Imaging findings of unusual presentations of tuberculosis infection
DOI:
https://doi.org/10.53903/01212095.328Keywords:
Tuberculosis, Extrapulmonary tuberculosis, Diagnostic imagingAbstract
Background: The diverse presentation of tuberculosis infection is commonly found in diagnostic imaging in worldwide radiology. Radiologists are often familiar with the common patterns of tuberculosis on diagnostic images. However, tuberculosis frequently presents with unknown imaging patterns and/or in unusual anatomical sites that still pose a diagnostic challenge. New imaging techniques such as MRI also contribute to differentials. Methodology: a review of the topic is presented focused on unusual findings of tuberculosis in multiple anatomical locations, providing
multiple cases with quite unusual forms of presentation that allow the radiologist to increase the diagnostic suspicion of tuberculosis in different organs. Discussion: Effective treatments for patients with immunodeficiency syndrome, such as increasing survival with the use of chemotherapy
and immunosuppressive drugs, have modified the presentation of tuberculosis by increasing the probability of non-target sites and conventional patterns of involvement. In this review we describe rare imaging patterns of tuberculosis, with few cases published in medical literature. Conclusions: It is important for radiologists to be aware of these unusual imaging patterns of tuberculosis to facilitate
early and accurate diagnosis for appropriate patient management in the face of current demographic changes and the pathological profile of tuberculosis in the current era of scientific advances.
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References
Jick SS, Lieberman ES, Rahman MU, Choi HK. Glucocorticoid use, other associated factors, and the risk of tuberculosis. Arthritis Rheum. 2006;55:19-26
Narasimhan P, Wood J, Macintyre CR, et al. Risk factors for tuberculosis. Pulm Med. 2013:828939
Lönnroth K, Jaramillo E, Williams BG, Dye C, Raviglione M. Drivers of tuberculosis epidemics: the role of risk factors and social determinants. Soc Sci Med. 2009;68(12):2240-6. https://doi.org/10.1016/j.socscimed.2009.03.041.
Li S, Liang Y, Hu X. Risk factors for multidrug resistance in tuberculosis patients with diabetes mellitus. BMC Infect Dis. 2022;22(1):835. https://doi.org/10.1186/s12879-022-07831-3.
Elango S, Prema S, Vijayakumar AR, Sravani N, Nagarajan K, Vijayalakshmi G. Unusual manifestations of extra-pulmonary tuberculosis: a pictorial essay. Pol J Radiol. 2022;87:e79-e86. https://doi.org/10.5114/pjr.2022.113475.
Rodríguez-Takeuchi SY, Renjifo ME, Medina FJ. Extrapulmonary tuberculosis: pathophysiology and imaging findings. Radiographics. 2019;39(7):2023-37. https://doi.org/10.1148/rg.2019190109.
Rana A, Krishnan V, Aggarwal A. Unusual patterns of tuberculosis on cross-sectional imaging: a pictorial review. Egypt J Radiol Nucl Med. 2022;53:190. https://doi.org/10.1186/s43055-022-00875-0
Burrill J, Williams CJ, Bain G, Conder G, Hine AL, Misra RR. Tuberculosis: a radiologic review. Radiographics. 2007;27(5):1255-73. https://doi.org/10.1148/rg.275065176.
Harisinghani MG, McLoud TC, Shepard JA, Ko JP, Shroff MM, Mueller PR. Tuberculosis from head to toe. Radiographics. 2000;20(2):449-70; quiz 528-9, 532. https://doi.org/10.1148/radiographics.20.2.g00mc12449.
Chong VH. Hepatobiliary tuberculosis: a review of presentations and outcomes. South. Med. J. 2008;101(4):356-61.
Tatco V, Mejía-Santos MM, Uy JA. The many faces of hepatic tuberculosis. TB Corner 2015;1(2):1-6.
Gallinger S, Strasberg SM, Marcus HI, et-al. Local hepatic tuberculosis, the cause of a painful hepatic mass: case report and review of the literature. Can J Surg. 1986;29(6):451-2.
Kakkar C, Polnaya AM, Koteshwara P, et-al. Hepatic tuberculosis: a multimodality imaging review. Insights Imaging. 2015;6(6):647-58.
Raut AA, Naphade PS, Ramakantan R. Imaging spectrum of extrathoracic tuberculosis. Radiol Clin North Am. 2016;54(3):475-501. https://doi.org/10.1016/j.rcl.2015.12.013.
da Rocha EL, Pedrassa BC, Bormann RL, Kierszenbaum ML, Torres LR, D’Ippolito G. Abdominal tuberculosis: a radiological review with emphasis on computed tomography and magnetic resonance imaging findings. Radiol Bras. 2015;48(3):181-91. https://doi.org/10.1590/0100-3984.2013.1801.
Tirumani SH, Ojili V, Gunabushanam G, Shanbhogue AK, Nagar A, Fasih N, et al. Imaging of tuberculosis of the abdominal viscera: beyond the intestines. J Clin Imaging Sci. 2013;3:17. https://doi.org/10.4103/2156-7514.111234.
Gupta A. Splenic tuberculosis: a comprehensive review of literature. Pol Przegl Chir. 2018;90(5):49-51. https://doi.org/10.5604/01.3001.0012.1754.
LamKY, Lo CY. A critical examination of adrenal tuberculosis and a 28-year autopsy experience of active tuberculosis. Clin Endocrinol (Oxf). 2001;54:633-9.
Wang YX, Chen CR, He GX, Tang AR. CT findings of adrenal glands in patients with tuberculous Addison’s disease. J Belge Radiol. 1998;81:226-8.
Zhang X C, Yang Z G, Li Y. Addison’s disease due to adrenal tuberculosis: MRI features. Abdom Imaging. 2008;33(06):689-94.
Joshi AR, Basantani AS, Patel TC. Role of CT and MRI in abdominal tuberculosis. Curr Radiol Rep. 2014;2:66. https://doi.org/10.1007/s40134-014-0066-8.
Nagar AM, Raut AA, Morani AC, et al. Pancreatic tuberculosis: a clinical and imaging review of 32 cases. J Comput Assist Tomogr. 2009;33:136-41.
Wu CS, Wang SH, Kuo TT. Pancreatic tuberculosis mimicking pancreatic head carcinoma: a case report and review of the literature. Infection. 1994;22:287-9.
De Backer AI, Mortelé KJ, Bomans P, De Keulenaer BL, Vanschoubroeck IJ, Kockx MM. Tuberculosis of the pancreas: MRI features. AJR Am J Roentgenol. 2005;184(1):50-4. https://doi.org/10.2214/ajr.184.1.01840050.
Naeem M, Zulfiqar M, Siddiqui MA, Shetty AS, Haq A, Varela C, et al. Imaging manifestations of genitourinary tuberculosis. Radiographics. 2021;41(4):1123-43.
Matsui N, Morita T. Magnetic resonance imaging as a clue to successful diagnosis of renal tuberculosis: A case report. Cases J. 2009;2:8879.
Salvador F, Los-Arcos I, Sánchez-Montalván A, Tórtola T, Curran A, Villar A, et al. Epidemiology and diagnosis of tuberculous lymphadenitis in a tuberculosis low-burden country. Medicine. 2015;94(4):e509. https://doi.org/10.1097/MD.0000000000000509.
De Backer AI, et al. Abdominal tuberculous lymphadenopathy: MRI features. Eur Radiol. 2005;15(10):2104-9.
Pereira JM, Madureira A, Vieira A, Ramos I. Abdominal tuberculosis: imaging features. Eur J Radiol. 2005;55(2):173-80.
Ladumor H, Al-Mohannadi S, Ameerudeen FS, Ladumor S, Fadl S. TB or not TB: A comprehensive review of imaging manifestations of abdominal tuberculosis and its mimics. Clin Imaging. 2021;76:130-43. https://doi.org/10.1016/j.clinimag.2021.02.012.
Eraksoy H. Gastrointestinal and abdominal tuberculosis. Gastroenterol Clin North Am. 2021;50(2):341-60. https://doi.org/10.1016/j.gtc.2021.02.004.
Aggarwal N, Mahto SK, Singh A, Gupta K, Aneja A, Singh A, Goel A. Disseminated tuberculosis presenting as massive lower gastrointestinal bleeding. J Family Med Prim Care. 2020;9(2):1226-8.
Kela M, Agrawal A, Sharma R, Agarwal R, Agarwal VB. Ileal tuberculosis presenting as a case of massive rectal bleeding. Clin Exp Gastroenterol. 2009;2:129-31. https://doi.org/10.2147/ceg.s8009.
Gaillard F, Rezaee A, Jones J, et al. HIV/AIDS: gastrointestinal manifestations [internet]. Radiopaedia.org. S. f. [citado: 2024 oct 11]. https://doi.org/10.53347/rID-22073
Delaval L, Goulenok T, Achouh P, Saadoun D, Gaudric J, Pellenc Q, et al. New insights on tuberculous aortitis. J Vasc Surg. 2017;66(1):209-15. https://doi.org/10.1016/j.jvs.2016.11.045.
Fernández-Castro I, Isorna-Porto MJ, Novo-Veleiro I, Casar-Cocheteux C, Barrera- López L, Andrade-Piña AH, et al. An atypical manifestation of mycobacterium tuberculosis infection. Eur J Case Rep Intern Med. 2021;8(7):002598. https://doi.org/10.12890/2021_002598.
Bukhary ZA, Alrajhi AA. Tuberculous aortitis. Ann Saudi Med. 2006;26(1):56-8. https://doi.org/10.5144/0256-4947.2006.56.
Santosham R, Deslauriers J. Tuberculosis and other granulomatous diseases of the airway. Thorac Surg Clin. 2018;28(2):155-61. https://doi.org/10.1016/j.thorsurg.2018.01.004.
Lee P. Endobronchial tuberculosis. Indian J Tuberc. 2015;62(1):7-12. https://doi.org/10.1016/j.ijtb.2015.02.002.
López-López JP, Posada-Martínez EL, Saldarriaga C, Wyss F, Ponte-Negretti CI, Alexander B, et al. Neglected Tropical Diseases, Other Infectious Diseases Affecting the Heart (the NET‐Heart Project). Tuberculosis and the Heart. J Am Heart Assoc. 2021;10(7):e019435. https://doi.org/10.1161/JAHA.120.019435.
Das KM, Mansoori TA, Alattar YH, Gorkom KV, Shamisi A, Melethil AP, et al. Tuberculosis of the heart: a diagnostic challenge. Tomography. 2022;8(4):1649-65. https://doi.org/10.3390/tomography8040137.
Singh R, Jagia P. Insights into imaging of pericardial and cardiac tuberculosis: a comprehensive review. Indographics. 2024;3:91-9.
Abid W, Ladeb MF, Chidambaranathan N, Peh WCG, Vanhoenacker FM. Imaging of musculoskeletal tuberculosis. Skeletal Radiol. 2024;53(10):2081-97. https://doi.org/10.1007/s00256-023-04556-5.
Moore SL, Rafii M. Imaging of musculoskeletal and spinal tuberculosis. Radiol Clin North Am. 2001;39(2):329-42. https://doi.org/10.1016/s0033-8389(05)70280-3.
Leonard MK, Blumberg HM. Musculoskeletal tuberculosis. Microbiol Spectr. 2017;5(2). https://doi.org/10.1128/microbiolspec.TNMI7-0046-2017.
De Vuyst D, Vanhoenacker F, Gielen J, Bernaerts A, De Schepper AM. Imaging features of musculoskeletal tuberculosis. Eur Radiol. 2003;13(8):1809-19. https://doi.org/10.1007/s00330-002-1609-6.
Pattamapaspong N, Kanthawang T, Bouaziz MC, Ladeb MF, Hammami N, Peh WCG. Imaging of musculoskeletal tuberculosis. Br J Radiol. 2024;97(1153):1-12. https://doi.org/10.1093/bjr/tqad019.
Andronikou S, Bindapersad M, Govender N, Waner JI, Segwe A, Palliam S, et al. Musculoskeletal tuberculosis - imaging using low-end and advanced modalities for developing and developed countries. Acta Radiol. 2011;52(4):430-41. https://doi.org/10.1258/ar.2011.100444.
Schaller MA, Wicke F, Foerch C, Weidauer S. Central nervous system tuberculosis: etiology, clinical manifestations and neuroradiological features. Clin Neuroradiol. 2019;29(1):3-18. https://doi.org/10.1007/s00062-018-0726-9.
Mahomed N, Kilborn T, Smit EJ, Chu WCW, Young CYM, Koranteng N, et al. Tuberculosis revisted: classic imaging findings in childhood. Pediatr Radiol. 2023;53(9):1799-828. https://doi.org/10.1007/s00247-023-05648-z.
Salvador GLO, Basso ACN, Barbieri PP, Leitao CA, Teixeira BCA, Neto AC. Central nervous system and spinal cord tuberculosis: Revisiting an important disease. Clin Imaging. 2021;69:158-68. https://doi.org/10.1016/j.clinimag.2020.07.020.
Patkar D, Narang J, Yanamandala R, Lawande M, Shah GV. Central nervous system tuberculosis: pathophysiology and imaging findings. Neuroimaging Clin N Am. 2012;22(4):677-705. https://doi.org/10.1016/j.nic.2012.05.006.
Park M, Gupta RK. Central nervous system mycobacterium infection: tuberculosis and beyond. Neuroimaging Clin N Am. 2023;33(1):105-24. https://doi.org/10.1016/j.nic.2022.07.006.
Chaudhary V, Bano S, Garga UC. Central nervous system tuberculosis: an imaging perspective. Can Assoc Radiol J. 2017;68(2):161-70. https://doi.org/10.1016/j.carj.2016.10.007.
Leonard JM. Central nervous system tuberculosis. Microbiol Spectr. 2017;5(2). https://doi.org/10.1128/microbiolspec.TNMI7-0044-2017.
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