Tuberculosis (TB) is no longer a disease limited to developing nations and is still a major cause of significant morbidity and mortality worldwide. The indolent clinical presentation, emergence of multidrug-resistant mycobacteria, and association with human immunodeficiency virus infection poses obstacles for early diagnosis and management. Compared with the other forms of TB, musculoskeletal involvement is relatively rare. Tuberculous spondylitis is the most common form of musculoskeletal TB and accounts for ~50% of cases. Extraspinal musculoskeletal TB shows a predilection for large weightbearing joints, long bones, and the skull. This article reviews the radiologic features of diverse forms of osseous TB and the diagnostic value of the different imaging techniques. It also reviews the imaging differential diagnoses, including other infections and malignancies/metastases. Conventional radiography is of key value in the diagnosis of musculoskeletal TB. Computed tomography, magnetic resonance imaging, and bone scintigraphy also play key roles in the early detection of disease and in demonstrating the extent of disease process and soft tissue involvement. Because delay in treatment significantly reduces the cure rate and increases the rate of complications and morbidity, early radiological diagnosis of TB is of paramount importance for appropriate management.

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MR imaging has become an important diagnostic tool in the evaluation of a vast number of pathologies and is of foremost importance in the evaluation of spine, joints, and soft tissue structures of the musculoskeletal system. MR imaging is susceptible to various artifacts that may affect the image quality or even simulate pathologies. Some of these artifacts have gained special importance with the use of higher field strength magnets and with the increasing need for MR imaging in postoperative patients, especially those with previous joint replacements or metallic implants. Artifacts may arise from patient motion or could be due to periodic motion, such as vascular and cardiac pulsation. Artifacts could also arise from various protocol errors including saturation, wraparound, truncation, shading, partial volume averaging, and radiofrequency interference artifacts. Susceptibility artifact occurs at interfaces with different magnetic susceptibilities and is of special importance with increasing use of metallic joint replacement prostheses. Magic angle phenomenon is a special type of artifact that occurs in musculoskeletal MR imaging. It is essential to recognize these artifacts and to correct them because they may produce pitfalls in image interpretation.

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A 23-year-old Indian man presented to the emergency department following an injury to his right leg. Radiographs showed a fracture of the midshaft of the right femur, for which open reduction and internal fixation was subsequently performed. The patient developed shortness of breath on Postoperative Day 2, along with new-onset confusion and altered mental state. His lungs were clear on the clinical examination, but there was a new rash on the chest. The patient's condition rapidly deteriorated over the next few hours with progressive worsening of the hypoxia, and he had to be intubated. He also experienced rapid neurological decline with a worsening score on the Glasgow Coma Scale (GCS) from 15 to 11. Blood tests demonstrated mild anaemia with thrombocytopenia. Computed tomography (CT) pulmonary angiography ( Fig. 1) was performed to evaluate the cause of shortness of breath, and magnetic resonance (MR) imaging of the brain was performed to assess the rapid neurological decline (Fig. 2). What do the images show? What is the diagnosis? CMEArticleClinics in diagnostic imaging (184)