Tubercular Osteomyelitis of Clavicle: A Rare Clinico-radiological Diagnostic Dilemma and Master Mimicker TC09-TC14
Dr. Deb Kumar Boruah,
Assistant Professor, Department of Radiology, Assam Medical College and Hospital, Dibrugarh-786002, Assam, India.
Introduction: Tuberculosis (TB) is one of the most common infections in developing countries. However, TB of the clavicle is a rare entity. Clinical suspicion and early radiological diagnosis of this entity is of utmost importance for patient outcome.
Aim: To evaluate and define the role of cross-sectional imaging in tubercular osteomyelitis of clavicle.
Materials and Methods: A hospital based prospective study was conducted in a tertiary care centre from June 2015 to December 2016. The study group comprised of pathologically proven eight patients of tubercular clavicular osteomyelitis. CT scans were done in six patients and MRI was done in two patients. Data were presented in terms of percentage, mean and standard deviation.
Results: The mean age of presentation of our study population was 37Â±1.8 years with a male: female ratio of 3:1. Medial 1/3rd of the clavicle was the most commonly affected site. Irregular expansile osteolytic lesions with bony destruction was noted in 5 (62.5%) patients, mild bony erosions in 3 (37.5%) patients, periosteal reaction in 4 (50%) patients, bony sclerosis in 4 (50%) patients and sequestrum formation in 2 (25%) patients. Contiguous affection of adjacent sterno-clavicular joint was seen in 3 (37.5%) patients.
Conclusion: Cross-sectional imaging, especially MRI is essential not only in the diagnosis of clavicular tubercular osteomyelitis, but also is important to evaluate the extent of bone marrow involvement, surrounding soft tissue involvement and myositis. This in turn may affect patient management and prognosis, where some of them may require surgical intervention.