Tubercular Osteomyelitis of the Clavicle: A Report of Four Cases

Abstract

We report the clinicoradiological features of tuberculosis in the clavicle in 4 patients. The patients' ages ranged from 9 months to 29 years. All patients were managed with antitubercular drug therapy for one year and one underwent surgical debridement and curettage as well. Clinicians should be aware of the varied presentation (pain, non-healing ulcer, abscess, multifocal osteoarticular tuberculosis) of this condition. With the worldwide resurgence of tuberculosis, clinicians should maintain a high index of suspicion. The diagnosis of osteoarticular tuberculosis is usually made on clinico-radiological features.

Mid Clavicular swelling; An Unusual Presentation of Clavicle Tuberculosis: A Case Report

“…[2] Isolated clavicular tuberculosis is even less common than other osteoarticular tuberculosis. [3] Tuberculosis can involve any part of clavicle with most common site medial 1/3 rd .…”

“…It can also involve sternoclavicular or acromioclavicular joint. It is associated with pain without major bone destruction, which later on may present with cold abscess, sinuses, non-healing ulcers [2] etc. Very rarely, it may present with unexplained chronic shoulder pain.…”

“…Radiologically the lesions in tuberculosis can be either destructive or proliferative (spina ventosa) and in very few cases pathological fractures are also seen. [2] Conventional radiograph gives very confusing picture which may show multiple cystic cavities or sequestrum, honeycombing or diffuse thickening. Diagnosis with plain radiograph is very difficult due to overlapping anatomical structure and hence it is not an effective tool for evaluating the changes.…”

“…Diagnosis with plain radiograph is very difficult due to overlapping anatomical structure and hence it is not an effective tool for evaluating the changes. [2] However, CT scan and MRI provide better images. [4] CT scan is better option for appreciating destructive changes particularly in bone window setting while MRI is more useful for appreciating the extent of lesion and determine soft tissue and bone marrow involvement.…”

“…Its rare entity and atypical presentation give confusing picture and often led to misdiagnosis and mismanagement which further adds on to complications. [2] Available diagnostic modalities like plain radiograph and MRI give picture same as other similar conditions like malignancy and infection may not bring any diagnosis toward tubercular nature. Here we are reporting a case of adolescent girl with swelling and pain over mid clavicular region primarily diagnosed as Ewing sarcoma on X ray and MRI, which was later, came out as tuberculosis on biopsy.…”