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Introduction: Spina Ventosa is a rare condition that is easy to misdiagnose as other diseases. We present a case of late-diagnosed Spina Ventosa, which had not only the osteoarticular tuberculosis symptoms but also some severe symptoms, including pleural effusion, ascites, and anemia. By intensive treatment, our patient recovered completely. Case Report: A 7-year-old boy was admitted with complaints of painless swelling of metacarpals, metatarsals, and phalanges of his hands and feet and a discharging sinus of the left toe. There was no family or past history of tuberculosis. His immunizations were up to date. General examination revealed that the child had pallor and was emaciated. No lymphadenopathy was detected. Investigations revealed hemoglobin: 74 g/l, and erythrocyte sedimentation rate (ESR) was 42 mm/hour. QuantiFERON-TB test was positive. The radiograph showed irregular swelling with sclerosis of the underlying bones. The right-hand x-ray showed cortical destruction, sclerosis, and cystic expansion or right second metacarpal. Chest x-ray indicated pleural effusion. Histopathological examination of specimen from the foot and lung and abdomen fluid confirmed tuberculosis. The child was treated with the first-line tuberculosis treatment regimen (Isoniazid, Rifampicin, Ethambutol, and Pyrazinamide) for two months, followed by Isoniazid, Rifampicin, and Pyrazinamide for a further four months. His lesions disappeared after six weeks of intensive treatment. Conclusion:A delay in diagnosis and treatment of tuberculosis can lead to systemic manifestations in multiple organs. Despite the delay in diagnosis, this child had a good outcome due to being treated promptly and adequately after the presentation.

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On the basis of morphological characteristics and erosion - accumulation of sediment, it is possible to divide the stretch of the Gianh River from Co Cang to Cua Gianh (about 54km in length) into 3 sections as follows: Meandering channel (from Co Cang to Tien Xuan Isles): the length of the channel is 27.69km and the width of the channel is 80-250m. The channel is in the form of a meandering, narrow riverbed, flow plays a dominant role, deposition activities develop strongly at the convex side, while erosion occurs strongly in the concave side (cut side); Braided channel (from Tien Xuan Isles to Quang Phu): the length of the channel is 17.06km and the width of the channel is 800-2,200m. The channel is straight, the river bed is large and the depth of the river bed is 2-11m. Sedimentation occurs mainly at the bottom of the channel and creates bar in the middle of the channel; Straight channel (from Quang Phu to Cua Gianh): the length of the channel is 9.23km and the width of the channel is 800-1,000m. The channel is straight and the depth of the river bed is 8-12.5m. In addition to the role of river flow, it is strongly influenced by marine dynamics. The erosion and accretion activities occur mainly in estuaries. The results above show trend of river development: i) Meandering channel is the most vulnerable to changes for morphology of channel by erosion and accretion of sediment and can create 1-2 horseshoe pools by the river change line; ii) Braided channel mainly changes in the bottom of channel by the formation of channel bar; iii) Straight channel mainly changes in the estuary (the mouth of the river can be moved, enlarged or narrowed).

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