Reappraisal of skeletal tuberculosis: role of radiological imaging

Skeletal tuberculosis (TB) can present with a broad spectrum of variable clinical manifestations which may cause diagnostic difficulties. To further elucidate these possible diagnostic pitfalls, 14 cases of bacteriologically or histologically proven skeletal TB, which were initially diagnosed otherwise, are reviewed. In five cases with lumbar or midthoracic spinal involvement, concomitant traumatic history and degenerative radiological changes were the main reasons for not suspecting the possibility of skeletal TB. A differential diagnosis between TB and metastatic lesions can be difficult in the very early stage when X-ray images usually have a low contrast and are not sharp. In nine cases with bone and joint involvement, a long-lasting discharging sinus led the clinician to an initial impression of septic arthritis; sometimes concomitant gouty arthritis can mask the clinical manifestations of skeletal TB. In five cases, minor erosive lesions over the peripheral margin of the involved bone were the earliest findings on the plain X-ray films and were overlooked. To facilitate the early diagnosis of skeletal TB and to avoid the possibility of complications in the management of patients, medical practitioners should be familiar with the usual forms of the condition and the wide variety of clinical manifestations.