Limits...
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 CT of the right elbow joint. A. Axial view showing a complex joint effusion (arrowed) and soft tissue swelling adjacent to the elbow. B. Axial slice through the proximal forearm, demonstrating the joint effusion surrounding the radial head (solid arrow) and increased soft tissue density involving the medullary shaft of the ulna (dashed arrow). C. Sagittal bone targeted reconstruction, showing subtle cortical erosions (arrowed) of the proximal ulna. D. Sagittal soft tissue reconstruction, demonstrating increased soft tissue density (arrowed) of the medullary shaft of the proximal ulna.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC1131917&req=5

Figure 4: Multiplanar CT of the right elbow joint. A. Axial view showing a complex joint effusion (arrowed) and soft tissue swelling adjacent to the elbow. B. Axial slice through the proximal forearm, demonstrating the joint effusion surrounding the radial head (solid arrow) and increased soft tissue density involving the medullary shaft of the ulna (dashed arrow). C. Sagittal bone targeted reconstruction, showing subtle cortical erosions (arrowed) of the proximal ulna. D. Sagittal soft tissue reconstruction, demonstrating increased soft tissue density (arrowed) of the medullary shaft of the proximal ulna.

Mentions: CT scan confirmed the presence of cortical erosions involving the right lateral epicondyle of the humerus and the ulna. Further, there was increased attenuation within the proximal medullary shaft of the ulna, and diffuse soft tissue thickening around the proximal ulna and radial head, with an associated joint effusion (Figure 4).


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 CT of the right elbow joint. A. Axial view showing a complex joint effusion (arrowed) and soft tissue swelling adjacent to the elbow. B. Axial slice through the proximal forearm, demonstrating the joint effusion surrounding the radial head (solid arrow) and increased soft tissue density involving the medullary shaft of the ulna (dashed arrow). C. Sagittal bone targeted reconstruction, showing subtle cortical erosions (arrowed) of the proximal ulna. D. Sagittal soft tissue reconstruction, demonstrating increased soft tissue density (arrowed) of the medullary shaft of the proximal ulna.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Multiplanar CT of the right elbow joint. A. Axial view showing a complex joint effusion (arrowed) and soft tissue swelling adjacent to the elbow. B. Axial slice through the proximal forearm, demonstrating the joint effusion surrounding the radial head (solid arrow) and increased soft tissue density involving the medullary shaft of the ulna (dashed arrow). C. Sagittal bone targeted reconstruction, showing subtle cortical erosions (arrowed) of the proximal ulna. D. Sagittal soft tissue reconstruction, demonstrating increased soft tissue density (arrowed) of the medullary shaft of the proximal ulna.
Mentions: CT scan confirmed the presence of cortical erosions involving the right lateral epicondyle of the humerus and the ulna. Further, there was increased attenuation within the proximal medullary shaft of the ulna, and diffuse soft tissue thickening around the proximal ulna and radial head, with an associated joint effusion (Figure 4).

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