Imaging features of pediatric musculoskeletal tuberculosis

Abstract

Tuberculosis (TB) is widely prevalent in developing nations and has recently made a comeback in industrialized countries, with the rise in immunocompromized patients. Musculoskeletal TB in children presents a diagnostic challenge because it is difficult to recognize in the early stages of the disease, and imaging features mimic other entities. The clinical onset is insidious, with an indolent course and a resultant late presentation. It leads to significant morbidity; a delay in diagnosis can cause potentially serious neurological complications and bone and joint destruction. Conventional radiographs are the initial imaging modality and US, CT and MRI are used in conjunction to better delineate the disease extent and morphology. Radiologists should be familiar with the spectrum of imaging features of TB, including plain radiographs and MRI, and aid the clinician in making an early diagnosis. Aspiration or biopsy with examination for acid-fast bacillus and histological evaluation is required to confirm the diagnosis.

Pyogenic and tuberculous discitis: magnetic resonance imaging findings for differential diagnosis

“…Magnetic resonance imaging (MRI) is the method of choice because of its high sensitivity and specificity (14) , as well as good tissue resolution and multiplanar capacity (15) . Also, MRI can be useful to suggest the origin of the infection -although this is not always possible -, aiding in the differentiation between tuberculous and pyogenic infections, thus allowing efficacy in the treatment of the patient (16) .…”

Polyarticular pain and swelling

“…neuroblastoma) [4,8,10,14]. Monoarticular involvement, insidious onset and chronicity favor a diagnosis of TB over pyogenic arthritis [4,8]. Radiographic changes due to fungal disease are closely similar to chronic pyogenic osteomyelitis or tuberculosis, also manifesting with lytic bone destruction, periosteal reaction, cortical thickening and sclerosis [13].…”

“…Phemister triad, consisting of periarticular osteoporosis, peripherally located osseous erosions, and gradual diminution of the joint space [3,5,13], although suggestive of TB arthritis [3,5,8], is nonspecific and may also be seen in cases of rheumatoid and fungal arthritis [3,12]. If left untreated, TB arthritis may lead to complete joint destruction and obliteration with fibrous ankylosis of the joint [3].…”

“…Although tuberculous spondylitis with involvement of the upper lumbar and lower thoracic vertebrae is the most common osseous manifestation of TB [3], peripheral joint manifestations including osteomyelitis, dactylitis and arthritis may be seen in immunocompromised patients [3,4,6], those who live in endemic countries [6], and in the pediatric population [3,4,7,8].…”

“…neuroblastoma) [4,8,10,14]. Monoarticular involvement, insidious onset and chronicity favor a diagnosis of TB over pyogenic arthritis [4,8].…”