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Isolated cystic tuberculosis of scapula; case report and review of literature.

Tripathy SK, Sen RK, Sharma A, Tamuk T - J Orthop Surg Res (2010)

Bottom Line: The isolated involvement of this flat bone without any primary focus confuses the surgeon with other pathology and as a result there is always delay in diagnosis.MRI picture was deceptive.Lack of awareness and nonspecific radiological picture may cause delay in diagnosis of scapular tuberculosis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India. sujitortho@yahoo.co.in.

ABSTRACT
Tubercular osteomylitis of scapula is extremely rare. The isolated involvement of this flat bone without any primary focus confuses the surgeon with other pathology and as a result there is always delay in diagnosis. This article discusses about an isolated multicystic tubercular lesion of scapula which remained untreated for about two years as the primary physician biased with the history of trauma and suspected it to be a post-traumatic hematoma. MRI picture was deceptive. Finally, diagnosis was established by fine needle aspiration which showed typical epitheloid granuloma on histology. Lack of awareness and nonspecific radiological picture may cause delay in diagnosis of scapular tuberculosis. Tuberculosis is an important consideration in isolated scapular swelling particularly in endemic regions and the histological diagnosis by fine needle aspiration may be helpful in cases of doubtful radiological pictures.

No MeSH data available.


Related in: MedlinePlus

A. Initial radiograph of right scapula (at the time of presentation) showing multiple cystic lesions over the scapular body with surrounding sclerosis B. After 6 months of anti tubercular therapy, most of the cystic lesions healed. Still one cystic cavity is noticed on supero-medial aspect C. After 2 years, the cystic lesions have completely healed.
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Figure 1: A. Initial radiograph of right scapula (at the time of presentation) showing multiple cystic lesions over the scapular body with surrounding sclerosis B. After 6 months of anti tubercular therapy, most of the cystic lesions healed. Still one cystic cavity is noticed on supero-medial aspect C. After 2 years, the cystic lesions have completely healed.

Mentions: A 22 year male presented with progressively increasing pain and swelling in the right upper back since 2 years. He had history of fall from a height of about 6 feet before two years. There were no injuries other than superficial skin abrasions over the site. After which he developed the pain and swelling in the above region for which he was treated with analgesic and local anti-inflammatory medication by the local physician. The symptoms subsided to some extent but did not relieved completely. He consulted many physicians but to receive the same treatment. The patient ignored the symptoms and continued to manage his daily activities with analgesics on demand. After 20 months he had significantly diminished pain but to have a massive swelling in that region. When he presented to us, the swelling appeared to be arising from right scapula that was mild tender with minimal rise in temperature. The size of the mass was 15×10 cms with a globular shape. It was non-pulsatile with soft to firm consistency. There was no lymphadenopathy or hepato-splenomegaly. Radiograph revealed multiple cystic lesions in the right scapular body with sclerotic margin and overlying soft-tissue involvement [Fig 1A]. The glenohumeral joint did not show any evidence of involvement. Other than a raised ESR (ESR = 74 mm/hr), rest of the haematological parameters were with in normal range. MRI of the lesion was advised with clinical suspicion of malignancy. It showed altered signal in the subcutaneous plane with hyperintense T1W and T2W images. No signal alterations and enhancement were noticed on fat saturated images and post-contrast images. It was dissecting into the fibers of infraspinatus muscle on the dorsal aspect of scapula [Fig 2A, B, C]. The scapular cortex was found to be discontinuous at that level. The likely possibility of hematoma was put forward by the radiologist.


Isolated cystic tuberculosis of scapula; case report and review of literature.

Tripathy SK, Sen RK, Sharma A, Tamuk T - J Orthop Surg Res (2010)

A. Initial radiograph of right scapula (at the time of presentation) showing multiple cystic lesions over the scapular body with surrounding sclerosis B. After 6 months of anti tubercular therapy, most of the cystic lesions healed. Still one cystic cavity is noticed on supero-medial aspect C. After 2 years, the cystic lesions have completely healed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2959054&req=5

Figure 1: A. Initial radiograph of right scapula (at the time of presentation) showing multiple cystic lesions over the scapular body with surrounding sclerosis B. After 6 months of anti tubercular therapy, most of the cystic lesions healed. Still one cystic cavity is noticed on supero-medial aspect C. After 2 years, the cystic lesions have completely healed.
Mentions: A 22 year male presented with progressively increasing pain and swelling in the right upper back since 2 years. He had history of fall from a height of about 6 feet before two years. There were no injuries other than superficial skin abrasions over the site. After which he developed the pain and swelling in the above region for which he was treated with analgesic and local anti-inflammatory medication by the local physician. The symptoms subsided to some extent but did not relieved completely. He consulted many physicians but to receive the same treatment. The patient ignored the symptoms and continued to manage his daily activities with analgesics on demand. After 20 months he had significantly diminished pain but to have a massive swelling in that region. When he presented to us, the swelling appeared to be arising from right scapula that was mild tender with minimal rise in temperature. The size of the mass was 15×10 cms with a globular shape. It was non-pulsatile with soft to firm consistency. There was no lymphadenopathy or hepato-splenomegaly. Radiograph revealed multiple cystic lesions in the right scapular body with sclerotic margin and overlying soft-tissue involvement [Fig 1A]. The glenohumeral joint did not show any evidence of involvement. Other than a raised ESR (ESR = 74 mm/hr), rest of the haematological parameters were with in normal range. MRI of the lesion was advised with clinical suspicion of malignancy. It showed altered signal in the subcutaneous plane with hyperintense T1W and T2W images. No signal alterations and enhancement were noticed on fat saturated images and post-contrast images. It was dissecting into the fibers of infraspinatus muscle on the dorsal aspect of scapula [Fig 2A, B, C]. The scapular cortex was found to be discontinuous at that level. The likely possibility of hematoma was put forward by the radiologist.

Bottom Line: The isolated involvement of this flat bone without any primary focus confuses the surgeon with other pathology and as a result there is always delay in diagnosis.MRI picture was deceptive.Lack of awareness and nonspecific radiological picture may cause delay in diagnosis of scapular tuberculosis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India. sujitortho@yahoo.co.in.

ABSTRACT
Tubercular osteomylitis of scapula is extremely rare. The isolated involvement of this flat bone without any primary focus confuses the surgeon with other pathology and as a result there is always delay in diagnosis. This article discusses about an isolated multicystic tubercular lesion of scapula which remained untreated for about two years as the primary physician biased with the history of trauma and suspected it to be a post-traumatic hematoma. MRI picture was deceptive. Finally, diagnosis was established by fine needle aspiration which showed typical epitheloid granuloma on histology. Lack of awareness and nonspecific radiological picture may cause delay in diagnosis of scapular tuberculosis. Tuberculosis is an important consideration in isolated scapular swelling particularly in endemic regions and the histological diagnosis by fine needle aspiration may be helpful in cases of doubtful radiological pictures.

No MeSH data available.


Related in: MedlinePlus