Skeletal tuberculosis in children

Abstract

The objective of this review is to present the imaging findings of skeletal tuberculosis in children. The incidence of tuberculosis is increasing and skeletal tuberculosis accounts for 10-20% of all extra-pulmonary cases. The most common manifestations of skeletal tuberculosis in children are spondylitis, arthritis and osteomyelitis. Tuberculous spondylitis involves the intervertebral disc only late in the disease. Subligamentous spread of the infection may lead to multiple levels of vertebral body involvement that may either be continuous or skipped. Extension of the disease into the paravertebral or extra-dural space may occur. Tuberculous arthritis usually occurs as a result of metaphyseal spread to the joint. Tuberculous osteomyelitis may appear as cystic, well-defined lesions, infiltrative lesions or spina ventosa. The latter is a term used to describe a form of tuberculous osteomyelitis where underlying bone destruction, overlying periosteal reaction and fusiform expansion of the bone results in cyst-like cavities with diaphyseal expansion. Radiographs are still the mainstay of evaluation of patients with bony lesions. Ultrasonography can detect soft-tissue extension of the bony lesions and guide drainage or biopsy procedures. CT accurately demonstrates bony sclerosis and destruction, especially in areas difficult to assess on radiographs such as the posterior elements of the vertebral body. MRI is the modality of choice in evaluating early marrow involvement and soft-tissue extension of the lesion.

Da tumefacção lombar à espondilodiscite tuberculosa – um caso clínico de doença de Pott

“…Este processo resulta na formação da cifose típica da doença, que deforma o canal da espinal medula, possibilitando a compressão da mesma com os consequentes sintomas neurológicos. 5 A paraplegia pode também resultar da presença de osteó-fitos ou de outras alterações degenerativas. Na espondilodiscite tuberculosa, a presença de um abcesso paravertebral também é comum, geralmente assintomático.…”

Multifocal osteoarticular tuberculosis of the extremities in an immunocompetent young man without pulmonary disease: A case report

“…MRI can be used to discriminate between abscesses and granulation tissue, delineate soft-tissue mass and identify the amount of bone destruction (16); however, MRI may not be appropriate for whole-body imaging as it is expensive and time-consuming (17). Bone scans, on the other hand, play an important role in the diagnosis and evaluation of TB (17,18), since they can detect unsuspected osseous TB in patients without known systemic diseases, particularly patients suffering from pain but without known malignancies.…”

Oligoarticular Tuberculous Infection of the Knee and Acromioclavicular Joints: An Unusual Manifestation and Characteristic Magnetic Resonance Imaging Findings

“…[2,16] Joint and periarticular involvement and lesions are particularly well defined by an MRI. The definitive diagnosis is performed from a positive mycobacterial culture and a histological examination of synovial fluid or synovial membranes.…”

“…This is largely due to the acquired immune deficiency syndrome (AIDS) epidemic and other immunosuppressive factors, immigration, homelessness and a decline in Tbc control programs. [2,3] The introduction of anti-tumor necrosis factor alpha (anti-TNF-α) drugs has rekindled interest in Tbc encountered in rheumatology. [4] Skeletal Tbc occurs in 1%-3% of cases and represents a third form of extra pulmonary Tbc after ganglion and kidney involvement.…”