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Age / Sex : 58 / F
Age / Sex : 58/F
Chief complaint : Left hip pain for several months
) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of
this case.
* Send Application Answers to In Sook Lee, MD (lis@pusan.ac.kr)
Courtesy : Jeongmi Park, Youido St.Mary’s Hospital, The Catholic University
of Korea
Diagnosis: Tubeculous trochanteric bursitis and osteomyelitis
Discussion
Findings:
Plain
radiography shows asymmetric enthesopathies of left greater trochanter.
CT reveals
mottled rarefaction and paraosseous swelling and calcifications.
MR shows
extensive trochanteric and iliopasoas bursits with soft tissue abscess in
proximal thigh laterally.
Chest PA
shows active fibroproductive tb in RUL.
Differential Diagnosis:
nonbacterial
trochanteric bursitis,lipoma, neoplasm, hematoma,and osteomyelitis of the
femur.
Diagnosis:
Tuberculous
bursitis with extension to trochanter.
Discussion:
Primary
tuberculous pyomyositis, tuberculous bursitis, and tuberculous tenosynovitis
are rare entities constituting 1% of skeletal tuberculosis. Tuberculous
bursitis occurs most commonly around the hip. The greater trochanteric bursa
and the greater trochanter are the most frequent sites of tuberculous bursitis
and bone involvment. Local trauma might be the frequent involvement of the
trochanter and trochanteric bursa of tubeculosis.
Tuberculous
tenosynovitis or bursitis showed soft-tissue swelling on plain radiographs,
with calcification demonstrated in three of nine (33%) cases and in sometimes
with bone involvement. CT and MR imaging allowed evaluation of all forms of
tuberculous tenosynovitis (hygromatous, serofibrinous, and fungoid forms), whereas
tuberculous bursitis exhibited two patterns of involvement: either a distended
bursa or multiple small abscesses.
Concomitant
infection of both bone and bursa is most common
Tuberculous
trochanteric bursitis is characterized by chronic, nonspecific symptoms, with
occasional symptom-free intervals. Pain and stiffness around the hip frequently
are present; swelling and subsequent fistula formation are uncommon
References:
1.
Yamamoto T,
Iwasaki Y, Kurosaka M: Tuberculosis of the greater trochanteric bursa occurring
51 years after tuberculous nephritis. Cli Theumatolo 2001;21:397-400.
2.
Tuberculous
tenosynovitis and bursitis: imaging findings in 21 cases. Jaovisidha S, Chen
C, Ryu KN, Siriwongpairat P, Pekanan P, Sartoris DJ, Resnick D. Radiology. 1996
Nov; 201(2):507-13.
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