Musculoskeletal tuberculosis – imaging using low-end and advanced modalities for developing and developed countries

Abstract

Musculoskeletal involvement by TB is rare in comparison to other forms of the disease. It most commonly involves the spine but can also involve large weight-bearing joints, long bones, the skull and the soft tissues. Characteristic appearances of musculoskeletal TB are described for numerous imaging modalities in this paper but it is also highlighted that when based on imaging appearances alone, there is always a differential diagnosis, including other infections and malignancies. Awareness of of TB as a possible cause of vertebral body lesions, arthritis and synovitis, long bone lesions and soft tissue collections will allow clinicians to consider TB based on imaging and will sometimes be characteristic enough to allow for a trial of therapy, thereby avoiding biopsy. This paper specifically describes the imaging appearances on both basic modalities such as plain radiographs and ultrasound for those working in resource-restricted areas, as well as on high-end modalities such as CT and MRI for those with access to these. Tuberculosis is no longer a disease limited to the developing world and radiologists in the developed world must be able to make this diagnosis in both immigrants and the native population.

Imaging in extrapulmonary tuberculosis

“…The main route of spread is haematogenous, from lungs, or via activation of dormant infection in bone or joint post-trauma. 27 Cases of musculoskeletal TB are usually subclassified as tubercular spondylitis (50%) (popularly called Potts' spine), peripheral tuberculous arthritis (60%), osteomyelitis (38%), and soft tissue TB, including tenosynovitis and bursitis. [28][29][30] [ ( F i g u r e _ 2 ) T D $ F I G ] [ ( F i g u r e _ 3 ) T D $ F I G ]…”

Extensive pulmonary and extrapulmonary tuberculosis in a child presenting with a chest wall abscess: The value of different modes of imaging

“…While CT may also demonstrate para‐spinal soft‐tissue masses, its strength is in identifying bony involvement 3 . In our patient, the primary site of bone involvement was the spine, whereas the multiple rib changes of scalloping and sclerosis were more indicative of pressure changes from the intrathoracic extrapulmonary abscesses.…”

A proposed CT classification of progressive lung parenchymal injury complicating pediatric lymphobronchial tuberculosis: From reversible to irreversible lung injury

“…19 Other complications and associations that can also be seen on CT, that are not related to the airway occlusion and include pericardial effusions, axillary adenopathy, 22 and musculoskeletal involvement. 23 Goussard et al 13 described the clinical, radiological, and bronchoscopy findings of expansile pneumonia in 24 children with TB. They showed that in patients with obstruction of more than 75% on fibreoptic bronchoscopy (FB) there was liquefaction on CT, while there was no liquefaction was present in obstructions less than 75%.…”