Tuberculous Osteomyelitis and Arthritis Bra Zengin busrazengin 95hotmail

Tuberculous Osteomyelitis and Arthritis Büşra Zengin busrazengin 95@hotmail. com

• Osteomyelitis is a secondary complication in 1– 3% of patients with pulmonary tuberculosis. • Isolated tuberculous osteomyelitis is rare • Affected areas: v v v • • Femur Tibia Small Bones of hand feet Metaphyses involvement Radiological findings: metaphyseal or epiphyseal destruction without sclerosis, sequestration, periosteal reaction and joint involvement Unlike pyogenic osteomyelitis, there is sparing of the articular margins and cartilage space. Sometimes a solitary lytic lesion may be seen which can mimic neoplasia.

Cystic Tuberculosis • more commonly in children • Multiple small, well-defined oval lytic lesions that lack a sclerotic margin • Children: metaphyses of long bone involvement • Adults: axial skeleton involvement (skull, shoulder, pelvis)

Tuberculous Dactylitis • Painless involvement of the short tubular bones of the hands and feet • more common in children. • Radiographic features : pronounced fusiform soft-tissue swelling with or without periostitis • Periostitis indicates involvement of the underlying bone. • Chronic untreated infection may lead to the formation of sinus tracts. • Diff. Dx: pyogenic or fungal infections, leukemia, sarcoidosis, hemoglobinopathies, hyperparathyroidism, and syphilis.

Tuberculuos Arthritis • Monoarthritis affecting large weight-bearing joints(hip and knee) • Imaging usually non-specific. (osteopenia, synovitis and other soft-tissue swellings, marginal erosions, and varying degrees of cartilage destruction) • Synovial involvement in the young results in hyperemia and epiphyseal overgrowth in knee • The joint is generally "cold" (eg, erythema, warmth, and other signs of acute infection are usually absent). Constitutional symptoms, fever, and weight loss occur in only about 30 percent of cases • Progression of infection, bone sequestration and sinus formation can develop. The end result is usually fibrous ankylosis of the joint.

• Pyogenous or Tuberculuos Arthritis? Bone ankylosis occasionally occurs but is more commonly seen with pyogenic infections. • Factors favoring a diagnosis of tuberculosis include insidious onset, minimal sclerosis , the relative absence of periosteal reaction and bone proliferation, and relative preservation of joint space in the early stages