Extrapulmonary Tuberculosis: Imaging Features Beyond the Chest

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Presentation transcript:

Extrapulmonary Tuberculosis: Imaging Features Beyond the Chest Kelly A. MacLean, MD, Annalisa K. Becker, MD, Silvia D. Chang, MD, Alison C. Harris, BSc(Hons), MBChB, MRCP, FRCR, FRCPC Canadian Association of Radiologists Journal Volume 64, Issue 4, Pages 319-324 (November 2013) DOI: 10.1016/j.carj.2012.07.002 Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 1 A 41-year-old man with tuberculous meningitis. Coronal T1-weighted gadolinium-enhanced magnetic resonance image demonstrates characteristic abnormal leptomeningeal enhancement (short, thick, white arrow), with intensely enhancing walls of both lateral ventricles (black arrows). High signal within the left frontal lobe represents an enhancing tuberculoma (thin white arrow). Entrapment of the left temporal horn (long, thick, white arrow) and midline shift to the right are due to the ventricular mass lesion. Canadian Association of Radiologists Journal 2013 64, 319-324DOI: (10.1016/j.carj.2012.07.002) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 2 A 41-year-old woman with human immunodeficiency virus and hepatitis C, who presented with acute left arm weakness and numbness, later found to have tuberculous meningitis. Magnetic resonance diffusion-weighted image demonstrates a perforator artery infarction that involved the posterior limb of the right internal capsule (arrow). Canadian Association of Radiologists Journal 2013 64, 319-324DOI: (10.1016/j.carj.2012.07.002) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 3 A 23-year-old woman who presented with a left-sided neck mass that had progressed for 4 weeks. Contrast-enhanced computed tomography demonstrates rim-enhancing lymphadenopathy (arrow), or scrofula, within the left neck. Central hypoattenuation is consistent with central necrosis. Canadian Association of Radiologists Journal 2013 64, 319-324DOI: (10.1016/j.carj.2012.07.002) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 4 A 44-year-old patient with cervical tuberculous spondylitis. Sagittal contrast-enhanced T1-weighted image demonstrates extensive tuberculous involvement of the cervical and upper thoracic vertebral bodies. Abscess formation is seen posterior to the anterior longitudinal ligament (white arrows), with additional epidural abscess posterior to the vertebral bodies (black arrows). There is relative sparing of the intervertebral disk space. These features help to distinguish tuberculous spondylitis from pyogenic infection. Canadian Association of Radiologists Journal 2013 64, 319-324DOI: (10.1016/j.carj.2012.07.002) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 5 A 48-year-old man with tuberculous arthritis. Anteroposterior radiograph demonstrates marked osteopenia and axial joint space loss of the right hip (arrow) due to extensive chronic synovitis. Canadian Association of Radiologists Journal 2013 64, 319-324DOI: (10.1016/j.carj.2012.07.002) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 6 A 30-year-old man with human immunodeficiency virus and micronodular hepatosplenic tuberculosis. Ultrasound demonstrates innumerable hypoechoic lesions (arrows) of the spleen. These findings are nonspecific, and the differential diagnosis includes metastatic disease and microabscesses of another etiology. Canadian Association of Radiologists Journal 2013 64, 319-324DOI: (10.1016/j.carj.2012.07.002) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 7 A 44-year-old man with macronodular hepatic tuberculosis. Contrast-enhanced computed tomography image in the portal venous phase demonstrates a peripherally enhancing, highly vascular lesion that involves segments VII and VIII. Central hypoattenuation is characteristic of caseous necrosis (arrow). Canadian Association of Radiologists Journal 2013 64, 319-324DOI: (10.1016/j.carj.2012.07.002) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 8 A 30-year-old woman who presented with fever of unknown origin, later found to have tuberculous peritonitis and salpingitis. Contrast-enhanced computed tomography image in the portal venous phase demonstrates massive ascites (23 HU), diffuse peritoneal enhancement (black arrow), omental caking (thin white arrow), and nodular soft-tissue thickening (thick white arrow). Canadian Association of Radiologists Journal 2013 64, 319-324DOI: (10.1016/j.carj.2012.07.002) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 9 A 60-year-old man presenting with right lower quadrant pain was found to have ileocecal tuberculosis. Coronal contrast-enhanced computed tomography image in the portal venous phase demonstrates a retracted appearance of the cecum, with mural thickening and mucosal hyperenhancement (arrow). Canadian Association of Radiologists Journal 2013 64, 319-324DOI: (10.1016/j.carj.2012.07.002) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 10 A 60-year-old woman with adrenal tuberculosis. Contrast-enhanced computed tomography image in the portal venous phase demonstrates right adrenal enlargement, rim enhancement and central low attenuation consistent with caseous necrosis (arrow). Canadian Association of Radiologists Journal 2013 64, 319-324DOI: (10.1016/j.carj.2012.07.002) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 11 A 75-year-old woman with ureteric tuberculosis. (A) Retrograde pyelogram image demonstrates irregularity of the ureter and absence of contrast in the strictured distal portion (arrow). (B, C) Contrast-enhanced computed tomography image in the portal venous phase of the same patient demonstrates right-sided hydronephrosis (arrow, B) caused by stricturing and thickening of the distal ureter (arrow, C). Canadian Association of Radiologists Journal 2013 64, 319-324DOI: (10.1016/j.carj.2012.07.002) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 12 A 30-year-old woman with bilateral salpingitis. Contrast-enhanced computed tomography demonstrates ascites with thickened, enhancing peritoneum (white arrows). Bilateral enhancement of the tubo-ovarian structures is also present (black arrows), consistent with pathologic diagnosis of tuberculous salpingitis. Canadian Association of Radiologists Journal 2013 64, 319-324DOI: (10.1016/j.carj.2012.07.002) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions