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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 MR imaging of the right elbow. A. T1 weighted axial image at the level of the elbow joint, demonstrating a complex effusion (arrow), particularly adjacent to the proximal ulna. B. Contrast enhanced axial image showing enhancement around the joint (arrow). C. T2 weighted axial image again showing extensive joint effusion D. Coronal contrast enhanced image showing the complex effusion and abnormal signal intensity in the medullary canal of the proximal ulna (arrow).
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Figure 7: Multiplanar MR imaging of the right elbow. A. T1 weighted axial image at the level of the elbow joint, demonstrating a complex effusion (arrow), particularly adjacent to the proximal ulna. B. Contrast enhanced axial image showing enhancement around the joint (arrow). C. T2 weighted axial image again showing extensive joint effusion D. Coronal contrast enhanced image showing the complex effusion and abnormal signal intensity in the medullary canal of the proximal ulna (arrow).

Mentions: MR demonstrated erosive changes involving the lateral epicondyle, a loculated joint effusion and thickening and enhancement of the joint capsule and the annular ligament of the superior radio-ulnar joint. These changes suggested either a neoplasm or possibly infection (Figure 7).


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 MR imaging of the right elbow. A. T1 weighted axial image at the level of the elbow joint, demonstrating a complex effusion (arrow), particularly adjacent to the proximal ulna. B. Contrast enhanced axial image showing enhancement around the joint (arrow). C. T2 weighted axial image again showing extensive joint effusion D. Coronal contrast enhanced image showing the complex effusion and abnormal signal intensity in the medullary canal of the proximal ulna (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 7: Multiplanar MR imaging of the right elbow. A. T1 weighted axial image at the level of the elbow joint, demonstrating a complex effusion (arrow), particularly adjacent to the proximal ulna. B. Contrast enhanced axial image showing enhancement around the joint (arrow). C. T2 weighted axial image again showing extensive joint effusion D. Coronal contrast enhanced image showing the complex effusion and abnormal signal intensity in the medullary canal of the proximal ulna (arrow).
Mentions: MR demonstrated erosive changes involving the lateral epicondyle, a loculated joint effusion and thickening and enhancement of the joint capsule and the annular ligament of the superior radio-ulnar joint. These changes suggested either a neoplasm or possibly infection (Figure 7).

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