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Tuberculosis

Extra pulmonary T.B Children younger than 5 Yr.s. Tuberculosis. Chronic Bone lesions. Chronic joint inflammation. 1953-1985. 1985-1991. Infected. ?. ?. Exposure. Diseased. Lungs. Kidney. Primary infection. Lymphatics. Heamatogenous. 1 Yr. Epiphysis or metaphysis. 1-3 Yr.

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Tuberculosis

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  1. Extra pulmonary T.B Children younger than 5 Yr.s Tuberculosis Chronic Bone lesions Chronic joint inflammation 1953-1985 1985-1991 Infected ? ? Exposure Diseased

  2. Lungs Kidney Primary infection Lymphatics Heamatogenous 1 Yr. Epiphysis or metaphysis 1-3 Yr. Human Bone & Joint Diseased organ Centrifugal destruction

  3. Round cystic With ill defined margin Inflammatory granulation tissue Reactive hyperemia Osteopenia Wide area & surrounding May Chronicity &hyperemia Widening &accelerated growth Little resistance No sclerosis & No preosteal reaction

  4. Round cystic With ill defined margin Osteopenia Wide area & surrounding No sclerosis & No preosteal reaction Before extra osseous abcess formation ,may mimic : Pyogenic infection Tumors E.g.: Eosinophilic granuloma

  5. Most skeletal TB affects The spine Lower thoracic Upper lumbar Ant/3 IVD when 2 adjacent Para vertebral abscess Characteristic Diagnostic Calcification Outside of the Spine Hip Knee Major joints

  6. Initially chronic inflammation Chronic inflammation JRA & Pigmented villonodular synovitis Osteopenia & epiphysial overgrowth Hyperemia produces widespread osteopenia & epiphysial overgrowth Pannus Formation Subchondral erosion Joit space narrowin Subchondral erosion Caseous material & Pus Cold abcess

  7. TB DactylitisSpina Ventosa Multifocal cystic involvement May resemble sickle cell dactylitis Swelling of phalanges Metacarpals & Metatarsals Not very painful & consecutive rather than simultaneous X-Ray : Cystic like expansion of the tubular bones & thinning of the cortex

  8. Multifocal cystic involvement Shaft of the long bones Simultaneous Flat bones Tendency to symmetry

  9. Diagnosis Early Consider it as a possiblity HIV Chronic appearing bone lesion Insidious Cold Bone & or Joints destruction beyond the symptoms Lab. Tests: C.B.C Normal ESR Elevated Skin test ++ Identification of Mycobacterium tuberculosis X-Ray Bx. Inflammatory reaction mislead you 73-85%

  10. Treatment Large abcess drainage Medical Surgical Bx. Do not vary for sinuses Super infection ? TB Spondylosis ? Surgery? ? Spinal instability & Failure of Medical treatment More than 2 disc spaces ASF & PSF Kyphosis Neurologic involvement

  11. Medical INH RMP Pyrazinamide Resistant ETB Streptomycin 1 Yr.

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