Morris B S, Varma R, Garg A, Awasthi M, Maheshwari M
Department of Radiology, King Edward Memorial Hospital, Parel, Mumbai 400 012, India,
Skeletal Radiol. 2002 Jan;31(1):1-8. doi: 10.1007/s00256-001-0439-y. Epub 2001 Nov 9.
The incidence of skeletal tuberculosis (TB), which once accounted for a majority of cases of extrapulmonary tuberculosis, has fallen significantly in recent years with the advent of effective drug therapy. Disseminated bone involvement in TB is very uncommon but it may still occur in countries where TB is endemic. We present the imaging findings of four children ranging in age from 2 to13 years, each of whom had multiple osseous stigmata of tuberculous infection. They presented to us over a period of 9 months.
Three of four children had calvarial lesions, with involvement of the bony orbit in one, and large abscesses were present in the chest wall and the mediastinum of another. Lesions along the dorsal spine were demonstrated in three cases, two of which showed epidural extensions. Bone lesions in the thoracic cage accompanying those in the spine were also seen in two children, one of whom had a solitary destructive focus in a rib distant from the site of vertebral involvement. Bone lesions involving the first metacarpal in one case and the scapular wing in two others are also described. The diagnosis in each of the cases was confirmed by the identification of epitheloid giant cells and caseous necrosis or tubercle bacilli in fine needle aspirates or on tissue culture studies.
骨结核的发病率曾占肺外结核病例的大多数，近年来随着有效药物治疗的出现而显著下降。结核分枝杆菌血行播散至骨骼非常罕见，但在结核病流行的国家仍可能发生。我们报告了4例年龄在2至13岁之间儿童的影像学表现，每例均有多个骨结核感染的体征。他们在9个月的时间里前来就诊。
4例儿童中有3例有颅骨病变，其中1例累及眶骨，另1例胸壁和纵隔有大脓肿。3例显示脊柱背侧病变，其中2例有硬膜外扩展。2例儿童还可见脊柱病变伴胸廓骨病变，其中1例在远离椎体受累部位的肋骨有孤立性破坏灶。还描述了1例累及第一掌骨和2例累及肩胛翼的骨病变。通过在细针穿刺抽吸物或组织培养研究中发现上皮样巨细胞、干酪样坏死或结核杆菌，确诊了每例病例。
