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Tuberculosis masquerading as malignancy: a multimodality approach to the correct diagnosis - a case report.

Amukotuwa S, Choong PF, Smith PJ, Powell GJ, Slavin J, Schlicht SM - Int Semin Surg Oncol (2005)

Bottom Line: As a result, patients may be referred to oncologists and surgeons for further evaluation and management, delaying the institution of appropriate anti-tuberculous drug therapy.Further investigation revealed extensive retroperitoneal abdominal and pelvic lymphadenopathy.The recognition of certain patterns on imaging, and finally the isolation of Mycobacterium tuberculosis from tissue samples obtained under image guidance, enabled the correct diagnosis to be made.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medical Imaging, St, Vincent's Hospital, Fitzroy 3065, Melbourne, Australia. shalini.AMUKOTUWA@svhm.org.au.

ABSTRACT
BACKGROUND: Extrapulmonary tuberculosis is one of the great mimickers of medicine, and often masquerades as malignancy. As a result, patients may be referred to oncologists and surgeons for further evaluation and management, delaying the institution of appropriate anti-tuberculous drug therapy. CASE PRESENTATION: We present the case of a 21 year old man with tuberculous osteomyelitis, who was referred to the Bone and Soft Tissue Sarcoma Service at our institution with a provisional diagnosis of malignancy. Further investigation revealed extensive retroperitoneal abdominal and pelvic lymphadenopathy. The recognition of certain patterns on imaging, and finally the isolation of Mycobacterium tuberculosis from tissue samples obtained under image guidance, enabled the correct diagnosis to be made. CONCLUSION: This case highlights the importance of remaining cognisant of the protean manifestations of extrapulmonary tuberculosis, and illustrates the advantage of a clinically directed multi-modality imaging approach to diagnosis.

No MeSH data available.


Related in: MedlinePlus

Multiplanar abdominal and pelvic CT, demonstrating extensive lymphadenopathy. A. Large low attenuation portal lymph node (solid arrow) showing peripheral enhancement, and associated para-aortic nodes (dashed arrows). B. Extensive heterogenous attenuation side wall pelvic adenopathy. C. Coronal image, demonstrating extensive low attenuation para-aortic and pelvic lymphadenopathy (arrowed)
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Figure 10: Multiplanar abdominal and pelvic CT, demonstrating extensive lymphadenopathy. A. Large low attenuation portal lymph node (solid arrow) showing peripheral enhancement, and associated para-aortic nodes (dashed arrows). B. Extensive heterogenous attenuation side wall pelvic adenopathy. C. Coronal image, demonstrating extensive low attenuation para-aortic and pelvic lymphadenopathy (arrowed)

Mentions: CT scanning of the chest, abdomen and pelvis, performed in light of the thallium findings, revealed extensive retroperitoneal lymphadenopathy. The lymphadenopathy was characterised by peripheral enhancement with prominent central areas of low attenuation (Figures 9 and 10).


Tuberculosis masquerading as malignancy: a multimodality approach to the correct diagnosis - a case report.

Amukotuwa S, Choong PF, Smith PJ, Powell GJ, Slavin J, Schlicht SM - Int Semin Surg Oncol (2005)

Multiplanar abdominal and pelvic CT, demonstrating extensive lymphadenopathy. A. Large low attenuation portal lymph node (solid arrow) showing peripheral enhancement, and associated para-aortic nodes (dashed arrows). B. Extensive heterogenous attenuation side wall pelvic adenopathy. C. Coronal image, demonstrating extensive low attenuation para-aortic and pelvic lymphadenopathy (arrowed)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1131917&req=5

Figure 10: Multiplanar abdominal and pelvic CT, demonstrating extensive lymphadenopathy. A. Large low attenuation portal lymph node (solid arrow) showing peripheral enhancement, and associated para-aortic nodes (dashed arrows). B. Extensive heterogenous attenuation side wall pelvic adenopathy. C. Coronal image, demonstrating extensive low attenuation para-aortic and pelvic lymphadenopathy (arrowed)
Mentions: CT scanning of the chest, abdomen and pelvis, performed in light of the thallium findings, revealed extensive retroperitoneal lymphadenopathy. The lymphadenopathy was characterised by peripheral enhancement with prominent central areas of low attenuation (Figures 9 and 10).

Bottom Line: As a result, patients may be referred to oncologists and surgeons for further evaluation and management, delaying the institution of appropriate anti-tuberculous drug therapy.Further investigation revealed extensive retroperitoneal abdominal and pelvic lymphadenopathy.The recognition of certain patterns on imaging, and finally the isolation of Mycobacterium tuberculosis from tissue samples obtained under image guidance, enabled the correct diagnosis to be made.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medical Imaging, St, Vincent's Hospital, Fitzroy 3065, Melbourne, Australia. shalini.AMUKOTUWA@svhm.org.au.

ABSTRACT
BACKGROUND: Extrapulmonary tuberculosis is one of the great mimickers of medicine, and often masquerades as malignancy. As a result, patients may be referred to oncologists and surgeons for further evaluation and management, delaying the institution of appropriate anti-tuberculous drug therapy. CASE PRESENTATION: We present the case of a 21 year old man with tuberculous osteomyelitis, who was referred to the Bone and Soft Tissue Sarcoma Service at our institution with a provisional diagnosis of malignancy. Further investigation revealed extensive retroperitoneal abdominal and pelvic lymphadenopathy. The recognition of certain patterns on imaging, and finally the isolation of Mycobacterium tuberculosis from tissue samples obtained under image guidance, enabled the correct diagnosis to be made. CONCLUSION: This case highlights the importance of remaining cognisant of the protean manifestations of extrapulmonary tuberculosis, and illustrates the advantage of a clinically directed multi-modality imaging approach to diagnosis.

No MeSH data available.


Related in: MedlinePlus