Presentation
Right wrist pain and swelling for 2 months. No trauma.
Patient Data
Cortical erosion of the volar aspect of the distal radius is associated with an ill-defined peripherally enhancing soft tissue lesion arising from bone and extending under the flexor tendons over the distal end of the radius, involving the pronator quadratus muscle. Mild extension of the soft tissue in the flexor compartment of the wrist.
Similar morphology soft tissue in the distal radio-ulnar joint space with cortical erosion of the lateral aspect of the adjacent ulna.
Soft tissue also encircles all the intercarpal joint spaces. Small erosions were noted in the carpal bones.
Erosion of the 3rd metacarpal bone base with soft tissues extending in the marrow.
Diffuse enhancing synovial thickening noted.
Diffuse STIR hyperintense marrow signal in the distal radius, ulna and all the carpal bones with diffuse post-contrast enhancement.
Case Discussion
This case illustrates all the typical findings noted in tuberculous arthropathy. This patient had a chest x-ray with findings of miliary tuberculosis.
Though uncommon in Western countries, tuberculous arthropathy is common in developing countries. It is usually secondary to pulmonary tuberculosis, as is presumed in this case. Tuberculous arthropathy is monoarticular, commonly involving weight-bearing joints like knees and hips, but it can also affect smaller joints. Treatment with antitubercular drugs is definitive; however, surgical intervention is needed in cases of deformity or drainage of large collections.
Unable to process the form. Check for errors and try again.