ARRS 2022 Abstracts

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E2143. Musculoskeletal Tuberculosis: The Great Masquerader
Authors
  1. Saloni Dagar; University College of Medical Sciences, GTB Hospital
  2. Anupama Tandon; University College of Medical Sciences, GTB Hospital
  3. Shuchi Bhatt; University College of Medical Sciences, GTB Hospital
  4. Siddhi Chawla; All India Institute of Medical Sciences(AIIMS), Jodhpur
  5. Arunima Aggarwal; University College of Medical Sciences, GTB Hospital
  6. Atha Ulla; University College of Medical Sciences, GTB Hospital
  7. Aayush Bhargava; University College of Medical Sciences, GTB Hospital
Background
Tuberculosis (TB) still remains a global epidemic, killing 1.4 million people annually worldwide. Traditionally considered a disease of the poor and the third world countries, the rising number of patients living with HIV, diabetics, organ transplant recipients, and patients receiving cancer chemotherapy has contributed to its resurgence worldwide. Extrapulmonary TB (EPTB) represents 15% of all the reported cases globally, of which musculoskeletal TB accounts for 10–30%, being the third most common site after the pleura and lymphatic system. Vertebral involvement (tuberculous spondylitis or Pott's disease) is the most common form of skeletal TB, accounting for 50% of all musculoskeletal TB. Musculoskeletal TB is often indolent and presents insidiously. It may present without the typical constitutional symptoms, making the diagnosis challenging and delayed. TB may not even be the initial consideration in the differential diagnosis. Concomitant pulmonary involvement may not be present, thus further making the diagnosis elusive. An early diagnosis is important to minimize deformity and enhance outcome. Radiographs may provide early clues to the diagnosis in some cases. Cross-sectional imaging (MRI and/or CT), however, remains a must for evaluating complex anatomy, the entire extent of disease, and its complications. Imaging also helps direct biopsies of affected areas for establishing a definitive microbiological/histopathological diagnosis.

Educational Goals / Teaching Points
The purpose of this review is to illustrate the common and rare presentations of musculoskeletal tuberculosis, familiarizing the practicing radiologist with rare presentations to help raise suspicion in atypical cases. Further, we aim to describe the differential diagnosis of each of these cases and the appropriate work up as well as clinical management.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The presentation, imaging appearance on various modalities (radiographs, ultrasonography, CT, MRI), differential diagnosis, and management of various common and rare presentations of musculoskeletal tuberculosis, in both in adults and children will be discussed. Cases to be discussed in the review include Potts’s spine (paradiscal, anterior, central, and neural arch lesions); tuberculous osteomyelitis of various bones like ribs, sternum, ilium, ischium, humerus; tubercular involvement of joints including hip, knee, shoulder, and elbow; soft tissue lesions like cold abscesses, empyema necessitans, and chest wall lesions mimicking a breast lump.

Conclusion
Through our review, we emphasize the need for better knowledge of musculoskeletal TB and awareness that it may have an unusual presentation. Knowledge of uncommon findings will lead to an early diagnosis and better management, thus improving clinical outcomes.