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

2. Lymphatics Heamatogenous Diseased organ Bone & Joint 1-3 Yr. 1 Yr. Epiphysis or metaphysis Centrifugal destruction

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

4. Round cystic With ill defined margin Osteopenia No sclerosis & No preosteal reaction Wide area & surrounding,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 Calcification Characteristic Diagnostic Major joints

6. Initially chronic inflammation Chronic inflammation Hyperemia produces widespread osteopenia & epiphysial overgrowth Osteopenia & epiphysial overgrowth Pannus Formation Subchondral erosion JRAPigmented villonodular synovitis&

7. TB Dactylitis Spina 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 Flat bones

9. Diagnosis Early InsidiousCold Bone & or Joints destruction beyond the symptoms Lab. Tests: C.B.C Normal ESR Elevated Skin test ++ Identification of Mycobacterium tuberculosis

10. Do not vary for sinuses Spinal instability & Failure of Medical treatment Neurologic involvement More than 2 disc spaces ASF & PSF

11. INH RMP Pyrazinamide ETB Streptomycin