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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

Functional metabolic imaging, using Thallium 201 chloride. Delayed whole body images, demonstrating abnormal tracer retention involving the mediastinum. (solid arrow), para-aortic region and left inguinal area (dashed arrow).
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Figure 6: Functional metabolic imaging, using Thallium 201 chloride. Delayed whole body images, demonstrating abnormal tracer retention involving the mediastinum. (solid arrow), para-aortic region and left inguinal area (dashed arrow).

Mentions: Further functional imaging with Thallium 201 chloride revealed intense early uptake in the right lateral epicondyle of the humerus and proximal ulna (Figure 5A). The delayed 4 hour images demonstrated tracer retention (Figure 5B). The delayed whole body views showed further abnormal thallium retention involving the mediastinum, para-aortic regions of the abdomen, the left inguinal region and the distal left radius (Figure 6).


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)

Functional metabolic imaging, using Thallium 201 chloride. Delayed whole body images, demonstrating abnormal tracer retention involving the mediastinum. (solid arrow), para-aortic region and left inguinal area (dashed arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Functional metabolic imaging, using Thallium 201 chloride. Delayed whole body images, demonstrating abnormal tracer retention involving the mediastinum. (solid arrow), para-aortic region and left inguinal area (dashed arrow).
Mentions: Further functional imaging with Thallium 201 chloride revealed intense early uptake in the right lateral epicondyle of the humerus and proximal ulna (Figure 5A). The delayed 4 hour images demonstrated tracer retention (Figure 5B). The delayed whole body views showed further abnormal thallium retention involving the mediastinum, para-aortic regions of the abdomen, the left inguinal region and the distal left radius (Figure 6).

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