worldwide, especially in the immunodepressed population, and it remains a complex pathology, both in terms of diagnosis and treatment. Because clinical symptoms are often nonspecific and blood culture negative, imaging plays an essential role in the diagnostic process. Magnetic resonance imaging, in particular, is the gold standard technique because it can show essential findings such as vertebral bone marrow, disk signal alteration, a paravertebral or epidural abscess, and, in the advanced stage of disease, fusion or collapse of the vertebral elements. However, many noninfectious spine diseases can simulate spinal infection. In this article, we present imaging features of specific infectious spine diseases that help radiologists make the distinction between infectious and noninfectious processes.
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Affiliation(s)
- Vito Chianca
- Clinica di Radiologia EOC IIMSI, Lugano, Switzerland.,Ospedale Evangelico Betania, Naples, Italy
| | - Majid Chalian
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, Washington
| | - Dorothee Harder
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
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17
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Parillo M, Vaccarino F, Beomonte Zobel B, Quattrocchi CC. A Rare Case of Contained Chronic Rupture of Abdominal Aortic Aneurysm Associated With Vertebral Erosion: Pre- and Post-operative Findings on Computed Tomography and a Narrative Review. Vasc Endovascular Surg 2022; 56:15385744221108040. [PMID: 35688795 DOI: 10.1177/15385744221108040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Contained chronic rupture of aortic aneurysm (CCR-AA) is a rare condition that can be associated with vertebral body erosion (VBE) and is often a diagnostic challenge; in fact, CCR-AAs are in general hemodynamically stable and the patients tend to present with a non-specific low-back pain syndrome secondary to vertebral involvement. Furthermore, the differential diagnosis of a retroperitoneal mass can be difficult on medical imaging. We discuss the case of a 79-years-old man, heavy smoker without history of cardiovascular diseases, admitted to the emergency department with signs of left lower limb ischemia. The patient was hemodynamically stable and the medical examination revealed a pulsatile abdominal mass. Doppler ultrasound showed the presence of aneurysmal dilatation of infra-renal abdominal aorta and chronic femoropopliteal occlusion on the left side. The subsequent computed tomography angiography (CTA) demonstrated a voluminous retroperitoneal mass continuous with the infra-renal aorta, which infiltrated the psoas muscles and caused vertebral bodies erosion of the anterior wall in L2, L3 and L4 suspected for CCR-AA or mycotic aortic aneurysm. Furthermore, the examination confirmed the occlusion of the peripheral arterial circulation of the left lower limb. The patient underwent a successful open replacement of the infra-renal abdominal aorta through aorto-aortic prosthetic graft insertion; the visualization during the surgical procedure of a posterior vessel wall opening in continuity with the eroded vertebral bodies associated with negative microbiological culture of the thrombotic material sample, led to the definitive diagnosis of CCR-AA. The post-operative CTA showed successful open vascular treatment. A bypass surgery of the left lower limb was then performed with positioning saphenous graft between femoral common artery and posterior tibial artery. The patient was finally discharged in good clinical conditions.
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Affiliation(s)
- Marco Parillo
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, 220431Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Federica Vaccarino
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, 220431Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Bruno Beomonte Zobel
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, 220431Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carlo C Quattrocchi
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, 220431Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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18
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Cardozo-Saavedra A, Ortiz S, Alvarez Moro F, Bassa P, Carrillo-Villamizar E, Garcia Garzón J. 18F-FDG PET/CT role in Pott disease. Rev Esp Med Nucl Imagen Mol 2022; 41:319-321. [DOI: 10.1016/j.remnie.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/27/2022]
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19
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Kubihal V, Sharma R, Krishna Kumar R, Chandrashekhara S, Garg R. Imaging update in spinal tuberculosis. J Clin Orthop Trauma 2022; 25:101742. [PMID: 34956831 PMCID: PMC8671643 DOI: 10.1016/j.jcot.2021.101742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis is ancient disease known to mankind. Diagnosis and management of spinal tuberculosis has immensely improved in last few decades. Imaging, particularly MRI, plays important role in diagnosis of spinal tuberculosis and its complications. Four common imaging patterns of spinal tuberculosis include paradiscal type, central type, Anterior subligamentous type, and posterior type. Imaging also plays important role in differentiation of spinal tuberculosis from its mimics, particularly pyogenic spondylitis, and metastasis. Radiological interventions, such as CT guided vertebral biopsy, and percutaneous drainage of cold abscess, are commonly used in management of spinal tuberculosis. Monitoring of therapeutic response is often based on clinical evaluation and imaging. MRI is most common imaging modality used. Signs of healing include bony ankylosis, resolution of marrow edema, decrease in contrast enhancement, and fatty change with in bone marrow. PET CT is recently evaluated for response assessment with promising results. This review summarizes pathophysiology, clinical presentation, imaging features, radiological interventions, and response assessment in spinal tuberculosis.
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Affiliation(s)
- Vijay Kubihal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - R.G. Krishna Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S.H. Chandrashekhara
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
- Corresponding author. Department of Radiodiagnosis, IRCH All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Rakesh Garg
- Department of Onco-anesthesiology and Palliative Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Alshoabi SA, Almas KM, Aldofri SA, Hamid AM, Alhazmi FH, Alsharif WM, Abdulaal OM, Qurashi AA, Aloufi KM, Alsultan KD, Omer AM, Daqqaq TS. The Diagnostic Deceiver: Radiological Pictorial Review of Tuberculosis. Diagnostics (Basel) 2022; 12:diagnostics12020306. [PMID: 35204395 PMCID: PMC8870832 DOI: 10.3390/diagnostics12020306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/11/2022] [Accepted: 01/21/2022] [Indexed: 02/01/2023] Open
Abstract
Tuberculosis (TB) is a bacterial infection with Mycobacterium tuberculosis; it is a public health problem worldwide and one of the leading causes of mortality. Since December 2019, the COVID-19 pandemic has created unprecedented health challenges and disrupted the TB health services, especially in high-burden countries with ever-increasing prevalence. Extrapulmonary and even pulmonary TB are an important cause of nonspecific clinical and radiological manifestations and can masquerade as any benign or malignant medical case, thus causing disastrous conditions and diagnostic dilemmas. Clinical manifestations and routine laboratory tests have limitations in directing physicians to diagnose TB. Medical-imaging examinations play an essential role in detecting tissue abnormalities and early suspecting diagnosis of TB in different organs. Radiologists and physicians should be familiar with and aware of the radiological manifestations of TB to contribute to the early suspicion and diagnosis of TB. The purpose of this article is to illustrate the common radiologic patterns of pulmonary and extrapulmonary TB. This article will be beneficial for radiologists, medical students, chest physicians, and infectious-disease doctors who are interested in the diagnosis of TB.
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Affiliation(s)
- Sultan Abdulwadoud Alshoabi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia; (F.H.A.); (W.M.A.); (O.M.A.); (A.A.Q.); (K.M.A.); (K.D.A.); (A.M.O.)
- Correspondence:
| | - Khaled M. Almas
- Radiology Department, Al-Hawbany Hospital, Alhodeidah, Yemen;
| | - Saif A. Aldofri
- Radiology Department, Central Military Hospital, Sana’a, Yemen;
| | | | - Fahad H. Alhazmi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia; (F.H.A.); (W.M.A.); (O.M.A.); (A.A.Q.); (K.M.A.); (K.D.A.); (A.M.O.)
| | - Walaa M. Alsharif
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia; (F.H.A.); (W.M.A.); (O.M.A.); (A.A.Q.); (K.M.A.); (K.D.A.); (A.M.O.)
| | - Osamah M. Abdulaal
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia; (F.H.A.); (W.M.A.); (O.M.A.); (A.A.Q.); (K.M.A.); (K.D.A.); (A.M.O.)
| | - Abdulaziz A. Qurashi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia; (F.H.A.); (W.M.A.); (O.M.A.); (A.A.Q.); (K.M.A.); (K.D.A.); (A.M.O.)
| | - Khalid M. Aloufi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia; (F.H.A.); (W.M.A.); (O.M.A.); (A.A.Q.); (K.M.A.); (K.D.A.); (A.M.O.)
| | - Kamal D. Alsultan
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia; (F.H.A.); (W.M.A.); (O.M.A.); (A.A.Q.); (K.M.A.); (K.D.A.); (A.M.O.)
| | - Awatif M. Omer
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia; (F.H.A.); (W.M.A.); (O.M.A.); (A.A.Q.); (K.M.A.); (K.D.A.); (A.M.O.)
| | - Tareef S. Daqqaq
- Radiology Department, Faculty of Medicine, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia;
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21
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Mote G, Patil R, Wankhede A, Wandile K, Badole C. Spinal tuberculosis and neurological deficit: A 10-year study in rural tertiary care center of central India. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2022. [DOI: 10.4103/jotr.jotr_29_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Goyal N, Keir G, Pavlica M, Little BP. Nonpulmonary Infections of the Thorax. Semin Roentgenol 2022; 57:105-118. [DOI: 10.1053/j.ro.2021.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 11/11/2022]
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23
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Liao F, Huang Z, Xu R, Luo Z, Qi W, Fan B, Yu J. Analysis of misdiagnosis and 18F-FDG PET/CT findings of lymph node tuberculosis. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2022; 30:941-951. [PMID: 35694951 DOI: 10.3233/xst-221195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate 18F-FDG PET/CT findings of tuberculous lymphadenitis and analyze the causes of misdiagnosis. METHOD Between 2013 and 2021, a retrospective review was conducted on 22 patients at Jiangxi Provincial People's Hospital Affiliated with Nanchang University who had lymph node tuberculosis confirmed by histology or clinical investigation. Subjective judgment and quantitative analysis were adopted. RESULTS Out of 22 patients, 14 are male and 8 are female. The average age was 55.5 years (55.5±12.4). The most common site of lymph node tuberculosis (LNTB) is the mediastinum (41.5%), followed by the neck (24.4%) and the abdominal cavity (21.9%). Half of the patients have more than one site affected. More than half of LNTB patients (54.5%) are concurrent with other types of TB, especially PTB. Among the 41 biggest affected lymph nodes, the average maximum diameter, minimum diameter, SUVmax and the lesion SUVmax/SUVmean liver ratio are 22.04±8.39, 16.93±6.75, 9.72±5.04 and 6.72±3.60, respectively. There is a poor correlation coefficient of 0.236 between the FDG uptake and the size of the biggest affected lymph node. Patients who are concurrent with no other TB have the significantly higher FDG uptake than patients who are concurrent with other TB (12.42 vs 8.02) (p = 0.005). Among these cases, 6 cases (27.3%) are accurately diagnosed with LNTB, all of which have pulmonary tuberculosis as a complication. However, 16 cases (72.7%) are misdiagnosed as lymphoma (50%), sarcoidosis (13.6%), and lymph node metastasis (9%). CONCLUSIONS This study demonstrates that 18F-FDG PET/CT is very useful in detecting LNTB because tuberculous granulomas show significant levels of glucose uptake. It proves to be an effective method for revealing lesion extent and discovering additional lesions that morphological imaging is missed. However, 18F-FDG PET/CT is not able to reliably distinguish LNTB from lymphoma, sarcoidosis, and metastatic lymph nodes. Nonetheless, 18F-FDG PET/CT allows for the selection of the most optimal biopsy location, and thus has potential to detect early treatment response and distinguish between active and inactive lesions.
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Affiliation(s)
- Fengxiang Liao
- Department of Nuclear Medicine, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Zizhen Huang
- Sterilization and Supply Center, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Rong Xu
- Department of Nuclear Medicine, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Zhehuang Luo
- Department of Nuclear Medicine, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Wanling Qi
- Department of Nuclear Medicine, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Bing Fan
- Department of Radiology, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Juhong Yu
- Department of Radiology, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
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Gupta N, Kadavigere R, Malla S, Bhat SN, Saravu K. Differentiating tubercular from pyogenic causes of spine involvement on Magnetic Resonance Imaging. LE INFEZIONI IN MEDICINA 2022; 31:62-69. [PMID: 36908382 PMCID: PMC9994822 DOI: 10.53854/liim-3101-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/30/2022] [Indexed: 03/07/2023]
Abstract
Introduction Based on clinical parameters alone, it is difficult to differentiate between tubercular (TB) and pyogenic spondylodiscitis. Therefore, this study aimed to identify imaging features that can help to differentiate these two entities. Methodology This retrospective observational study included microbiologically confirmed cases of TB and pyogenic spondylitis over three years. Magnetic resonance imaging of included cases was reviewed for a predefined set of imaging findings. A multivariable logistic regression analysis was done to compare the radiological features of both groups. A scoring system was created using the features that were significant in univariate and multivariable analysis. Results Of the 90 included cases, 44 were TB and 46 were pyogenic. Involvement of the thoracic vertebra, paravertebral abscess, epidural abscess, posterior element involvement, loss of height, spine deformity, nerve compression, destruction of the disc and larger abscess size were more common in patients with TB. Involvement of the thoracic spine, posterior element involvement and spine deformity were independent predictors of diagnosing TB spine. At a score of 7 (out of 11) or above, the scoring system had a sensitivity and specificity of 86% and 94%, respectively, in diagnosing the TB spine. Conclusion In the presence of relevant clinical findings, specific MRI findings can help to differentiate TB from pyogenic spondylitis.
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Affiliation(s)
- Nitin Gupta
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rajagopal Kadavigere
- Department of Radiodiagnosis, Kasturba Medical College and Hospital, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sundeep Malla
- Department of Radiodiagnosis, Indraprastha Apollo Hospitals, New Delhi, India
| | - Shyamasunder N Bhat
- Department of Orthopaedics, Kasturba Medical College and Hospital, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kavitha Saravu
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Rehman S, Rehman AU, Naveed MA, Iftikhar A. Intracranial and Spinal Tuberculosis: A Rare Entity. Cureus 2021; 13:e20787. [PMID: 35111471 PMCID: PMC8795229 DOI: 10.7759/cureus.20787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 11/26/2022] Open
Abstract
CNS tuberculosis has a broad spectrum of disease patterns and a high risk of complications and mortality. We present a case of a 36-year-old man who was diagnosed with neurotuberculosis with intracranial and spinal tuberculomas, meningitis, and spondylodiscitis. The patient was a known case of sarcoidosis and was being managed on corticosteroids. His presenting complaints were headache, low-grade fever, severe backache, lower limb weakness, and one episode of altered sensorium. The initial diagnosis was based on imaging findings, which were confirmed with positive cerebrospinal fluid (CSF) culture for Mycobacterium tuberculosis. Imaging and clinicopathological correlation enables early diagnosis and treatment and prevents permanent neurological sequelae.
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Shetty AP, Viswanathan VK, Rajasekaran S. Cervical spine TB - Current concepts in management. J Orthop Surg (Hong Kong) 2021; 29:23094990211006936. [PMID: 34711081 DOI: 10.1177/23094990211006936] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Cervical tubercular disease (CTB) is a rare pathology and constitutes 3-5% of all spinal TB. It includes atlantoaxial TB and sub-axial TB. As the literature evidence on this subject is scarce, majority of issues concerning CTB are still controversial. The current narrative review comprehensively discusses the various aspects related to CTB. Literature search: An elaborate search was made using keywords cervical tuberculosis, atlantoaxial tuberculosis, sub-axial tuberculosis, and cervico-thoracic tuberculosis, on pubmed and google (scholar.google.com) databases on 2 December 2020. We identified crucial questions regarding CTB and included relevant articles pertaining to them. RESULTS The initial search using keywords cervical tuberculosis, atlantoaxial tuberculosis, sub-axial tuberculosis, and cervico-thoracic tuberculosis yielded 4128, 76, 3 and 9 articles on 'pubmed' database, respectively. A similar search using the aforementioned keywords yielded 1,96,000, 2130, 117 and 728 articles on 'google scholar' database. The initial screening resulted in the identification of 178 articles. Full manuscripts were obtained for these articles and thoroughly scrutinised at the second stage. Review articles, randomised controlled trials and level 1 studies were given preference. Overall, 41 articles were included. CONCLUSION AATB and SACTB constitute 0.3 to 1% and 3% of spinal TB, respectively. The incidence of neuro-deficit in CTB is significantly more than other spinal TB. The general principles of management of CTB are similar to spinal TB elsewhere and medical therapy remains the cornerstone. Surgery is advocated in specific scenarios involving gross neuro-deficit, later stages of disease with significant bony/ligamentous disruptions, altered sagittal balance, drug resistance, and poor response to medications. The surgical approaches for AATB include anterior-alone, posterior-alone and combined approaches, although posterior access is the most preferred. Most of the studies on SACTB have supported the role of anterior approach. Additionally, posterior stabilisation may be necessary in specific scenarios. The overall long-term outcome in CTB is favourable.
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Affiliation(s)
- Ajoy Prasad Shetty
- Department of Spine surgery, 76290Ganga Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
| | | | - S Rajasekaran
- Department of Spine surgery, 76290Ganga Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
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Naselli N, Facchini G, Lima GM, Evangelisti G, Ponti F, Miceli M, Spinnato P. MRI in differential diagnosis between tuberculous and pyogenic spondylodiscitis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:431-441. [PMID: 34379210 DOI: 10.1007/s00586-021-06952-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of the study was to investigate whether MRI findings together with epidemiological data could help in differentiating between tuberculous and pyogenic spondylodiscitis. METHODS Clinical records of 260 patients with a suspicion of spondylodiscitis were analysed. Patients were selected using the following inclusion criteria: confirmed diagnosis of spondylodiscitis either from pyogenic bacteria or from Mycobacterium tuberculosis and contrast-enhanced MRI performed before treatment. Clinical data concerning age, sex and country-of-origin were also collected. For each patient, several MRI-features were evaluated by two-expert musculoskeletal radiologists. A chi-squared test and a multiple logistic regression were used to find the best predictors of tuberculous or pyogenic spondylodiscitis. RESULTS 114 patients were retrospectively enrolled, 30 with tuberculous and 84 with pyogenic spondylodiscitis. We found 18 MRI-features, significantly different between the two groups. Among these, the most strongly associated with tuberculous spondylodiscitis were: heterogeneous vertebral signal on T1w-sequences (Odds Ratio(OR) = 205.759-p < 0.001), presence of epidural abscess (OR = 86.221-p < 0.001), severe vertebral destruction (OR = 10.017-p < 0.001) and absence of epidural phlegmon (OR = 86.221-p < 0.001). Moreover, patients coming from countries with a middle-high prevalence of tuberculosis were more frequently affected by tuberculous spondylodiscitis than others were (OR = 229.136-p < 0.001). The best prediction model demonstrated a correct classification rate of 94.7%. CONCLUSION To the best of our knowledge this is the largest study comparing MRI-features of tuberculous and pyogenic spondylodiscitis. The above-mentioned MRI-features and epidemiological data are crucial in the differential diagnosis between these two entities, guiding the choice of the appropriate therapy, especially when a pathogen cannot be clearly identified with other modalities.
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Affiliation(s)
- Nicoletta Naselli
- Department of Radiology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | - Giancarlo Facchini
- Department of Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giacomo Maria Lima
- Nuclear Medicine Department, University Hospital of Modena, Modena, Italy
| | - Gisberto Evangelisti
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Ponti
- Department of Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Miceli
- Department of Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Spinnato
- Department of Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Miller AG, Spicer PJ. Extrapulmonary tuberculosis: a case report involving the spine and soft tissues. Radiol Case Rep 2021; 16:2236-2239. [PMID: 34178198 PMCID: PMC8213895 DOI: 10.1016/j.radcr.2021.05.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Abstract
Tuberculosis (TB) is a major health concern worldwide, and its incidence is increasing in developed countries, especially among immigrant populations. Extrapulmonary TB with musculoskeletal involvement is often a difficult and delayed diagnosis, as the disease can mimic metastases or infection. We present a case of extrapulmonary TB affecting the spine and soft tissues of a Vietnamese-born patient living in the United States. We discuss the imaging findings associated with extrapulmonary TB of the spine. Familiarity with key imaging features of disease can lead to early suspicion and detection of the disease as well as timely treatment.
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Affiliation(s)
- Aden Gunnar Miller
- University of Kentucky College of Medicine, 800 Rose Street MN 150, Lexington, KY 40506, USA
| | - Paul J. Spicer
- Division of Musculoskeletal Radiology, Department of Radiology, University of Kentucky, 800 Rose Street HX-315D, Lexington, KY 40506, USA
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Zanon IDB, Tsai VL, Ribeiro TC, Astur N, Mendonça RGMD, Gotfryd AO, Salles MJC, Caffaro MFS, Klautau GB, Meves R. THE PROFILE OF POTT’S DISEASE IN A SOUTH AMERICAN REFERENCE SERVICE. COLUNA/COLUMNA 2021. [DOI: 10.1590/s1808-185120212002234844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: Tuberculosis (TB) represents one of the top ten causes of death in the world. Its insidious onset and nonspecific symptoms usually result in delayed diagnosis. The objective is to evaluate the characteristics of patients with tuberculous spondylodiscitis in follow-up at a South American reference hospital. Method: Retrospective evaluation of the medical records of patients of both sexes and between 0 and 80 years of age diagnosed with tuberculosis of the spine between 2009 and 2018. The variables were analyzed based on groups: epidemiological, clinical, laboratorial, microbiological, imaging tests and treatment. Results: Total of 26 cases, about 80.8% male, mean age 41.6 ± 22.46 years. Axial pain was the most prevalent symptom (84.6%), the VAS score was 6.85 ± 2.87. The mean time between symptom onset and diagnosis was 23.8 ± 24.1 weeks (4-96). The most affected region was the thoracic spine (50% of the cases). Most participants (61.4%) had no change in neurological function (Frankel D and E) at the beginning of treatment and after 6 months, and 84.5% improved. During treatment 34.6% required surgery and the main indication was isolated neurological deficit (55.5%). The most frequently performed procedure was decompression and arthrodesis (55.5%). The average time to cure was 12.0 ± 8.8 months (8-48). Conclusion: Disease with insidious onset, nonspecific symptoms, high frequency of negative microbiological tests in cases with the disease. A small number of the cases required surgical treatment and most of them achieved good neurological recovery. Level of evidence IV; Case series.
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Cardozo-Saavedra A, Ortiz S, Alvarez Moro FJ, Bassa P, Carrillo-Villamizar E, Garcia Garzón JR. 18F-FDG PET/CT role in Pott disease. Rev Esp Med Nucl Imagen Mol 2021; 41:S2253-654X(21)00105-0. [PMID: 34074621 DOI: 10.1016/j.remn.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Affiliation(s)
- A Cardozo-Saavedra
- CETIR, Grupo Biomédico ASCIRES, Esplugues de Llobregat, Barcelona, España.
| | - S Ortiz
- CETIR, Grupo Biomédico ASCIRES, Esplugues de Llobregat, Barcelona, España
| | - F J Alvarez Moro
- CETIR, Grupo Biomédico ASCIRES, Esplugues de Llobregat, Barcelona, España
| | - P Bassa
- CETIR, Grupo Biomédico ASCIRES, Esplugues de Llobregat, Barcelona, España
| | | | - J R Garcia Garzón
- CETIR, Grupo Biomédico ASCIRES, Esplugues de Llobregat, Barcelona, España
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31
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Natali D, Cloatre G, Brosset C, Verdalle P, Fauvy A, Massart JP, Vo Van Q, Gerard N, Dobler CC, Hovette P. What pulmonologists need to know about extrapulmonary tuberculosis. Breathe (Sheff) 2021; 16:200216. [PMID: 33664835 PMCID: PMC7910020 DOI: 10.1183/20734735.0216-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Extrapulmonary tuberculosis (EPT) can affect all organs. Its diagnosis is often challenging, especially when the lung is not involved. Some EPT locations, such as when the central nervous system is involved, are a medical emergency, and some have implications for treatment options and length. This review describes clinical features of EPT, diagnostic tests and treatment regimens. Extrapulmonary tuberculosis can affect any organ, can be potentially life threatening or disabling, poses diagnostic difficulties and may change the type and length of treatment. Looking for concomitant pulmonary tuberculosis is essential.https://bit.ly/2YEaRVb
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Affiliation(s)
| | | | | | - Pierre Verdalle
- Ear-Nose-Throat Diseases, Hanoi French Hospital, Hanoi, Vietnam
| | - Alain Fauvy
- Orthopedic Surgery, Hanoi French Hospital, Hanoi, Vietnam
| | | | - Quy Vo Van
- Urology, Hanoi French Hospital, Hanoi, Vietnam
| | - Nelly Gerard
- Dermatology, Hanoi French Hospital, Hanoi, Vietnam
| | - Claudia C Dobler
- Dept of Respiratory Medicine, Liverpool Hospital, Sydney, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
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32
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Iloanusi NI, Unigwe US, Uche EO, Iroezindu MO, Okafor OC. Pott's disease with extensive bilateral psoas abscesses in a Nigerian woman: an unusual case. Malawi Med J 2021; 32:168-172. [PMID: 33488989 PMCID: PMC7812151 DOI: 10.4314/mmj.v32i3.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Bilateral psoas abscesses are uncommon in Pott's disease. We describe a 28-year-old Nigerian woman with a 2-year history of constitutional symptoms and a 1-year history of bilateral paravertebral masses. She had received anti-tuberculosis (TB) treatment in an interrupted manner. A computed tomography (CT) scan revealed T10-T12 spondylitis, wedge collapse and extensive bilateral psoas abscesses. Histology of the abscess wall was definitively diagnosed as soft tissue TB, and special staining for acid-fast bacilli was positive. She was successfully treated with anti-TB therapy and ultrasound-guided surgical drainage of 6 L of abscess fluid. Complicated cases of Pott's disease may require multi-disciplinary interventions for optimal outcome.
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Affiliation(s)
- Nneka I Iloanusi
- Department of Radiation Medicine, Faculty of Medical Sciences, University of Nigeria, Ituku/Ozalla Campus, Enugu, Nigeria
| | - Uche S Unigwe
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Enoch O Uche
- Department of Surgery, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Michael O Iroezindu
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Okechukwu C Okafor
- Department of Morbid Anatomy, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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Bäck M, Michel JB. From organic and inorganic phosphates to valvular and vascular calcifications. Cardiovasc Res 2021; 117:2016-2029. [PMID: 33576771 PMCID: PMC8318101 DOI: 10.1093/cvr/cvab038] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/26/2020] [Accepted: 02/03/2021] [Indexed: 02/06/2023] Open
Abstract
Calcification of the arterial wall and valves is an important part of the pathophysiological process of peripheral and coronary atherosclerosis, aortic stenosis, ageing, diabetes, and chronic kidney disease. This review aims to better understand how extracellular phosphates and their ability to be retained as calcium phosphates on the extracellular matrix initiate the mineralization process of arteries and valves. In this context, the physiological process of bone mineralization remains a human model for pathological soft tissue mineralization. Soluble (ionized) calcium precipitation occurs on extracellular phosphates; either with inorganic or on exposed organic phosphates. Organic phosphates are classified as either structural (phospholipids, nucleic acids) or energetic (corresponding to phosphoryl transfer activities). Extracellular phosphates promote a phenotypic shift in vascular smooth muscle and valvular interstitial cells towards an osteoblast gene expression pattern, which provokes the active phase of mineralization. A line of defense systems protects arterial and valvular tissue calcifications. Given the major roles of phosphate in soft tissue calcification, phosphate mimetics, and/or prevention of phosphate dissipation represent novel potential therapeutic approaches for arterial and valvular calcification.
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Affiliation(s)
- Magnus Bäck
- Division of Valvular and Coronary Disease, Department of Cardiology, Karolinska University Hospital, 141 86 Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,University of Lorraine, Nancy University Hospital, INSERM U1116, Nancy, France
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34
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Ren X, Li K, Li L, Zhao G. Mediastinal tuberculous lymphadenitis presenting with insidious back pain in a male adult: a case report and review of the literature. J Int Med Res 2021; 49:300060520987102. [PMID: 33445984 PMCID: PMC7812410 DOI: 10.1177/0300060520987102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Mediastinal tuberculous lymphadenitis (MTL) is mostly observed in primary tuberculosis in infants, children and adolescents, and is not found commonly in adults. Mediastinal tuberculous lymphadenitis cases may present with an insidious progression of tuberculous symptoms, including gradual deterioration in the lungs and a variety of clinical characteristics; however, initial symptoms are rarely only chronic back pain. We present the case of a 33-year-old man with mediastinal tuberculous lymphadenitis misdiagnosed as myofascitis. Since such individuals do not develop respiratory symptoms in the initial stages, they often go undiagnosed and can potentially spread tuberculosis.
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Affiliation(s)
- Xuli Ren
- Department of Anaesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Kai Li
- Department of Anaesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Longyun Li
- Department of Anaesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Guoqing Zhao
- Department of Anaesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
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35
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Casali M, Lauri C, Altini C, Bertagna F, Cassarino G, Cistaro A, Erba AP, Ferrari C, Mainolfi CG, Palucci A, Prandini N, Baldari S, Bartoli F, Bartolomei M, D’Antonio A, Dondi F, Gandolfo P, Giordano A, Laudicella R, Massollo M, Nieri A, Piccardo A, Vendramin L, Muratore F, Lavelli V, Albano D, Burroni L, Cuocolo A, Evangelista L, Lazzeri E, Quartuccio N, Rossi B, Rubini G, Sollini M, Versari A, Signore A. State of the art of 18F-FDG PET/CT application in inflammation and infection: a guide for image acquisition and interpretation. Clin Transl Imaging 2021; 9:299-339. [PMID: 34277510 PMCID: PMC8271312 DOI: 10.1007/s40336-021-00445-w] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/19/2021] [Indexed: 02/06/2023]
Abstract
AIM The diagnosis, severity and extent of a sterile inflammation or a septic infection could be challenging since there is not one single test able to achieve an accurate diagnosis. The clinical use of 18F-fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) imaging in the assessment of inflammation and infection is increasing worldwide. The purpose of this paper is to achieve an Italian consensus document on [18F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases, such as osteomyelitis (OM), prosthetic joint infections (PJI), infective endocarditis (IE), prosthetic valve endocarditis (PVE), cardiac implantable electronic device infections (CIEDI), systemic and cardiac sarcoidosis (SS/CS), diabetic foot (DF), fungal infections (FI), tuberculosis (TBC), fever and inflammation of unknown origin (FUO/IUO), pediatric infections (PI), inflammatory bowel diseases (IBD), spine infections (SI), vascular graft infections (VGI), large vessel vasculitis (LVV), retroperitoneal fibrosis (RF) and COVID-19 infections. METHODS In September 2020, the inflammatory and infectious diseases focus group (IIFG) of the Italian Association of Nuclear Medicine (AIMN) proposed to realize a procedural paper about the clinical applications of [18F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases. The project was carried out thanks to the collaboration of 13 Italian nuclear medicine centers, with a consolidate experience in this field. With the endorsement of AIMN, IIFG contacted each center, and the pediatric diseases focus group (PDFC). IIFG provided for each team involved, a draft with essential information regarding the execution of [18F]FDG PET/CT or PET/MRI scan (i.e., indications, patient preparation, standard or specific acquisition modalities, interpretation criteria, reporting methods, pitfalls and artifacts), by limiting the literature research to the last 20 years. Moreover, some clinical cases were required from each center, to underline the teaching points. Time for the collection of each report was from October to December 2020. RESULTS Overall, we summarized 291 scientific papers and guidelines published between 1998 and 2021. Papers were divided in several sub-topics and summarized in the following paragraphs: clinical indications, image interpretation criteria, future perspectivess and new trends (for each single disease), while patient preparation, image acquisition, possible pitfalls and reporting modalities were described afterwards. Moreover, a specific section was dedicated to pediatric and PET/MRI indications. A collection of images was described for each indication. CONCLUSIONS Currently, [18F]FDG PET/CT in oncology is globally accepted and standardized in main diagnostic algorithms for neoplasms. In recent years, the ever-closer collaboration among different European associations has tried to overcome the absence of a standardization also in the field of inflammation and infections. The collaboration of several nuclear medicine centers with a long experience in this field, as well as among different AIMN focus groups represents a further attempt in this direction. We hope that this document will be the basis for a "common nuclear physicians' language" throughout all the country. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40336-021-00445-w.
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Affiliation(s)
- Massimiliano Casali
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Chiara Lauri
- grid.7841.aNuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Corinna Altini
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Francesco Bertagna
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Gianluca Cassarino
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | | | - Anna Paola Erba
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Cristina Ferrari
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Ciro Gabriele Mainolfi
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Andrea Palucci
- grid.415845.9Department of Nuclear Medicine, “Ospedali Riuniti di Torrette” Hospital, Ancona, Italy
| | - Napoleone Prandini
- grid.418324.80000 0004 1781 8749Nuclear Medicine Unit, Department of Diagnostic Imaging, Centro Diagnostico Italiano, Milan, Italy
| | - Sergio Baldari
- grid.10438.3e0000 0001 2178 8421Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Francesco Bartoli
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Mirco Bartolomei
- grid.416315.4Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | - Adriana D’Antonio
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Francesco Dondi
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Patrizia Gandolfo
- grid.418324.80000 0004 1781 8749Nuclear Medicine Unit, Department of Diagnostic Imaging, Centro Diagnostico Italiano, Milan, Italy
| | - Alessia Giordano
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Riccardo Laudicella
- grid.10438.3e0000 0001 2178 8421Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, Messina, Italy
| | | | - Alberto Nieri
- grid.416315.4Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | | | - Laura Vendramin
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Francesco Muratore
- Rheumatology Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Valentina Lavelli
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Domenico Albano
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Luca Burroni
- grid.415845.9Department of Nuclear Medicine, “Ospedali Riuniti di Torrette” Hospital, Ancona, Italy
| | - Alberto Cuocolo
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Laura Evangelista
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Elena Lazzeri
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Natale Quartuccio
- grid.419995.9Nuclear Medicine Unit, A.R.N.A.S. Civico di Cristina and Benfratelli Hospitals, Palermo, Italy
| | - Brunella Rossi
- Nuclear Medicine Unit, Department of Services, ASUR MARCHE-AV5, Ascoli Piceno, Italy
| | - Giuseppe Rubini
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Martina Sollini
- grid.417728.f0000 0004 1756 8807Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Annibale Versari
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Alberto Signore
- grid.7841.aNuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, Rome, Italy
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Wu X, Liu J, Wang G, Wu F. Bone and joint tuberculosis in patients undergoing dialysis: clinical features, risk factors, and outcomes in 17 patients. J Int Med Res 2020; 48:300060520945501. [PMID: 32815456 PMCID: PMC7444120 DOI: 10.1177/0300060520945501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study was performed to investigate the clinical features, risk factors, and outcomes of bone and joint tuberculosis in patients undergoing dialysis. METHODS We systematically reviewed the medical records of 17 patients with bone and joint tuberculosis undergoing dialysis who were admitted to our hospital from January 2009 to January 2019. RESULTS Seventeen patients with bone and joint tuberculosis undergoing dialysis were identified in this retrospective study, and 13 patients were undergoing hemodialysis. The mean age of the 17 patients was 61.3 years (range, 32-82 years), and 10 (58.9%) patients were male. Most of the patients had a low CD4+ cell count and low hemoglobin and albumin levels. Surgery was performed in 6 patients (35.3%), and 13 of the 17 patients (76.4%) were cured. Three patients had bone or spine sequelae, mainly because of a delayed diagnosis, and one patient died of heart failure. CONCLUSION These findings indicate that older age, a low CD4+ cell count, and low hemoglobin and albumin levels are possible risk factors for bone and spine tuberculosis in patients undergoing dialysis. If diagnosed early, most patients should have a good outcome after anti-tubercular therapy with or without surgery.
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Affiliation(s)
- Xuehua Wu
- Department of Orthopedics, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, Zhejiang, China
| | - Jing Liu
- Department of Anaesthesiology, Huzhou Maternity & Child Health Care hospital, Huzhou, Zhejiang, China
| | - Guorong Wang
- Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Zhejiang University Huzhou Hospital, Huzhou, Zhejiang, China
| | - Fengfeng Wu
- Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Zhejiang University Huzhou Hospital, Huzhou, Zhejiang, China
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Tan TSE, Mahmood RD. Atypical spinal tuberculosis mimicking malignancy: the utility of multimodality imaging evaluation. Postgrad Med J 2020; 97:197-198. [PMID: 32595111 DOI: 10.1136/postgradmedj-2020-138350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/03/2022]
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Kumaran SP, Thippeswamy PB, Reddy BN, Neelakantan S, Viswamitra S. An Institutional Review of Tuberculosis Spine Mimics on MR Imaging: Cases of Mistaken Identity. Neurol India 2020; 67:1408-1418. [PMID: 31857525 DOI: 10.4103/0028-3886.273630] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Although MRI has a spectrum of findings which help in the diagnosis of tuberculosis (TB) spine, a broad spectrum of spine pathologies resemble Pott's spine on MRI and are often missed due to inadequate clinical details. As a result, patients are often subject to unnecessary biopsy. A blinded radiologist may misdiagnose such mimic cases as TB. Our aim is to enable the reader to learn the main criteria that differentiate spine TB from other spine etiologies that mimic TB. A retrospective search was done and authors collected only MRI spine reports that showed a differential diagnosis or diagnosis of TB spine from the computer-based data records of the institution over a four-year period. This revealed 306 cases of TB spine out of which 78 cases with an alternate diagnosis that resembled TB spine were included. We describe a single institute review of 78 such cases that resemble and mimic Pott's spine on MRI. The cases being: (n = 15) pyogenic spondylitis, (n = 1) brucellar spondylodiscitis, (n = 12) rheumatoid arthritis, (n = 12) metastases, (n = 8) lymphoma, (n = 5) post-trauma fractures, (n = 10) degenerative disc disease, (n = 2) Baastrup's disease, (n = 9) osteoporotic fracture, (n = 3) spinal neuropathic arthritis, and (n = 1) case of Rosai-Dorfman disease. The clinical and radiological findings of all these cases were correlated with lab findings and histopathology wherever necessary. Appropriate recognition of these entities that resemble and mimic TB spine on MRI is important for optimal patient care. This paper exposes radiologists to a variety of spine pathologies for which biopsy is not indicated, and highlights key imaging findings of these entities to facilitate greater diagnostic accuracy in clinical practice.
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Affiliation(s)
- Sunitha Palasamudram Kumaran
- Department of Radiology, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India
| | | | - Bhavana Nagabhushan Reddy
- Department of Radiology, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India
| | | | - Sanjaya Viswamitra
- Department of Radiology, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India
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39
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Pandita A, Madhuripan N, Pandita S, Hurtado RM. Challenges and controversies in the treatment of spinal tuberculosis. J Clin Tuberc Other Mycobact Dis 2020; 19:100151. [PMID: 32154388 PMCID: PMC7058908 DOI: 10.1016/j.jctube.2020.100151] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Current guidelines regarding management of spinal TB are mostly extrapolated from trials on pulmonary disease. Since the British Medical Research Council (BMRC) trials in the 1970s, there are not many good quality studies that substantiate best practice guidelines for the management of this entity. Tuberculous infection of the spine behaves much differently from bacterial osteomyelitis and limited data leads to ambiguity in many cases. Although a few studies have been conducted in patients with spinal TB, most were in the era preceding short course chemotherapy and prior to current radiological and surgical advances. While spinal TB is primarily managed medically, surgical intervention may be needed in certain cases. We discuss areas of uncertainty and challenges that exist with regards to medical treatment, diagnosis, therapeutic endpoints, and a few surgical considerations. Substantial delay in diagnosis continues to be common with this disease even in the developed nations, leading to substantial morbidity. In light of limited evidence, there is an emerging recognition of the need to individualize various aspects of its treatment such as duration, frequency and acknowledging the limitations of various diagnostic and radiological modalities. We aim to consolidate potential areas of research in the diagnosis and management of spinal TB and to revisit the latest published evidence on its redressal.
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Affiliation(s)
- Aakriti Pandita
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Nikhil Madhuripan
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Saptak Pandita
- Division of Medicine, Hind Institute of Medical Sciences, India
| | - Rocio M. Hurtado
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
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40
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MRI findings in Pott’s spine and correlating clinical progress with radiological findings. Neuroradiology 2020; 62:825-832. [DOI: 10.1007/s00234-020-02402-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
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41
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Abstract
The role of fluorodeoxyglucose (FDG)-PET/computed tomography (CT) in tuberculosis (TB) continues to expand in disease detection, assessment of the extent of the disease, and treatment response monitoring. This article reviews available data regarding the use of FDG-PET/CT in patients with TB. A new method of quantification for patients with TB is introduced. This method produces robust parameters that represent the total disease burden.
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42
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Affiliation(s)
- Ahmed Ali
- Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, England
| | - Omar Musbahi
- Oxford University Clinical Academic Graduate School, Oxford University, Oxford, England
| | - Veronica L C White
- Department of Respiratory Medicine and Infectious Diseases (V.L.C.W.) and Spinal Department (A.S.M.), Royal London Hospital, London, England
| | - Alexander Sheriff Montgomery
- Department of Respiratory Medicine and Infectious Diseases (V.L.C.W.) and Spinal Department (A.S.M.), Royal London Hospital, London, England
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43
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Neurological recovery after early decompression for dorsal Pott's spine. Int J Surg Case Rep 2019; 66:236-239. [PMID: 31874383 PMCID: PMC6931094 DOI: 10.1016/j.ijscr.2019.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Tuberculosis spondylitis or Pott's disease is the most common destructive form of skeletal tuberculosis. The most commonly affected site is the thoracolumbar vertebra. Once invading the adjacent structures of the vertebrae and intervertebral discs ultimately form an abscess causing spinal cord compression, vertebral collapse, and severe kyphotic deformity. PRESENTATION OF CASE We present the first-ever case done in King Fahd Military Medical Complex in Dhahran, Saudi Arabia, of an 18-year-old male diagnosed with tuberculosis spondylitis who was complaining of progressive upper back pain and lower limb weakness. Emergent anterior decompression with expandable cage, plates, and screws were done. The patient showed a smooth and rapid recovery and was discharged with improved lower limb power and sensations. DISCUSSION Pott's disease can lead to progressive neurological deficits in which surgical decompression is indicated. Current surgical practice includes anterior or posterior decompression with or without fusion and/or instrumentation. CONCLUSION Surgery with either anterior or posterior decompression should assure complete clearance of the lesion, correcting the kyphotic deformity that prevents disease progression.
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Strauss SB, Gordon SR, Burns J, Bello JA, Slasky SE. Differentiation between Tuberculous and Pyogenic Spondylodiscitis: The Role of the Anterior Meningovertebral Ligament in Patients with Anterior Epidural Abscess. AJNR Am J Neuroradiol 2019; 41:364-368. [PMID: 31831466 DOI: 10.3174/ajnr.a6370] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/03/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Differentiation between tuberculous and pyogenic spondylodiscitis is a diagnostic challenge because imaging often does not reliably distinguish the 2 entities and percutaneous biopsies are often culture-negative. The purpose of this study was to determine whether violation of the anterior meningovertebral ligament in the setting of anterior epidural abscess discriminates between these entities. MATERIALS AND METHODS This was a retrospective cohort study of all patients with acid-fast bacillus testing and anterior epidural abscess diagnosed on spinal MR imaging between May 2014 and September 2019, with a final diagnosis of tuberculous or pyogenic spondylodiscitis. Six cases of tuberculous spondylodiscitis (mean age, 45.5 years; 80% male) and 35 cases of pyogenic spondylodiscitis were evaluated (mean age, 56.6 years; 49% male). Demographic characteristics were recorded. Cases were assessed for anterior meningovertebral ligament destruction on MR imaging, as demonstrated by the shape of the epidural collection. Segmental location of the infection was also assessed. Independent 2-sample t tests and χ2 tests of independence were performed to evaluate the significance of the difference between the groups. RESULTS Five of 6 (83.3%) cases of tuberculous epidural abscess had an intact anterior meningovertebral ligament, and 0/35 cases of pyogenic epidural abscess demonstrated an intact ligament (P < .001). The presence of an intact anterior meningovertebral ligament had 83.3% sensitivity and 100% specificity for tuberculous spondylodiscitis, a 100% positive predictive value, and a 97.2% negative predictive value. CONCLUSIONS The presence of an intact anterior meningovertebral ligament has high sensitivity and specificity for tuberculous spondylodiscitis-associated epidural abscess, though these results should be validated in a larger sample.
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Affiliation(s)
- S B Strauss
- From the Department of Radiology (S.B.S.), Weill Cornell Medical Center, New York, New York
| | - S R Gordon
- Department of Radiology (S.R.G., J.B., J.A.B., S.E.S.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - J Burns
- Department of Radiology (S.R.G., J.B., J.A.B., S.E.S.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - J A Bello
- Department of Radiology (S.R.G., J.B., J.A.B., S.E.S.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - S E Slasky
- Department of Radiology (S.R.G., J.B., J.A.B., S.E.S.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
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45
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Pu F, Feng J, Yang L, Zhang L, Xia P. Misdiagnosed and mismanaged atypical spinal tuberculosis: A case series report. Exp Ther Med 2019; 18:3723-3728. [PMID: 31611930 PMCID: PMC6781804 DOI: 10.3892/etm.2019.8014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 01/18/2019] [Indexed: 11/11/2022] Open
Abstract
Compared to other diseases, early or atypical spinal tuberculosis (TB) is prone to being misdiagnosed due to the lack of specific clinical manifestations and misleading negative results of various laboratory analyses and imaging examinations. Various methods for diagnosing spinal TB have become research hotspots. Recently, it has been proposed that effective vaccination is a mainstay of long-term policies to combat and control the TB epidemic. However, some new TB vaccines require further evaluation and clinical trials to demonstrate their efficiency and safety. Thus, early diagnosis and effective treatment are the other essential long-term strategies for controlling the TB epidemic immunization is closely associated with the diagnosis of spinal TB, which will become the focus of future research and set the direction for future developments. The present study provides a case series and a literature review of the characteristics of spinal TB to provide guidance for the diagnosis, treatment and prognosis of spinal TB.
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Affiliation(s)
- Feifei Pu
- Department of Orthopedics, Wuhan No. 1 Hospital, Wuhan Integrated TCM & Western Medicine Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Jing Feng
- Department of Orthopedics, Wuhan No. 1 Hospital, Wuhan Integrated TCM & Western Medicine Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Lin Yang
- Department of Orthopedics, Wuhan No. 1 Hospital, Wuhan Integrated TCM & Western Medicine Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Lin Zhang
- Department of Orthopedics, Wuhan No. 1 Hospital, Wuhan Integrated TCM & Western Medicine Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Ping Xia
- Department of Orthopedics, Wuhan No. 1 Hospital, Wuhan Integrated TCM & Western Medicine Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
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Sánchez-Montalvá A, Barios M, Salvador F, Villar A, Tórtola T, Molina-Morant D, Lorenzo-Bosquet C, Espinosa-Pereiro J, Molina I. Usefulness of FDG PET/CT in the management of tuberculosis. PLoS One 2019; 14:e0221516. [PMID: 31454368 PMCID: PMC6711521 DOI: 10.1371/journal.pone.0221516] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 08/08/2019] [Indexed: 11/18/2022] Open
Abstract
Background The aim of our study is to describe the FDG-PET/CT findings in patients with tuberculosis and to correlate them with the patient’s prognosis. Methods We retrospectively collected data from patients with tuberculosis, who had an FDG-PET/CT performed prior to treatment initiation from 2010 to 2015. Results Forty-seven out of 504 patients with active tuberculosis diagnosis (9.33%) underwent an FDG-PET/CT. The reasons for performing the FDG-PET/CT were: characterization of a pulmonary nodule (24; 51.1%), study of fever of unknown origin (12; 25.5%), study of lymph node enlargement (5; 10.6%) and others (6; 12.8%). Median age was 64 (IQR 50–74) years and 31 (66%) patients were male. Twenty-six (55.3%) patients had an immunosuppressant condition. According to the FDG-PET/CT, 48.6% of the patients had more than 1 organ affected and 46.8% had lymph node involvement. Median SUVmax of the main lesion was 5 (IQR 0.28–11.85). We found an association between the FDG accumulation and the size of the main lesion with a correlation coefficient of 0.54 (p<0.002). Patients with an unsuccessful outcome had a higher ratio SUVmax main lesion / SUVmean liver (1.92 vs 7.67, p<0.02). Conclusions In our cohort, almost half of the patients had more than 1 organ affected and 46.8% of them had lymph node involvement. FDG uptake was associated with the size of the main lesion and seems to be related to the treatment outcome. The extent of its potential to be used as an early predictor of treatment success still needs to be defined.
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Affiliation(s)
- Adrián Sánchez-Montalvá
- Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Grupo de Estudio de micobacterias (GEIM), Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
- * E-mail:
| | - Marta Barios
- Nuclear Medicine Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fernando Salvador
- Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Grupo de Estudio de micobacterias (GEIM), Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
| | - Ana Villar
- Pneumology Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teresa Tórtola
- Microbiology Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Daniel Molina-Morant
- Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carles Lorenzo-Bosquet
- Nuclear Medicine Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Espinosa-Pereiro
- Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Grupo de Estudio de micobacterias (GEIM), Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
| | - Israel Molina
- Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
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Meng Y, Hang Y, Hao D, Jia S, He X, Liu D, Sun L. Application of transforaminal-lumbar interbody fusion technology combined with lesion clearance and chemotherapy via catheter for the treatment of spinal tuberculosis. Exp Ther Med 2019; 18:57-62. [PMID: 31258637 PMCID: PMC6566072 DOI: 10.3892/etm.2019.7536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/03/2018] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to analyze the clinical and radiological outcomes of active thoracolumbar spinal tuberculosis (TB) treated by application of transforaminal-lumbar interbody fusion technology combined with lesion clearance and chemotherapy via catheter (TCLC). Posterior debridement and indwelling catheterization in the lesion area were performed for direct injection of anti-TB drugs, so as to reduce the recurrence rate. The present prospective study comprised 26 patients with active thoracolumbar spinal TB who underwent TCLC at Hong Hui Hospital affiliated to Xi'an Jiaotong University (Xi'an, China). The kyphotic Cobb angle at presentation, after surgery and at the final follow-up were 22.7±9.8, 9.8±7.3 and 10.3±8.8°, respectively, with an average correction of 13.1±5.4° after surgery, and a loss of correction of 1.8±1.0° at the final follow-up. The rate of correction and loss of correction were 56.6 and 8.3%, respectively. At six months after the surgery, all abnormal erythrocyte sedimentation rates and C-reactive protein levels had returned to normal. The average time to union was ~5 months. All patients had bony union and improved neurological function, with their daily activity returning to normal. In conclusion, in the present study, application of TCLC for the treatment of spinal TB achieved satisfactory healing of lesions. The surgical treatment for spinal TB comprised the removal of the disease as far as possible, and the local administration of anti-TB chemotherapy to the lesion is key to successful treatment.
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Affiliation(s)
- Yibin Meng
- Department of Spine Surgery, Hong Hui Hospital affiliated to Xi'an Jiaotong University, Xi'an, Shaanxi 710054, P.R. China
| | - Yunfei Hang
- Department of Spine Surgery, Hong Hui Hospital affiliated to Xi'an Jiaotong University, Xi'an, Shaanxi 710054, P.R. China
| | - Dingjun Hao
- Department of Spine Surgery, Hong Hui Hospital affiliated to Xi'an Jiaotong University, Xi'an, Shaanxi 710054, P.R. China
| | - Shuaijun Jia
- Department of Spine Surgery, Hong Hui Hospital affiliated to Xi'an Jiaotong University, Xi'an, Shaanxi 710054, P.R. China
| | - Xirui He
- Department of Clinical Pharmacy, Hong Hui Hospital affiliated to Xi'an Jiaotong University, Xi'an, Shaanxi 710054, P.R. China
| | - Deyin Liu
- Department of Orthopaedics, Hong Hui Hospital affiliated to Xi'an Jiaotong University, Xi'an, Shaanxi 710054, P.R. China
| | - Liang Sun
- Department of Orthopaedics, Hong Hui Hospital affiliated to Xi'an Jiaotong University, Xi'an, Shaanxi 710054, P.R. China
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Blum A, Mudji J, Blum J. Extrapulmonary Tuberculosis Presenting With Double Vision in a Resource-Limited Tropical Setting. Am J Trop Med Hyg 2019; 100:7-8. [PMID: 30652664 PMCID: PMC6335926 DOI: 10.4269/ajtmh.18-0473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Anna Blum
- Hôpital Evangélique de Vanga, Bandundu, Democratic Republic of Congo.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Junior Mudji
- Hôpital Evangélique de Vanga, Bandundu, Democratic Republic of Congo
| | - Johannes Blum
- Hôpital Evangélique de Vanga, Bandundu, Democratic Republic of Congo.,Medical Faculty, University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
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Vaishnav B, Suthar N, Shaikh S, Tambile R. Clinical study of spinal tuberculosis presenting with neuro-deficits in Western India. ACTA ACUST UNITED AC 2019; 66:81-86. [DOI: 10.1016/j.ijtb.2018.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 02/03/2018] [Accepted: 04/09/2018] [Indexed: 11/25/2022]
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50
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Gibson J, Coucher J, Coulter C, Eather G. Pleuropulmonary tuberculosis with spinal lesions due to metastatic malignancy differentiated definitively on imaging. BMJ Case Rep 2018; 11:11/1/e226160. [PMID: 30580297 DOI: 10.1136/bcr-2018-226160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A healthy 31-year-old man presenting with back pain was found to have multiple spinal enhancing lesions on MRI. An incidental asymptomatic large pleural effusion was identified on investigations for the back pain and pleural and pulmonary tuberculosis (TB) was subsequently diagnosed. The radiographical features on MRI spine were not typical of spinal TB and a Ga68 DOTATATE Positron Emission Tomography (PET)/CT confirmed metastatic paraganglioma with multiple bone metastases. Although metastatic paraganglioma is rare, this case highlights that even in young patients dual pathology needs to be considered. Most importantly, it is a reminder to physicians managing TB of the clues that help distinguish spinal TB from important alternative causes, including metastatic malignancy.
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Affiliation(s)
- Justine Gibson
- Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Metro South Clinical Tuberculosis Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - John Coucher
- Department of Diagnostic Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Chris Coulter
- Metro South Clinical Tuberculosis Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Queensland Mycobacterium Reference Laboratory, Pathology Queensland, Brisbane, Queensland, Australia
| | - Geoffrey Eather
- Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Metro South Clinical Tuberculosis Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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