Atypical radiographic appearances of tuberculous granulomas of bone

We present four adults with tuberculous granulomas of bone. In three patients the granuloma involved the end of a long bone. The vertebral body and the right pedicle of the 10th thoracic vertebra were involved in the fourth patient. In all four the adjacent joint or the disk space was spared; hence the lesions mimicked bone neoplasms. Sclerotic changes, periosteal reaction and sequestration were present in three patients. Three of the four patients were not white. Since histologic specimens may not reveal mycobacteria, radiologists should alert orthopedic surgeons to the need to obtain material for culture at the time of biopsy of lesions that might be unusual manifestations of skeletal tuberculosis.