Imaging features of musculoskeletal tuberculosis. Eur Radiol
ABSTRACT The purpose of this article is to review the imaging characteristics of musculoskeletal tuberculosis. Skeletal tuberculosis represents one-third of all cases of tuberculosis occurring in extrapulmonary sites. Hematogenous spread from a distant focus elsewhere in the body is the cornerstone in the understanding of imaging features of musculoskeletal tuberculosis. The most common presentations are tuberculous spondylitis, arthritis, osteomyelitis, and soft tissue involvement. The diagnostic value of the different imaging techniques, which include conventional radiography, CT, and MR imaging, are emphasized. Whereas conventional radiography is the mainstay in the diagnosis of tuberculous arthritis and osteomyelitis, MR imaging may detect associated bone marrow and soft tissue abnormalities. MR imaging is generally accepted as the imaging modality of choice for diagnosis, demonstration of the extent of the disease of tuberculous spondylitis, and soft tissue tuberculosis. Moreover, it may be very helpful in the differential diagnosis with pyogenic spondylodiscitis, as it may easily demonstrate anterior corner destruction, the relative preservation of the intervertebral disk, multilevel involvement with or without skip lesions, and a large soft tissue abscess, as these are all arguments in favor of a tuberculous spondylitis. On the other hand, CT is still superior in the demonstration of calcifications, which are found in chronic tuberculous abscesses.
- SourceAvailable from: György Pálfi
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- "The route of infection is usually through the respiratory tract, although infection occasionally occurs through the intestinal tract. Osseous alterations are associated with only 1–3 % of the TB cases (Tuli, 2004; Vanhoenacker et al., 2009). Bone alterations develop slowly after the haematogenous dissemination from the remote septic foci. "
ABSTRACT: Osseous ankylosis of large joints that occurs secondary to infection is rarely described in developed countries, thanks to diagnostic techniques that allow early detection and treatment of the underlying infection. Evidence of the natural history and progression of the disease is now primarily studied through the observation and analysis of osteoarcheological specimens, and medical reports or books dating from the pre-antibiotic era. This report illustrates several cases where modern medical imaging techniques and ancient medical literature were successfully interpreted to diagnose rare, advanced-stage tuberculous alterations in osteoarcheological specimens. Two skeletons from the Bátmonostor cemetery (Hungary) demonstrate complete unilateral ankylosis of the knee. Macroscopic and radiographic examinations were undertaken to assess the extent of skeletal changes and determine their cause. Data obtained from computed tomography (CT) were constructed in 2D and 3D. The 2D CT images revealed cavities involving both the metaphyses and the epiphyses. The 3D reconstructions allowed us to reconstruct the more precise volumetric morphology of the circumscribed lytic lesions, as well as clear ‘image-mirror’ lacunar volumes. On the basis of the macroscopic and radiological analyses, extra-spinal tuberculous infection seems to have been the most probable etiology of these two cases.International Journal of Osteoarchaeology 11/2012; 2012(Wiley Online Library). DOI:10.1002/oa.2284 · 0.95 Impact Factor
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- "Tuberculous infections of the bones and joints   Tuberculous arthritis "
ABSTRACT: Infections of the bone and soft tissue of the limbs need to be diagnosed and treated urgently regardless of the patient's age. Clinical features are often non-specific. MRI and, in some cases, sonography investigations lead to early diagnosis and appropriate management. Computed tomography has limited value. Needle aspiration and biopsy need not be routine. In children, anatomical particularities explain the different morphological manifestations, which vary with age. It is important to both know when to propose the diagnosis of infection, so that appropriate imaging investigations are carried out, and to be aware of the symptomatology of limb infections in children and adults and understand the differential diagnoses for each age group. Clinicians should also be aware of the specific characteristics in children.06/2012; 93(6):530-46. DOI:10.1016/j.diii.2012.03.014
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- "L'IRM permet d'e ´voquer le diagnostic a ` un stade précoce en précisant la localisation de l'infection, unique ou multiple, son extension osseuse, vertébrale, discale, e ´pidurale ou para vertébrale     . L'IRM peut déceler des complications e ´ventuelles (abcès) susceptibles de bénéficier d'une intervention chirurgicale de décompression, ou d'un geste de drainage percutané . "
ABSTRACT: The objective is to study the rehabilitation management and to assess autonomy in daily life activities as well as walking recovery in patients with complicated Pott's disease. Retrospective study in nine patients over a period of 8 years extending from 2000 to 2008, collated in the Department of Physical Medicine and Functional Rehabilitation, CHU Sahloul, Sousse, Tunisia. The mean age of our patients was 43.8 years; sex ratio was 5/4. The spine involvement of tuberculosis was dorsal in seven cases, dorso-lumbar in one patient, and multiple (cervical, dorsal and lumbar) in one case. All patients were paraplegic with a neurological involvement of the bladder. They had prior antituberculosis chemotherapy for at least 8 months. Decompression surgery was performed in six cases. Two female patients presented disorders of spinal posture during treatment requiring surgical revision with osteosynthesis. All patients received additional rehabilitation care. Following a mean duration of hospitalisation in the Rehabilitation department of 47 days with twice-daily sessions of tailored physiotherapy, three patients remained in complete paraplegia, autonomous in wheel-chair and with vesical and sphincter incontinence. The measure of functional independence (MFI) was at admission/discharge 71/92. Rehabilitation takes an important place in the medico-surgical management in Pott's disease, to limite or compensate the disabilities and handicap related to this pathology.Annals of physical and rehabilitation medicine 03/2012; 55(3):190-200. DOI:10.1016/j.rehab.2012.02.004