Multifocal skeletal tuberculosis

Common Disease with Uncommon Presentation: Multifocal Tuberculosis

“…However, the extra-spinal lesions were all limited to ribs and no other lesions in the appendicular skeleton were noted on isotope scans. Multicentric presentations mimic malignancy and need to be differentiated carefully [3,11,12]. Bruce et al reported a patient who was diagnosed with multicentric skeletal tuberculosis during a repeat admission to the hospital more than three years following earlier diagnosis and chemotherapy of unifocal tuberculosis in the lumbar spine [13].…”

“…Multicentric spinal tuberculosis may present with atypical radiographic features such as sparing of the intervertebral disc and destruction of pedicles that are usual in malignant lesions [11]. Isotope bone scan is a useful investigative modality when multi-centric tuberculosis is suspected since it draws attention to all possible areas of involvement [7,12,13,14]. MR imaging has been used extensively in the last decade [1,6,9,11] and whole body MR imaging may be advisable in patients with multicentric lesions in the spine.…”

Radionuclides in Pulmonary and Extra-Pulmonary Tuberculosis

“…Radioisotope imaging is usually more sensitive than plain radiography in the detection of bone and joint tuberculosis (Dickinson et al 1996), as an uncertain time interval can exist between the onset ofthe clinical presentation and the radiological diagnosis (Everaert et al 1997). There is a possibility of false negative results however and, if there is a strong clinical suspicion of skeletal tuberculosis, further investigations should be performed even if the nuclear medicine studies are normal (Pui et al 1986).…”

“…There is a possibility of false negative results however and, if there is a strong clinical suspicion of skeletal tuberculosis, further investigations should be performed even if the nuclear medicine studies are normal (Pui et al 1986). Nuclear medicine techniques may be more useful when the diagnosis has been made and when an assessment of the extent of involvement is required, particularly to detect asymptomatic lesions (Dickinson et al 1996), many of which are unsuspected clinically (Rust et aI.1981). A whole body survey in a patient with extra-pulmonary tuberculosis is important because multiple lesions are not uncommon.…”

“…The present mainstay of investigation is the polyphosphonate scan, which was introduced in the early 1970s (Fanning et al 1974). Bone scintigraphy is an excellent test for detecting disseminated D. Hamilton and J. AI-Nabulsi tuberculosis of the skeleton (Boumpas et al 1987;Lin et al 1998;Dickinson et al 1996), both in making the diagnosis and in localizing further areas of increased uptake (Dickinson et al 1996). It can be used as a relatively inexpensive investigation to decide which patients are likely to benefit from MRI, particularly at the stage when X-rays are normal (Desai 1994).…”