ARRS 2022 Abstracts

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E1845. Imaging Manifestations of Extrapulmonary Tuberculosis
Authors
  1. Christian Fourquet; SUNY Downstate Health Sciences University
  2. Mossum Sawhney; SUNY Downstate Health Sciences University
  3. Mussanna Ahmed; SUNY Downstate Health Sciences University
  4. Anju Dubey; SUNY Downstate Health Sciences University
Background
Tuberculosis (TB) is a highly contagious infectious disease caused by Mycobacterium tuberculosis, with increased prevalence in the US among immunocompromised individuals. TB can infect any part of the body, including the CNS, lymphovascular system, abdominopelvic viscera, and musculoskeletal system, although pulmonary involvement is most common. Extrapulmonary TB accounts for approximately 15% of all TB infections. Clinical, nonimaging-based diagnosis may prove difficult for extrapulmonary TB, and early detection on imaging may facilitate early therapeutics and can help mitigate disease dissemination/progression.

Educational Goals / Teaching Points
The goals of this exhibit are to describe the varying presentation and imaging findings of extrapulmonary TB, ranging from abdominopelvic to CNS involvement; and facilitate a diagnostic, imaging-based approach, to ensure timely and accurate diagnosis of extrapulmonary TB to promote early detection and treatment.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Pathological manifestations of extrapulmonary TB are broad and depend on the organ system involved. In abdominopelvic TB, there is intestinal, solid-organ (e.g. liver, spleen, adrenals), peritoneal, and mesenteric involvement. In CNS TB, the most common manifestation is tuberculous meningitis (pachymeningeal or leptomeningeal involvement). Parenchymal manifestations include tuberculomas/abscesses. Additional findings of hydrocephalus (usually communicating) may be present. Musculoskeletal involvement of TB is uncommon; however, the spine is the most common site of osseous involvement (thoracic > lumbar). TB spondylitis (Pott disease) represents vertebral body osteomyelitis and intervertebral discitis due to TB. Complications of spinal or paraspinal abscesses may occur with disease extension.

Conclusion
Although TB is a less prevalent disease entity in developed nations such as the US, its prevalence is still high amongst immunocompromised individuals who are also at increased risk of disseminated and extrapulmonary disease. Clinical diagnosis may be challenging for extrapulmonary TB, and imaging manifestations are broad and varied. Thus, familiarity with the imaging manifestations of extrapulmonary TB are crucial not only for enhancing diagnostic radiologic proficiency but also for timely detection and early medical intervention to mitigate disease progression and dissemination as well as to avoid invasive interventions such as surgery.