TB in Elbow Joint.pptx
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This document describes a case of tuberculous arthritis in a 55-year-old male's right elbow joint. The patient presented with 6 months of right elbow pain and swelling, as well as weight loss. Examination found swelling and limited range of motion in the elbow. Imaging and tests confirmed tuberculous arthritis, with involvement also seen in the lungs. The patient was started on antitubercular treatment and showed improvement after 6 months of treatment. Tuberculous arthritis can affect the elbow and cause chronic pain if not properly diagnosed and treated.
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Isolated tubercular orchi epididymitis with painful hydrocoele - case report
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This case report describes a 43-year-old man who presented with a painful right scrotal swelling and fever that had been evolving over a year. Ultrasound revealed a poorly limited scrotal swelling with thick echogenic content and swelling of the right spermatic cord. Surgical exploration showed a hydrocele with fibrous tissue involving the right testicle. Biopsies were positive for tuberculosis. The patient was treated with anti-tuberculosis drugs and surgery for the hydrocele. His condition improved with medical treatment, demonstrating that tuberculous orchi-epididymitis can initially present as a painful hydrocele.Bone Infections
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A Case of Tuberculous Sacro-iliitis
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- The case report describes an unusual presentation of sacroiliac joint tuberculosis in a young female patient, initially diagnosed as non-tuberculous sacroiliitis.
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- Diagnosis relies on clinical exam, imaging, and molecular/histological tests since culture has low yield from bone. MRI is often diagnostic.
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Double_Primordial_Uterine_Vaginal_Atresia_Torsion_Left_Ovarian_Cyst_Pedicle.pdf
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Background: A 51-year-old woman had left lower abdomen pain for 18 hours with nausea and vomiting. Prior CT scans suggested pelvic neoplasms. Our hospital's emergency CT showed an enlarged uterus with cystic shadows, right adnexal cysts, and stomach fluid. Physical examination revealed left lower abdomen discomfort. A gynaecological examination revealed a painful, firm pelvic mass of 151210 cm. Further diagnosis is underway. Method: The patient underwent emergency exploratory laparotomy, discovering a twisted, swollen left ovary with a 540° rotation, classified as a benign cyst. It was found that the patient had congenital upper vaginal atresia and bilateral initial uteri. Pain was reduced after surgery, thanks to symptomatic treatment. An abnormal karyotype of 46, XX,1qh+ was found during genetic testing. Result: Fallopian tubes, uterus, and vagina develop from the embryonic accessory mesonephric duct. MRKH syndrome is caused by bilateral accessory mesonephric duct dysplasia and disappearance of the uterus or vagina. MRKH has three types, with Type 1 lacking uterus or vagina. Due to ovarian cyst torsion, this Type 1 MRKH with double initial uterus and upper vaginal atresia needed left adnexa resection. Genetic testing showed a typical female karyotype. MRKH's complex aetiology incorporates chromosomal abnormalities, emphasizing early cytogenetic evaluation for personalized treatment and fertility assistance. Conclusion: Early cytogenetic testing for MRKH syndrome patients is crucial for determining the underlying cause and guiding personalized treatment plans to restore reproductive function and improve quality of life.
Key-words: Double primordial uterus; MRKH syndrome; Upper vaginal atresia; Torsion of left ovarian cyst pedicleStudy on Clinical observation in Patients Presenting With Right Iliac Fossa P...
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Diagnostics in Inflammatory Bowel Disease (IBD): Ultrasound
Intestinal ultrasound has a good accuracy in the diagnosis of Crohn's disease, as well as in the assessment of disease activity, extent, and evaluating disease-related complications, namely strictures, fistulae, and abscesses.
Even though not fully validated, several scores have been developed to assess disease activity using ultrasound. Importantly, intestinal ultrasound can also be used to assess response to treatment. Changes in ultrasonographic parameters are observed as early as 4 weeks after treatment initiation and persist during short- and long-term follow-up. Additionally, Crohn's disease patients with no ultrasound improvement seem to be at a higher risk of therapy intensification, need for steroids, hospitalisation, or even surgery.
Similarly to Crohn's disease, intestinal ultrasound has a good performance in the diagnosis, activity, and disease extent assessment in ulcerative colitis patients. In fact, in patients with severe acute colitis, higher bowel wall thickness at admission is associated with the need for salvage therapy and the absence of a significant decrease in this parameter may predict the need for colectomy.
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A case of childhood Burkitt's lymphoma with gingival swelling as the first sy...
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- 1. TUBERCULOUS ARTHRITIS OF RIGHT ELBOW JOINT Dr. V. R. Raghul, M.S. 2nd Year PG, Department of Orthopaedics Prof. Dr. Nalli R Yuvraj, HOD - Department of Orthopaedics Dr. Pradeep E, Associate Professor Dr. Arun K V, Associate Professor Chettinad Hospital and Research Institute, Kelambakkam
- 2. INTRODUCTION Incidence of TB elbow: 2-5% of all skeletal locations. The elbow joint is the most frequently involved joint in tubercular infections of the upper limb. Despite substantial progression of the disease and ambiguous symptoms, necessary evaluation are not performed. TB arthritis is often misdiagnosed.
- 3. CASE REPORT A 55-year-old male with complaints of pain over right elbow for past 6 months. Swelling and difficulty in movement for past 3 months. H/o loss of weight. (5kgs lost in the past 6 months) No other history of constitutional symptoms. NO H/O cough with expectoration
- 4. L/E OF RIGHT ELBOW 5*3cm swelling present over posteromedial aspect of elbow extending into distal arm Muscle wasting present over forearm, biceps, triceps Warmth present Non tender Firm in consistency Mobile Elbow ROM: FFD 60° to 100°; further restricted and painful Pre-op Images
- 5. RADIOGRAPHS Right elbow shows arthritic changes: AP view Lateral view
- 6. MRI MRI right elbow showed inflamed synovium and joint effusion,
- 7. RADIOGRAPH OF CHEST PA view Non homogenous opacities seen in right upper zone and lower zone and left upper zone and mid zone.
- 8. INVESTIGATIONS ESR and CRP elevated. Mantoux positive (17mm) Sputum for AFB was sent and was positive
- 9. SURGERY Excision biopsy of the swelling was done Sent for histopathology gene xpert and microbiology
- 12. LJ media: shows typical rough and tough buff- colored colonies AFB: Long slender, beaded, less uniformly stained and red coloured acid-fast acid-fast bacilli MGIT Tube: Mycobacterial Growth Indicator Tube from tissue bit and pus was positive. Rapid card test: Card Test for Mycobacterium tuberculosis yielded a positive result
- 13. Histopathology Report: Features consistent with caseating granulomatous inflammation.
- 14. DIAGNOSIS Tuberculous Arthritis of right elbow joint Patient was started on ATT • FDC • 4 HRZE for 2 months (Intensive phase) followed by 4 HRE continuation phase, patient is in the 5th month maintenance phase
- 15. 6 MONTHS FOLLOW UP
- 16. 6 MONTHS FOLLOW UP
- 18. DISCUSSION Osteoarticular TB and AIDS have grown increasingly widespread in developing countries. Increased HIV incidence due to factors like immigration, alcoholism, chronic diseases, homelessness, and limited healthcare access. Osteoarticular tuberculosis affects 1%-3% of cases, with 2%-4% in immuno-depressed individuals. Osteoarticular TB primarily affects spinal, upper limb joints, and elbows.
- 19. DISCUSSION Tubercle bacilli spread from pulmonary lesions cause musculoskeletal involvement. Tuberculous arthritis causes chronic pain, edema, and function loss, with slow diagnosis and poor therapy outcomes. 50% of individuals have no radiological pulmonary involvement, TB history possible. Positive tuberculin skin test confirms diagnosis, negative results don't rule out TB.
- 20. DISCUSSION Early lesions may be missed due to non-specific radiological findings; periarticular osteopenia may progress, leading to joint narrowing. Joint obliteration, fibrous ankylosis, osteoarticular tuberculosis, osteoporosis, erosions, and progressive cartilage constriction may develop without treatment. MRI assesses soft-tissue masses, 99mTc bone scans detect osteomyelitis early. CT-guided percutaneous biopsy aids diagnosis, mycobacterial culture confirms diagnosis, and biopsies are the best tool for early treatment in osteoarticular TB.
- 21. DISCUSSION Disability is determined by diagnosis and treatment period for osteoarticular tuberculosis. Osteoarticular tuberculosis treated with chemotherapy and non weight- bearing joint exercises. Osteoarticular tuberculosis treated with chemotherapy and joint exercises. Surgery may be necessary for biopsy and confirmation, and joint arthrodesis or replacement may be considered.
- 22. CONCLUSION In conclusion, immunocompromised and endemic individuals with unexplained soft-tissue edema, swelling, and discomfort should be investigated for osteoarticular tuberculosis. Early diagnosis and therapy may improve function. An enlarged elbow should be checked for pyogen arthritis, gout, pigmented villonodular synovitis, haemophilic arthropathy, rheumatoid arthritis, synovial osteochondromatosis, and malignancies.
- 23. REFERENCES 1. Tangadulrat P, Suwannaphisit S (March 08, 2021) Tuberculosis Septic Arthritis of the Elbow: A Case Report and Literature Review. Cureus 13(3): e13765. doi:10.7759/cureus.13765 2. Domingo, A., Nomdedeu, M., Tomás, X. et al. Elbow tuberculosis: an unusual location and diagnostic problem. Arch Orthop Trauma Surg 125, 56–58 (2005). 3. Dhillon MS, Goel A, Prabhakar S, Aggarwal S, Bachhal V. Tuberculosis of the elbow: A clinicoradiological analysis. Indian J Orthop. 2012 Mar;46(2):200-5.
- 24. THANK YOU