Spectrum of Extrapulmonary Tuberculosis: Radiologic Manifestations Figan Binokay, MD, Mehmet Inal, MD, Kenon Bicakci, MD, Sureyya Soyupak, MD, Erol Akgul, MD, and Mahmut Oguz, MD Abstract Extrapulmonary tuberculosis mostly affects mus- culoskeletal, genitourinary, gastrointestinal, and central nervous systems. In the musculoskele- tal system, tuberculosis manifests characteristi- cally as monoarthritis or osteomyelitis that most frequently involves the vertebral column, hip, and knee. Genitourinary involvement usually begins in the upper tracts as tuberculous pyelo- nephritis and spreads out to the lower tract along the uroepithelial mucosa. Tuberculosis may involve the gastrointestinal tract, hepatobiliary system, and mesenteric or peritoneal structures in the abdominal cavity. Within the central nervous system, tuberculosis may manifest as meningitis or mass lesions, such as tuberculoma or tuberculous brain abscesses. Rare reported sites of tuberculous involvement include the eye, larynx, paranasal sinuses, pericardium, and breast. Since tuberculous involvement in any system or organ may be confused with many other pathology, both clinically and radiological- ly, radiologists should be aware of the different radiographic appearances of this protean but curable disease and should consider it in the differential diagnosis. (The Radiologist 2003;10:221–234) T uberculosis is as old as humanity itself. In the first half of the 20th century, tuberculosis was a common and deadly disease. After a period of decline in inci- dence, the rapid increase in the number of severely immunocompromised patients and the development of multidrug-resistant strains have led to tuberculosis reemerging as a major health problem throughout the world. 1–5 This article reviews the imaging features of tuberculous involvement of extra- pulmonary sites in an effort to alert radiol- ogists for the differential diagnosis and correct management of this protean but curable disease. MUSCULOSKELETAL TUBERCULOSIS Tuberculous Spondylitis (Pott Disease) The spine is the most common site of musculoskeletal tuberculosis. The disease most often affects the lower thoracic and upper lumbar regions of the spine. 2–4 The most common site of origin is within the anterior part of the vertebral body near the vertebral end plates. Disk space involvement, angulation, gibbous deformity, and subluxation of the vertebral bodies in Pott disease occur late in the course progress of the disease. 6–8 Plain radiographs characteristically show destruction of the vertebral body, involvement of several vertebrae, and disk space narrowing (Fig. 1). There is anterior wedging and decreased height of the verte- bral body or pedicular erosion. Computed tomography (CT) typically demonstrates disk space narrowing, para- vertebral soft-tissue masses, multilevel in- volvement, and kyphosis. Lytic areas of destruction, which are better observed by CT, have a cystic or ‘‘Swiss cheese’’ appear- ance. Paraspinal soft-tissue masses are well demonstrated on axial scans, and calcifica- tion within the abscess is virtually pathogno- monic for tuberculosis (Fig. 2). 2,8 At the early stage, bone lesions in spinal tuberculosis are hypointense on T1-weighted images and hyperintense on T2-weighted spin echo sequences. The signal changes are DOI: 10.1097/01.rad.0000088080.77991.0e The RADIOLOGIST Volume 10, Number 5 September 2003 Department of Radiology, Faculty of Medicine, C ¸ukurova University, Balcaly ´ Adana. Address correspondence and reprint requests to: Figen Binokay, MD, Department of Radiology, Faculty of Medicine, C ¸ukurova University, Balcaly´ Adana 01330, Turkey. E-mail: fbinokay@cu.edu.tr. Copyright A 2003 by Lippincott Williams & Wilkins ISSN: 1069-1286/03/1005-0221 Original Article 221 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.