Extrapulmonary Manifestations of Tuberculosis: A Radiologic Review

Transcription

1 Extrapulmonary Manifestations of Tuberculosis: A Radiologic Review Poster No.: C-1958 Congress: ECR 2014 Type: Authors: Educational Exhibit J. Isern 1, S. Llaverias Borrell 1, A. Olarte 1, E. Grive 1, A. M. Gallart Ortuño 1, V. Querol Borras 1, Z. Araujo 2, L. Milla Rallo 1, C. Pineda 1 ; 1 Barcelona/ES, 2 Caracas/VE Keywords: DOI: Tropical diseases, Education and training, Diagnostic procedure, Ultrasound, MR, CT, Musculoskeletal soft tissue, Head and neck, Abdomen /ecr2014/C-1958 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 13

2 Learning objectives Identify and describe the radiologic findings in tuberculosis affecting the central nervous, musculoskeletal, gastrointestinal, genitourinary and lymphatic systems. Background Tuberculosis can affect any organ system and can be devastating if left untreated. The increasing prevalence of tuberculosis in recent years in immunocompetent and immunocompromised patients makes this disease a topic of universal concern. Both, computed tomography (CT) and magnetic resonance (MR) imaging, are helpful to diagnose tuberculosis when it involves the central nervous or the musculoskeletal system. CT is especially useful on depicting gastrointestinal and genitourinary tuberculosis. It is important to recognize the spectrum of imaging findings in extrapulmonary tuberculosis and to know its high variability. Findings and procedure details We present our cases of extrapulmonary tuberculosis in a retrospective study of the last 2 years. Imaging studies were performed in all cases. Depending on the system involved, we used CT, MRI or ultrasound. The abdomen is the most common focus of extrapulmonary tuberculosis, with the solid viscera being affected more often than the gastrointestinal tract. Peritonitis is the most common clinical manifestation of abdominal tuberculosis (Fig. 1 on page 3). Gastrointestinal tuberculosis is rare; when present, however, it almost always involves the ileocecal region and the most common CT finding is mural thickening, which is typically concentric but if eccentric tends to involve the medial cecal wall (Fig. 2 on page 4). 1,2 Page 2 of 13

3 Lymphadenopathy is the most common manifestation of abdominal tuberculosis. The characteristic pattern is mesenteric and peripancreatic lymph node group enlargement, with multiple groups affected simultaneously (Fig. 3 on page 5). The most common location is within neck nodes, often manifesting as bilateral painless cervical lymphadenitis, also known as scrofula, with hypoattenuating centers and hyperattenuating enhancing rims at CT that are characteristic of, but not pathognomonic for, caseous necrosis (Fig. 4 on page 6). 2 CNS (Central Nervous System) tuberculosis usually results from hematogenous spread but it may also result from direct rupture or extension of a subependymal or subpial focus, and may be located in the meninges, brain, or spinal cord. CNS tuberculosis can manifest in a variety of forms, including tuberculous meningitis (Fig. 5 on page 7), tuberculomas (Fig. 6 on page 8), tuberculous abscesses, tuberculous cerebritis, miliar tuberculosis or spinal tuberculosis (Fig. 7 on page 9). 2 Tuberculous arthritis is characteristically a monoarthritis affecting large weight-bearing joints. 3 These findings include osteopenia, synovitis and other soft-tissue swelling, marginal erosions, and varying degrees of cartilage destruction. 4 Although MR imaging is more sensitive than conventional radiography in assessing the extent of bone and joint involvement, the findings are nonspecific (Fig. 8 on page 10). 2 Genitourinary Tuberculosis is the most common clinical manifestation of extrapulmonary tuberculosis. 5 Approximately 75% of renal tuberculous involvement is unilateral, the most common CT finding being renal calcification (Fig. 9 on page 11). 2 Genital male involvement is confined to the seminal vesicles or prostate gland, with occasional calcification. The testes and epididymides are rarely involved. US shows focal or diffuse areas of decreased echogenicity; however, these findings are very nonspecific. 2 Images for this section: Page 3 of 13

4 Fig. 1: Tuberculous Peritonitis Page 4 of 13

5 Fig. 2: Small bowel Gastrointestinal Tuberculosis Page 5 of 13

6 Fig. 3: Abdominal lymphadenopathy Page 6 of 13

7 Fig. 4: Tuberculous cervical lymphadenitis Page 7 of 13

8 Fig. 5: Tuberculous meningitis Page 8 of 13

9 Fig. 6: CNS Parenchymal tuberculosis Page 9 of 13

10 Fig. 7: Spinal tuberculous meningitis Page 10 of 13

11 Fig. 8: Tuberculous arthritis Page 11 of 13

12 Fig. 9: Renal Tuberculosis Page 12 of 13

13 Conclusion In Europe, over the past 20 years, there has been an increase in the prevalence of tuberculosis, particularly in immigrant populations. Imaging plays a leading role in diagnosis because the signs and symptoms of extrapulmonary tuberculosis may be nonspecific. Accurate and timely diagnosis promotes an effective treatment. Personal information References 1. Leder RA, Low VH. Tuberculosis of the abdomen. Radiol Clin North Am 1995;33: Burrill J, Williams C, Bain G, Conder G, Hine A, Misra R. Tuberculosis: A Radiologic Review, Radiographics 2007;27(5): Berney S, Goldstein M, Bishko F. Clinical and diagnostic features of tuberculous arthritis. Am J Med 1972;53(1): Haygood TM, Williamson SL. Radiographic findings of extremity tuberculosis in childhood: backto the future? RadioGraphics 1994;14(3): Engin G, Acunas B, Acunas G, Tunaci M. Imaging of extrapulmonary tuberculosis. RadioGraphics 2000;20(2): Page 13 of 13