Musculoskeletal tuberculosis

Abstract

The incidence of musculoskeletal tuberculosis is increasing because of the general resurgence of the disease (i.e., its spread among homeless persons, the expanding immigrant population, and the AIDS epidemic) and increasing multidrug-resistant strains of Mycobacterium tuberculosis. Prompt diagnosis and treatment of musculoskeletal tuberculosis are important to prevent serious bone and joint destruction, as well as severe neurologic sequelae in the case of spinal involvement. This article describes variations in the morphological patterns of musculoskeletal tuberculosis and reviews the use of plain radiography, CT, and MRI in the diagnosis and management of this disease process. The role of diagnostic imaging is discussed to 1) orient the viewer with the classic imaging presentation of tuberculous spondylitis (although the specific diagnosis is more of a problem with the more atypical presentations of tuberculous spondylitis), 2) highlight the sensitivity of CT and MR in detecting and delineating infectious lesions of the spine, and 3) illustrate difficulties in differentiating peripheral osteoarticular tuberculosis from other inflammatory or neoplastic disorders (where CT and MR imaging play a limited role).