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Extrapulmonary tuberculosis with paravertebral abscess formation and thyroid involvement.
Extrapulmonary tuberculosis has a broad spectrum of clinical manifestations. Involvement of the thyroid gland has rarely been reported. We report a case in a patient with a non-tender swelling of the thyroid, whose symptoms, sonographic and scintigraphic features mimicked carcinoma. Initially the patient presented with back pain due to a paravertebral mass. Fine needle aspiration and culture of the aspirate both from the paravertebral mass and the thyroid ensured the diagnosis. Although seldom observed, tuberculosis should be kept in mind in the differential diagnosis of nodular lesions of the thyroid. The preponderant absence of thyroid dysfunction in mycobacterial thyroiditis is confirmed by this case.
Acute adrenocortical failure due to tuberculosis.
A 55-year-old woman presented with acute adrenal failure, active pulmonary tuberculosis and an enlarged adrenal mass which was subsequently removed surgically. Histopathologic examination disclosed adrenal tuberculoma. It was concluded that tuberculosis might result not only in chronic adrenocortical insufficiency but also in acute adrenal failure.
Wasting illness in a 33-year-old woman.
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Addisonian crisis induced by treatment with rifampicin.
A patient with spinal tuberculosis and subclinical adrenal tuberculosis who developed acute Addisonian crisis on starting anti-tuberculosis therapy including rifampicin is reported. The possibility that many patients with tuberculosis have adrenal involvement with limited hormonal reserve and that they may develop incipient adrenal failure on commencing treatment is discussed.
Active tuberculosis unrecognised until necropsy.
12 of the 24 cases of active tuberculosis which came to necropsy in Dundee hospitals from 1968 to 1975 were diagnosed after death. The overall distribution of anatomical types was similar to that in previous surveys, but in those diagnosed at necropsy there was an excess of psoas abscess and miliary, colonic, and adrenal lesions. Class-IV patients and a history of steroid therapy were also more common in cases diagnosed at necropsy. None of these differences is statistically significant.
CT findings of abdominal tuberculosis in 12 patients.
Our purpose was to evaluate the Computed Tomography (CT) findings of the abdominal tuberculosis (TBC) retrospectively which was diagnosed histopatologically. This study included 12 patients. All patients were evaluated by abdominal CT study. Most findings of CT studies were mesenteric calcified or noncalcified lymphadenopathies, ascites, thickened intestinal wall located on the right lower quadrant of abdomen, thickening of peritoneum, mottled soft-tissue densities in omentum and mesenterium. In addition, one of the patients had bilateral calcified adrenal glands and one of them had calcified mass in adrenal gland. If peritoneal thickening, ascites, abdominal lymphadenophaties and thickened intestinal walls are obtained, TBC should be considered in differential diagnosis in developing countries.
[Hyponatremia: an unusual case report].
Hyponatremia is a frequent finding and asks for a rapid diagnostic evaluation. We report a case of recurrent hyponatremia secondary to an adrenal insufficiency of medicamentous and tuberculous origin. This case illustrates the importance of a rapid etiologic diagnosis of hyponatremia and allows us to review adrenal insufficiency of tuberculous origin. It also stresses the danger of potential drug interactions in case of corticosteroid substitution.
CASE RECORDS of the Massachusetts General Hospital: case 44391.
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 13-1971.
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CT findings in Addison's disease.
The computed tomographic findings in five patients with depleted adrenal cortical reserve were evaluated. A single patient with idiopathic adrenal atrophy revealed small adrenal remnants bilaterally. Three patients with tuberculosis demonstrated dense calcification in one or both adrenal beds without evidence of normal glandular remnants. On patient and active histoplasmosis showed enlarged nonhomogeneous glands of normal contour, a possible clue in distinguishing acute granulomatous adrenalitis from primary or secondary intraadrenal tumors.
Computerised tomography in tuberculous Addison's disease--a case report.
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Disseminated tuberculosis causing acute adrenal failure, C.T. findings with post mortem correlation.
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Addison's disease from tuberculosis in a centenarian.
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CT and MR imaging of head and neck tuberculosis.
Tuberculosis of the head and neck can involve the cervical lymph nodes, larynx, temporal bone, sinonasal cavity, eye, pharynx, thyroid gland, and skull base. Although computed tomography (CT) and magnetic resonance (MR) imaging can accurately demonstrate the sites, pattern, and extent of the disease, both modalities have limitations in the evaluation of head and neck tuberculosis. Imaging and clinical features of head and neck tuberculosis are often varied and nonspecific and frequently mistaken for those of carcinoma. However, tuberculous lymphadenitis is often characterized by areas of low attenuation or low signal intensity with rim enhancement or calcification, and laryngeal tuberculosis usually manifests as a diffuse bilateral lesion with or without a focal mass. A thorough knowledge of head and neck tuberculosis is important because early diagnosis and therapy may prevent a permanent loss of function or needless surgery.
Imaging of extrapulmonary tuberculosis.
Diagnosis of extrapulmonary tuberculosis is often difficult. Although positive chest radiographic findings or a positive tuberculin skin test supports the diagnosis, negative results do not exclude extrapulmonary tuberculosis. However, recognition and understanding of the radiologic findings of extrapulmonary tuberculosis can help in diagnosis. The spine is the most common site of skeletal involvement. The femur, tibia, and small bones of the hands and feet are most commonly involved by tuberculous osteomyelitis. Tuberculosis of the joints is characteristically monoarticular; the knee and hip are most frequently affected. Central nervous system tuberculosis takes various forms, including meningitis, tuberculoma, abscess, cerebritis, and miliary tuberculosis. Ileocecal involvement is seen in 80%-90% of patients with abdominal tuberculosis. The most common manifestation of abdominal tuberculosis is lymphadenopathy. Genitourinary tuberculosis is the most common manifestation of extrapulmonary tuberculosis. Lymphatic tuberculosis is more common among children, with cervical or supraclavicular nodes most frequently involved. Tuberculosis of the breast is extremely rare and occurs most often in young, multiparous, lactating women. The radiologic features of extrapulmonary tuberculosis mimic those of many diseases. A high level of suspicion is required, especially in high-risk populations. A positive culture or histologic analysis of biopsy specimens is still required in many patients for definitive diagnosis.
Extrapulmonary tuberculosis in Oklahoma, 1965 to 1973.
Three hundred seventy cases of extrapulmonary tuberculosis were reported to the Oklahoma State Department of Health between January 1, 1965 and December 31, 1973. The annual number of cases reported showed no tendency to decrease with time. A greater proportion of cases reported in recent years had bacteriologic confirmation. When compared to the distribution of all newly diagnosed cases of tuberculosis in the population, a greater proportion of newly diagnosed cases of extrapulmonary tuberculosis occurred in nonwhites. This was especially true to tuberculous meningitis, tuberculous lymphadenitis, and miliary tuberculosis. Possible reasons for the failure of the number of newly reported cases of extrapulmonary tuberculosis to decrease in recent years are presented.
Tuberculosis of the thyroid gland; report of a case.
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