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Benramdane H, Nasri S, Kamaoui I, Skiker I. Sternal tuberculosis: A rare manifestation of extrapulmonary disease. Radiol Case Rep 2025; 20:15-17. [PMID: 39429715 PMCID: PMC11488405 DOI: 10.1016/j.radcr.2024.09.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 09/19/2024] [Accepted: 09/21/2024] [Indexed: 10/22/2024] Open
Abstract
Sternal tuberculosis is a rare and challenging diagnosis. We present a case of a 63-year-old woman who presented with a progressively enlarging anterior chest wall mass and nonspecific symptoms. Imaging studies revealed a destructive sternal lesion. A biopsy confirmed the tuberculosis diagnosis. The patient responded well to anti-tuberculosis treatment. This case highlights the importance of considering tuberculosis when making a differential diagnosis of sternal masses and emphasizes the need for early diagnosis and treatment.
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Affiliation(s)
- Hicham Benramdane
- Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
- Department of Radiology, Mohammed VI University Hospital, Mohammed I University, Oujda, Morocco
| | - Siham Nasri
- Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
- Department of Radiology, Mohammed VI University Hospital, Mohammed I University, Oujda, Morocco
| | - Imane Kamaoui
- Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
- Department of Radiology, Mohammed VI University Hospital, Mohammed I University, Oujda, Morocco
| | - Imane Skiker
- Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
- Department of Radiology, Mohammed VI University Hospital, Mohammed I University, Oujda, Morocco
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2
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Grover DSB, Rai DV, Grover DH, Kumar DD, Kundra DR, Gautam DV, Devra DAG. Imaging diagnosis of sternal tuberculosis- A report of two cases of the ancient disease with a new demeanour. Radiol Case Rep 2021; 16:3125-3133. [PMID: 34457101 PMCID: PMC8377555 DOI: 10.1016/j.radcr.2021.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/18/2021] [Accepted: 07/18/2021] [Indexed: 02/05/2023] Open
Abstract
Tuberculosis is an ancient disease known to have existed even in the Egyptian civilization. It is estimated that a quarter of the world's population is already infected and 1 million will die of the disease, in the current year. Although tuberculosis may occur in any organ, extra- pulmonary tuberculosis accounts for 10%-14% of all cases of tuberculosis. Skeletal involvement comprises only 1 to 5 % of all types of tuberculosis and the most frequently involved site in the skeleton is the vertebral column, amongst the skeletal structures, the sternum is involved very rarely, accounting for just 1-2% of all bone and joint tuberculosis. We report two cases of sternal tuberculosis,and enumerate the imaging appearances seen at ultrasound, CT and MRI and also highlight a relatively underemphasised complication of mediastinal involvement due to a retrosternal abscess. Rapid diagnosis by imaging studies led to early treatment and prevented catastrophic consequences of diffuse mediastinitis. Awareness of tuberculosis and its atypical skeletal manifestations is important not only in developing countries with endemic disease, but also in developed countries, due to its resurgence by the HIV epidemic and also because extensive international travel and transcontinental migration continues to facilitate greater disease transmission.
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Affiliation(s)
- Dr Shabnam Bhandari Grover
- Department of Radiology and Imaging, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306, Uttar Pradesh, India
| | - Dr Vikrant Rai
- Department of Radiology and Imaging, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306, Uttar Pradesh, India
| | - Dr Hemal Grover
- Department of Radiology & Imaging, Ichan School of Medicine at Mount Sinai West, New York
| | - Dr Dev Kumar
- Department of Radiology and Imaging, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306, Uttar Pradesh, India
| | - Dr Rohit Kundra
- Department of Radiology and Imaging, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306, Uttar Pradesh, India
| | - Dr V.K. Gautam
- Department of Orthopedic Surgery, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306, Uttar Pradesh, India
| | - Dr Anshu Gupta Devra
- Department of Pathology, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306, Uttar Pradesh, India
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3
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Swarup MS, Bhatt S, Rawal R, Tandon A, Dangwal S. Tuberculosis, a great masquerader: A case series unveiling rare sites of musculoskeletal involvement through imaging. SA J Radiol 2020; 24:1919. [PMID: 33101726 PMCID: PMC7564854 DOI: 10.4102/sajr.v24i1.1919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/06/2020] [Indexed: 12/16/2022] Open
Abstract
Skeletal tubercular infections that do not involve the spine or large joints are rarely encountered. This case series aims to highlight the importance of imaging in diagnosing skeletal tuberculosis (TB) at uncommon sites in clinically unsuspected patients by demonstrating specific imaging findings. We present the clinical details and imaging findings of seven pathologically confirmed cases of extraspinal skeletal TB. A multimodality imaging approach including radiography, ultrasonography (USG) and computed tomography (CT) scan was used in most cases. The imaging studies revealed an infective soft tissue collection over different sites including the sternoclavicular joint, acromion process, chest wall and temporo-mandibular joint, along with destruction and erosion of the underlying or adjacent bones. In tubercular endemic countries, strong clinical suspicion should be entertained in cases presenting with a soft tissue collection, even around unusual skeletal sites.
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Affiliation(s)
- M Sarthak Swarup
- Department of Radiology, University College of Medical Sciences and GTB hospital, Delhi, India
| | - Shuchi Bhatt
- Department of Radiology, University College of Medical Sciences and GTB hospital, Delhi, India
| | - Rajesh Rawal
- Department of Radiology, University College of Medical Sciences and GTB hospital, Delhi, India
| | - Anupama Tandon
- Department of Radiology, University College of Medical Sciences and GTB hospital, Delhi, India
| | - Saumya Dangwal
- Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
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Toyne JM, Esplin N, Buikstra JE. Examining variation in skeletal tuberculosis in a late pre-contact population from the eastern mountains of Peru. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2020; 30:22-34. [PMID: 32416540 DOI: 10.1016/j.ijpp.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 03/31/2020] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE AND MATERIALS This research evaluates the presence and chronology of tuberculosis (TB) in the northeastern highlands of Peru (CE 800-1535) through the analysis of osseous lesions from Pre-Contact Kuelap, Chachapoyas. METHODS We examined macroscopic lesion morphology and distribution from the skeletal series (MNI = 207). RESULTS We determined that skeletal evidence was highly consistent with advanced multifocal and spinal tuberculosis in 13 individuals. Destructive lesions of the lower thoracic and/or lumbar vertebra bodies and sacroiliac joints are evident in most cases, but we also observed lesions within the manubriosternal, hip, and knee joints. Both adult males (n = 7) and females (n = 6) present skeletal lesions from young adult to older adults, but there is only one late adolescent. Only three individuals demonstrate similar lesion distributions. CONCLUSIONS Variation in lesion distribution in this population-based study shows the importance of identifying extra-vertebral tuberculosis and suggests that the disease may have manifested differently than at other coastal sites. These cases confirm the presence of tuberculosis both before and after Inca occupation across this central Andean highlands region. SIGNIFICANCE This evidence for the likely endemic presence of TB in the New World prior to European Contact furthers our understanding of the distribution of this infectious disease across the region as well as elucidating lesion distribution. LIMITATIONS The diagnosis of tuberculosis is based on skeletal lesions and it should be confirmed by molecular analysis. FUTURE RESEARCH Additional examination of vertebral bodies (including juvenile remains) for evidence of earlier manifestations of infection.
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Affiliation(s)
- J Marla Toyne
- Department of Anthropology, University of Central Florida, Orlando, FL 32803-1361, United States.
| | - Nathan Esplin
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Jane E Buikstra
- School of Human Evolution and Social Change, Arizona State University, Phoenix metropolitan area, AZ, United States
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5
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Lesión lítica esternal por tuberculosis. Arch Bronconeumol 2020; 56:260-261. [DOI: 10.1016/j.arbres.2019.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022]
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Bains L, Lal P, Chand T, Gautam KK, Beg MY, Kumar P. Isolated primary cold abscess of the sternum: a case report. J Med Case Rep 2019; 13:267. [PMID: 31445516 PMCID: PMC6708553 DOI: 10.1186/s13256-019-2210-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/30/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Musculoskeletal tuberculosis forms 10-25% of extrapulmonary tuberculosis which mainly involves the spine or weight-bearing joints. Tuberculous involvement of the sternum is a rare clinical entity even in countries where tuberculosis has high prevalence. Primary tuberculous sternal osteomyelitis accounts for approximately 0.3% of all types of tubercular osteomyelitis and the probable source appears to be extension from paratracheal or hilar lymph nodes. Despite tuberculosis being a common disease in endemic countries and worldwide, a thorough literature search of the PubMed database for keywords "primary tuberculosis of sternum" and "primary tuberculous osteomyelitis of sternum" yielded 30 and 22 articles, respectively. CASE PRESENTATION We present an unusual case of a large dumb-bell-shaped cold abscess arising due to infection of the sternum. A 23-year-old immunocompetent Asian woman presented with a gradually progressing painless swelling on anterior chest wall for the last 5 months. She had a large visible swelling on anterior chest wall which was 12.5 cm in diameter, soft, non-tender, temperature was not raised, and fluctuant. Magnetic resonance imaging showed a large dumb-bell-shaped hyperintense collection in upper anterior chest wall with marrow edema and cortical irregularity in left side of manubrium. Pus was positive for nucleic acid testing (cartridge-based nucleic acid amplification test) for Mycobacterium tuberculosis and later culture was also positive. She was started on anti-tubercular therapy and aspirated twice. Currently, she has completed 6 months of therapy and the swelling has now disappeared. DISCUSSION Swelling, pain localized to sternum, or ulceration of the skin with discharging sinus along with or without constitutional symptoms are the usual presentation. A high element of suspicion is needed for early diagnosis and treatment to prevent its complications. Sternal mycobacterial infections are categorized as primary, secondary, and/or acquired postoperatively. Although radiological investigations aid in diagnosis, the diagnosis is established by positive culture or histopathological examination. Anti-tubercular therapy is the mainstay of treatment with standard four-drug regimen for 6-9 months. Surgical drainage of the abscess should be considered only if it does not resolve by aspiration and anti-tubercular therapy.
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Affiliation(s)
- Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Pawan Lal
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Tirlok Chand
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | | | - Mohd Yasir Beg
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Pritesh Kumar
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
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7
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Boruah DK, Sanyal S, Sharma BK, Prakash A, Dhingani DD, Bora K. Role of Cross Sectional Imaging in Isolated Chest Wall Tuberculosis. J Clin Diagn Res 2017; 11:TC01-TC06. [PMID: 28274020 DOI: 10.7860/jcdr/2017/23522.9185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/08/2016] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Isolated chest wall tuberculosis though a rare entity, the incidence of it has been on rise among immunocompromised population making it an important challenging diagnosis for the physicians. Its clinical presentation may resemble pyogenic chest wall abscess or chest wall soft tissue tumour. Sometimes it is difficult to detect clinically or on plain radiograph. AIM The present study was conducted with an aim to evaluate the common sites and varying appearances of isolated chest wall tuberculosis. MATERIALS AND METHODS A hospital based cross-sectional retrospective study was conducted in Assam Medical College and Hospital, a tertiary care centre in North East India. The study group comprise of 21 patients (n=15 male and n=6 females) with isolated chest wall tuberculosis without associated pulmonary or spinal involvement who were subjected to Computed Tomography/Magnetic Resonance Imaging (CT/MRI) of the thorax following initial Ultrasonogram (USG) evaluation of the local site. Pathological correlation was done from imaging guided sampling of the aspirate or surgery. RESULTS Variable sites of involvement were seen in the chest wall in our patients (n=21), with chest wall abscess formation being the most common presentation and rib being the most common bony site affected in the thoracic cage. Bony sclerosis was noted in 11 patients (52.4%), periosteal reaction in 10 patients (47.6%) and sequestration in five patients (23.8%). CT/MRI not only localized the exact site and extent of the abscesses which facilitated guided aspirations, but also helped in detecting typical bony lesions thereby, differentiating from pyogenic osteomyelitis besides ruling out associated pulmonary or pleural involvement in such patients. CONCLUSION Cross-sectional imaging plays an important role by giving a wholesome picture of both soft tissue and bony pathology. It is important to have adequate understanding of the radiologic manifestations of the chest wall involvement and complications of tuberculosis to facilitate diagnosis and in assessing response to treatment on follow up in patients.
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Affiliation(s)
- Deb Kumar Boruah
- Assistant Professor, Department of Radiodiagnosis, Assam Medical College , Dibrugarh, Assam, India
| | - Shantiranjan Sanyal
- Consultant Radiologist, Department of Radiology, Airedale General Hospital , Keighley, West Yorkshire, United Kingdom
| | - Barun K Sharma
- Associate Professor, Department of Radiology, Sikkim Manipal Institute of Medical Sciences , Gangtok, Sikkim, India
| | - Arjun Prakash
- Postgraduate Student, Department of Radiodiagnosis, Assam Medical College , Dibrugarh, Assam, India
| | - Dhabal D Dhingani
- Postgraduate Student, Department of Radiodiagnosis, Assam Medical College , Dibrugarh, Assam, India
| | - Karobi Bora
- Postgraduate Student, Department of Radiodiagnosis, Assam Medical College , Dibrugarh, Assam, India
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8
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Mencarini J, Veloci S, Simonetti MT, Carocci A, Meli M, Tortoli E, Rossolini GM, Bartoloni A, Bartalesi F. Two cases of sternal osteomyelitis due to Mycobacterium africanum: a casual or causal association. Int J Mycobacteriol 2016; 5:354-356. [PMID: 27847025 DOI: 10.1016/j.ijmyco.2016.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/23/2016] [Indexed: 11/29/2022] Open
Abstract
The sternal localization of bone and joint tuberculosis (TB) is rare, has an insidious clinical presentation, and usually affects young adults living in endemic areas. Mycobacterium africanum causes a relevant proportion of human TB in West Africa and in migrants from endemic countries. Here, we report two cases of sternal osteomyelitis due to M. africanum in migrants.
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Affiliation(s)
- Jessica Mencarini
- Infectious Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sara Veloci
- Infectious Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Tullia Simonetti
- Tuscany Regional Reference Centre for Mycobacteria, Microbiology and Virology Unit, Careggi Hospital, Florence, Italy
| | - Antonio Carocci
- Infectious and Tropical Diseases Unit, Careggi Hospital, Florence, Italy
| | - Massimo Meli
- Infectious and Tropical Diseases Unit, Careggi Hospital, Florence, Italy
| | - Enrico Tortoli
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gian Maria Rossolini
- Tuscany Regional Reference Centre for Mycobacteria, Microbiology and Virology Unit, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Alessandro Bartoloni
- Infectious Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Infectious and Tropical Diseases Unit, Careggi Hospital, Florence, Italy
| | - Filippo Bartalesi
- Infectious and Tropical Diseases Unit, Careggi Hospital, Florence, Italy.
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9
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Abstract
Sternal mycobacterial infections are rare. Due to the rarity, its clinical characteristics, diagnoses, and regular management strategies are still scanty. A total of 76 articles on this topic were obtained by a comprehensive literature collection. The clinical features, diagnosis, management strategies and prognosis were carefully analyzed. There were totally 159 patients including 152 (95%) cases of tuberculosis (TB) and seven (5%) cases of non-TB sternal infections. Sternal mycobacterial infections can be categorized into three types: Primary, secondary, and postoperative, according to the pathogenesis; and categorized into isolated, peristernal, and multifocal, according to the extent of the lesions. Microbiological investigation is more sensitive than medical imaging and Mantoux tuberculin skin test in the diagnosis of sternal infections. Most patients show good responses to the standard four-drug regimen and a surgical intervention was necessary in 28.3% patients. The prognoses of the patients are good with a very low mortality. A delayed diagnosis of sternal mycobacterial infections may bring about recurrent sternal infections and sustained incurability. An early diagnosis and prompt antibiotic regimens may significantly improve the patients' outcomes.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, People's Republic of China
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10
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Dunphy L, Shetty P, Kavidasan A, Rice A. Unusual cause of chest pain: empyema necessitans and tubercular osteomyelitis of the rib in an immunocompetent man. BMJ Case Rep 2016; 2016:bcr-2015-212311. [PMID: 26729824 DOI: 10.1136/bcr-2015-212311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 33-year-old man, born in India but resident in the UK for 5 years, presented to the emergency department with a 4-week history of a dry cough and right-sided pleuritic chest pain. He reported systemic features, including fever and unintentional weight loss. His medical history included vitamin D deficiency. He had travelled to India 10 months previously and denied any exposure to tuberculosis (TB). He was an ex-smoker with a 20 pack history. Respiratory examination confirmed decreased air entry of the right lower lobe and stony dullness on percussion. His C reactive protein was 178 mg/L. A chest radiograph identified a moderate-sized right-sided pleural effusion and destruction of the lateral aspect of the right fifth rib, strongly suggestive of underlying malignancy. Further investigation with a CT of the thorax identified a focal lytic lesion in the right fifth rib, at its lateral aspect, with expansion of the rib observed. Ultrasound-guided pleural aspiration confirmed an exudative pleural effusion. Gram stain revealed no organisms or polymorphs. Four days post admission, the patient was transferred to the regional thoracic surgery unit and underwent video-assisted thoracic surgery, bronchoscopy and drainage of his empyema. His Mantoux tuberculin skin test and his TB Elispot were negative, suggesting that TB infection was unlikely. Culture confirmed no growth after 48 h incubation. Histology of his pleural biopsy identified multiple non-confluent necrotising granulomatous inflammation with very occasional acid-alcohol-fast bacilli-like organisms, highly suspicious for mycobacterial infection. The isolate, Mycobacterium tuberculosis, was identified by Accuprobe and HAIN tests, respectively. MPT64 erythrocyte sedimentation rate (ESR) results from the fifth rib were positive for M. tuberculosis. This case report discusses the aetiology, clinical presentation and pathophysiology of both empyema necessitans and tubercular osteomyelitis of the rib.
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Affiliation(s)
- Louise Dunphy
- Department of Respiratory Medicine, Milton Keynes University Hospital, Buckinghamshire, Milton Keynes, UK
| | - Prashanth Shetty
- Department of Respiratory Medicine, Milton Keynes University Hospital, Buckinghamshire, Milton Keynes, UK
| | - Ajitkumar Kavidasan
- Department of Respiratory Medicine, Milton Keynes University Hospital, Buckinghamshire, Milton Keynes, UK
| | - Alexandra Rice
- Department of Thoracic and Transplant Pathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Dave K, Gandhi B, Kalthoonical V. Uncommon presentation of tuberculosis in a renal allograft recipient. INDIAN JOURNAL OF TRANSPLANTATION 2015. [DOI: 10.1016/j.ijt.2015.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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12
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Gorospe L, Ayala-Carbonero AM, Rodríguez-Díaz R, García Latorre R, Muñoz-Molina GM, Cabañero-Sánchez A. Tuberculosis of the manubriosternal joint and concurrent asymptomatic active pulmonary tuberculosis in a patient presenting with a chest wall mass. Clin Imaging 2015; 39:311-4. [DOI: 10.1016/j.clinimag.2014.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 08/17/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
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13
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Patel P, Gray RR. Tuberculous osteomyelitis/arthritis of the first costo-clavicular joint and sternum. World J Radiol 2014; 6:928-931. [PMID: 25550999 PMCID: PMC4278155 DOI: 10.4329/wjr.v6.i12.928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/01/2014] [Accepted: 11/10/2014] [Indexed: 02/06/2023] Open
Abstract
A young Somali immigrant presents with a two-year history of a large, firm, painful right anterolateral chest wall sternal mass. The patient denied any history of trauma or infection at the site and did not have a fever, erythematous lesion at the site, clubbing, or lymphadenopathy. A lateral chest radiograph demonstrated a low density mass isolated to the subcutaneous soft tissue overlying the sternum, ribs and clavicle. Computed tomography (CT) with contrast demonstrated a cystic lesion in the right anterolateral chest wall deep to the pectoralis muscle. Enhanced CT of the chest demonstrated sclerosis and destruction of the rib and costochondral joint and manubrio-sternal joint narrowing. Ultrasound-guided biopsy and aspiration returned 500 cc of purulent, cloudy yellow, foul-smelling fluid. Acid-fact bacilli stain and the nucleic acid amplification test identified and confirmed Mycobacterium tuberculosis. A diagnosis of tuberculous osteomyelitis/septic arthritis was made and antibiotic coverage for tuberculosis was initiated.
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14
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Canella C, Zanetti G, Marchiori E. Sternal tuberculosis: the role of imaging. Arch Bronconeumol 2014; 51:100-101. [PMID: 25301413 DOI: 10.1016/j.arbres.2014.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 07/05/2014] [Accepted: 07/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Clarissa Canella
- Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Gláucia Zanetti
- Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Edson Marchiori
- Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil.
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15
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Cherif E, Ben Hassine L, Boukhris I, Khalfallah N. Sternal tuberculosis in an immunocompetent adult. BMJ Case Rep 2013; 2013:bcr2013008810. [PMID: 23580679 PMCID: PMC3645650 DOI: 10.1136/bcr-2013-008810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Skeletal tuberculosis accounts for 1-3% of patients with mycobacterial infection. Any bone can be a site for tuberculosis, but sternum involvement is quite rare. We report the case of a 37-year-old woman admitted because of chest pain and increased swelling over the anterior chest. She was immunocompetent and had no systemic features. She was diagnosed with tuberculosis of the sternum without active pulmonary disease. Conservative management with oral multidrug antituberculous therapy completely cured the patient.
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Affiliation(s)
- Eya Cherif
- Department of Internal Medicine, Charles Nicolle's Hospital, Tunis, Tunisia.
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16
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Chermiti Ben Abdallah F, Boudaya MS, Chtourou A, Taktak S, Mahouachi R, Ayadi A, Ben Kheder A. [Sternal tuberculosis causing spontaneous fracture of the sternum]. REVUE DE PNEUMOLOGIE CLINIQUE 2013; 69:89-92. [PMID: 23474101 DOI: 10.1016/j.pneumo.2013.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 01/04/2013] [Accepted: 01/21/2013] [Indexed: 06/01/2023]
Abstract
Sternal tuberculosis is an uncommon condition. Few cases have been reported. We report the case of a 74-year-old man, presented with a swelling and pain of the anterior chest wall associated to worsening of general state. All routine investigations were normal. Chest radiograph in lateral view showed sternal and chest wall hypertrophy with spontaneous fracture of the sternum. Computed tomography (CT) scan demonstrated ring-enhancing hypodense soft tissue mass surrounding the sternum with sternal fracture. Tuberculosis diagnosis was confirmed by histological study of the mass biopsy. We noted clinical and radiological recovery with medical tuberculosis treatment.
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17
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Marchiori E, Dalston M, Zanetti G, Hochhegger B. Paracoccidioidomycosis: Another cause of sternal osteomyelitis. Joint Bone Spine 2012; 79:323-4. [DOI: 10.1016/j.jbspin.2011.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 01/05/2011] [Indexed: 11/25/2022]
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18
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Singh S, Nagaraj C, Khare GN, Kumaraswamy V. Multicentric tuberculosis at two rare sites in an immunocompetent adult. J Orthop Traumatol 2011; 12:223-5. [PMID: 22006175 PMCID: PMC3225630 DOI: 10.1007/s10195-011-0157-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 08/27/2011] [Indexed: 11/25/2022] Open
Abstract
The case of a 20-year-old female who presented with refractory coccydynia and sternal pain is described. She was immunocompetent, and had no systemic features. She was diagnosed with tuberculosis of the sternal and coccygeal regions based on magnetic resonance imaging and histopathology of biopsy specimens. Conservative management with oral multidrug antituberculous therapy completely cured the patient, and she had not suffered any recurrence after three years of follow-up. This case highlights the possibility of the multicentric presentation of tuberculosis at two rare sites in the same immunocompetent patient, even though the differential diagnosis was coccydynia.
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Affiliation(s)
- Saurabh Singh
- Department of Orthopedics, Institute of Medical Sciences, Lanka, Varanasi, 221005, India.
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Singal R, Singh P, Mittal A, Gupta S, Singla S, Kenwar DB. Primary sternal tuberculous ulcer with dissemination to the bone marrow: a clinical rarity. Ann Saudi Med 2011; 31:542-5. [PMID: 21911997 PMCID: PMC3183694 DOI: 10.4103/0256-4947.84642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Primary tubercular osteomyelitis of the sternum with dissemination to bone marrow is a rarely described entity even in countries where tuberculosis is endemic. Delayed presentations can be in the form of sinus formation, spontaneous fracture of the sternum, extrasternal spread, and sepsis. Diagnosis can be made by CT of the chest wall and Ziehl-Neelsen staining of aspirate from the lesion or by tissue biopsy. We present a case of tuberculous osteomyelitis of the sternum with sinus formation along with widespread involvement of bone marrow, which was successfully treated with antituberculous therapy. Sternal osteomyelitis is difficult to diagnose on chest radiography and ultrasonography, but we were able to make the probable diagnosis of sternal tuberculous osteomyelitis. CT showed erosion of part of the sternal bone. Diagnosis was confirmed on histopathology and by bone marrow trephine biopsy. During the follow-up period of 3 months, the patient showed a satisfactory response to treatment.
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Affiliation(s)
- Rikki Singal
- From the Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana Ambala, Haryana, India
| | - Prem Singh
- Department of Pathology, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana Ambala, Haryana, India
| | - Amit Mittal
- Department of Radiodiagnosis, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana Ambala, Haryana, India
| | - Samita Gupta
- Department of Radiodiagnosis, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana Ambala, Haryana, India
| | - Shveta Singla
- Department of Pathology, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana Ambala, Haryana, India
| | - Deepesh Benjamin Kenwar
- From the Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana Ambala, Haryana, India
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Grover SB, Jain M, Dumeer S, Sirari N, Bansal M, Badgujar D. Chest wall tuberculosis - A clinical and imaging experience. Indian J Radiol Imaging 2011; 21:28-33. [PMID: 21431030 PMCID: PMC3056366 DOI: 10.4103/0971-3026.76051] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIMS Tuberculous infection of the thoracic cage is rare and is difficult to discern clinically or on radiographs. This study aims to describe the common sites and the imaging appearances of chest wall tuberculosis. MATERIALS AND METHODS A retrospective review of the clinical and imaging records of 12 confirmed cases of thoracic cage tuberculosis (excluding that of the spine), seen over the last 7 years, was performed. Imaging studies available included radiographs, ultrasonographies (USGs), and computed tomography (CT) scans. Pathological confirmation was obtained in all cases. RESULTS All patients had clinical signs and symptoms localized to the site of involvement, whether it was the sternum, sternoclavicular joints, or ribs. CT scan revealed sternal destruction in three patients and osteolytic lesions with sclerosis of the articular surfaces of the sternoclavicular joints in two patients. In five patients with rib lesions, USG elegantly demonstrated the bone destruction underlying the cold abscess. All cases were confirmed to be of tuberculous origin by pathology studies of the aspirated/curetted material, obtained by CT / USG guidance. CONCLUSIONS Tuberculous etiology should be considered for patients presenting with atypical sites of skeletal inflammation. CT scan plays an important role in the evaluation of these patients. However, the use of USG for demonstrating rib destruction in a chest wall cold abscess has so far been under-emphasized, as has been the role of CT and USG guided aspiration in confirming the aetiology.
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Affiliation(s)
- Shabnam Bhandari Grover
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Meghna Jain
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Shifali Dumeer
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Nanda Sirari
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Manish Bansal
- Department of Orthopedic Surgery, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Deepak Badgujar
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
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de Carli DM, Severo MD, Haygert CJP, Guollo M, Omairi A, Pedro VD, Silva EP, Rodrigues AT. Sternal osteomyelitis caused by infection with Mycobacterium tuberculosis. J Bras Pneumol 2010; 35:709-12. [PMID: 19669010 DOI: 10.1590/s1806-37132009000700013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 01/12/2009] [Indexed: 11/21/2022] Open
Abstract
We report the case of a 74-year-old male patient with a one-year history of chest pain in the suprasternal notch associated with erythema, edema and drainage of purulent material from a fistulous lesion. The patient was HIV-negative with no history of TB. A CT scan of the chest showed an osteolytic lesion in the sternum, and a biopsy revealed caseous granuloma, which, in the microbiological evaluation, was negative for fungi and acid-fast bacilli. The diagnosis of sternal osteomyelitis caused by Mycobacterium tuberculosis was confirmed using PCR.
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Restrepo CS, Martinez S, Lemos DF, Washington L, McAdams HP, Vargas D, Lemos JA, Carrillo JA, Diethelm L. Imaging appearances of the sternum and sternoclavicular joints. Radiographics 2009; 29:839-59. [PMID: 19448119 DOI: 10.1148/rg.293055136] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The sternum and sternoclavicular joints--critical structures of the anterior chest wall--may be affected by various anatomic anomalies and pathologic processes, some of which require treatment. Pectus excavatum and pectus carinatum are common congenital anomalies that are usually benign but may warrant surgical treatment if they cause compression of vital internal structures. By contrast, developmental variants such as the sternal foramen are asymptomatic and do not require further evaluation or treatment. Arthritides of the sternoclavicular joint (osteoarthritis, septic arthritis, and seronegative arthropathies) are common and must be differentiated before an appropriate management method can be selected. The recognition of complications of sternotomy (eg, sternal dehiscence, secondary osteomyelitis) is critical to avoid life-threatening sequelae such as acute mediastinitis. Likewise, the detection of sternal fractures and sternoclavicular dislocations is important, especially where they impinge on vital structures. In addition, sternal malignancies (most commonly, metastases and chondrosarcoma) must be distinguished from benign neoplasms. To achieve accurate and timely diagnoses that facilitate appropriate treatment, radiologists must be familiar with the appearances of these normal anatomic variants and diseases of the sternum.
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Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex., USA
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Saifudheen K, Anoop TM, Mini PN, Ramachandran M, Jabbar PK, Jayaprakash R. Primary tubercular osteomyelitis of the sternum. Int J Infect Dis 2009; 14:e164-6. [PMID: 19524467 DOI: 10.1016/j.ijid.2009.03.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 03/15/2009] [Accepted: 03/20/2009] [Indexed: 12/20/2022] Open
Abstract
Primary tuberculous osteomyelitis of the sternum is a rare clinical entity. Sternal tuberculosis can result from direct extension of the disease from hilar lymph nodes, hematogenous or lymphatic dissemination from other sites, and following BCG vaccination in children. An unusual case of primary tuberculous osteomyelitis of the sternum that presented with a swelling and pain over the manubrium sterni is reported. Diagnosis was confirmed by demonstration of epithelioid granulomas and acid-fast bacilli and a positive M. tuberculosis culture from the aspirate taken from the sternal swelling. Extensive diagnostic work-up did not reveal any other focus of tuberculosis in this case. The patient was successfully managed with anti-tubercular treatment.
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Sternal Tuberculosis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2009. [DOI: 10.1097/ipc.0b013e3181841f97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
A series of 14 patients suffering from tuberculosis of the sternum with a mean follow-up of 2.8 years (2 to 3.6) is presented. All were treated with antitubercular therapy: ten with primary therapy, two needed second-line therapy, and two required surgery (debridement). All showed complete healing and no evidence of recurrence at the last follow-up. MRI was useful in making the diagnosis at an early stage because atypical presentations resulting from HIV have become more common. Early adequate treatment with multidrug antitubercular therapy avoided the need for surgery in 12 of our 14 patients.
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Affiliation(s)
- S A Khan
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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Sinha S, Sinha A, Nagarajah K, Oei EL, Critchley P, McNally MA. Chronic sternal osteomyelitis complicating primary manubriosternal septic arthritis. Clin Rheumatol 2005; 25:934-6. [PMID: 16328095 DOI: 10.1007/s10067-005-0101-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2005] [Revised: 09/19/2005] [Accepted: 09/21/2005] [Indexed: 10/25/2022]
Abstract
We present a 40-year-old woman complaining of worsening chest pain. She was previously treated with a prolonged course of antibiotics for suspected sternal osteomyelitis. Radiological investigations were suggestive of ongoing inflammation within the manubriosternal joint. Formal surgical debridement yielded evidence corroborating the diagnosis although microbiological samples were negative. Prolonged empirical treatment with intravenous antibiotics leads to a complete resolution of symptoms. Primary culture-negative manubriosternal septic arthritis is rare, and suboptimal treatment, particularly if confused with other conditions such as synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome, compounds its considerable morbidity.
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Affiliation(s)
- S Sinha
- Department of Paediatric Surgery, John Radcliffe Hospital, Oxford, UK.
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Abstract
Tubercular involvement of the sternum, leading to osteomyelitis, is a rarely described entity even in countries where tuberculosis is endemic. Presentation in pediatric age group is even more uncommon. We describe a 12 year old girl who presented with a mass over the manubruim sterni and fever. CT chest demonstrated a soft tissue mass in the anterior mediastinum, eroding the cortex of the manubrium. Tubercular etiology was suggested by presence of epithelioid granulomas and acid fast bacilli in the Ziehl-Neelsen staining of the aspirate from the lesion. The patient responded well to antitubercular treatment.
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Affiliation(s)
- Suvasini Sharma
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.
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28
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Abstract
Isolated involvement of the sternum is rare, representing less than 1% of tuberculosis osteomyelitis. Only a few cases of sternal tuberculosis have been reported in the pediatric literature. The authors report the case of a 10 year old boy presenting with a 6 month history of presternal swelling and pain. Computed tomography (CT) showed a ring-enhancing hypodense soft tissue mass surrounding the sternum, with marked cortical thickening. Treatment included both surgical intervention and medical therapy.
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Affiliation(s)
- N Allali
- Service de radiologie, hôpital d'enfant, CHU, Rabat, Maroc.
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Abstract
BACKGROUND When reporting bone scans, it is important to distinguish between normal variants and skeletal pathology involving the sternum. There are only limited reports dealing with age-related normal variants of the sternum on bone scintigraphy. METHODS We have studied the age-related variants of sternal uptake on bone scintigraphy. In a prospective study, 152 consecutive patients (66 males and 86 females) undergoing whole-body bone scanning, and who had no symptoms associated with the sternum, were evaluated for patterns of normal sternal uptake. Three hours after intravenous injection of (99m)Tc-methylene diphosphonate ((99m)Tc-MDP), whole-body bone scans in the anterior and posterior projections were acquired. Patterns of sternal uptake, including the sites and distribution of increased and decreased uptake, were analysed using age-related groups. RESULTS Three patterns of tracer uptake in the sternum were recognized: a uniform pattern was most common in children (< or =12 years); a heterogeneous uptake pattern was frequently seen in adolescents, young adult and adult groups; and a segmented pattern was commonly seen in the geriatric group (>60 years). A predominant focal finding was a hot spot at the angle of Louis. In addition, there were focal spots of decreased tracer uptake in the lower sternum, just above the xiphoid process, and spots of increased tracer uptake in the body of the sternum. Such focal spots were not seen in subjects of less than 12 years of age. CONCLUSION Evolutionary changes of the sternum appear to exist throughout life. There are age-related normal variants of sternal uptake on bone scintigraphy.
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Affiliation(s)
- Ghulam M Syed
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110, Kuwait.
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