title: Diagnostic value of 99mTc-HMDP bone scan in atypical osseous tuberculosis mimicking multiple secondary metastases.
abstract: METHODS
  A case of atypical osseous tuberculosis (TB) mimicking multiple secondary metastases on radiologic and nuclear imaging is presented.
  
  
  OBJECTIVE
  To emphasize the contribution of nuclear bone scanning for the assessment of osseous tuberculosis in typical and atypical presentations.
  
  
  BACKGROUND
  Skeletal locations of TB mostly involve the dorsolumbar spine and diagnosis is often delayed. The presence of multiple TB sites can mimic secondary metastases and biopsy remains the mainstay for final diagnosis.
  
  
  METHODS
  Clinical symptoms, lab tests, and imaging data are presented. Possible diagnoses are discussed. A review of imaging characteristics in cases of typical and atypical presentations of osseous TB is proposed.
  
  
  RESULTS
  A dorsal spine spondylitis was first diagnosed on a 56-year-old patient presenting neurologic deficit of the left arm. Fine needle aspiration identified bacterial infection but was negative for Mycobacterium tuberculosis. Whole-body bone scan allowed the identification of an asymptomatic sacroiliac lesion, which was accessible to biopsy and gave a final diagnosis.
  
  
  CONCLUSIONS
  Nuclear bone scanning should be kept in mind when assessing spinal pain in patients at high risk of TB infection or reactivation.
authors.affiliation: Department of Nuclear Medicine, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris XII University, Creteil, France. evaev@tiscalinet.it
authors.forename: Eva
authors.initials: E
authors.lastname: Evangelista
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Itti
authors.forename: Zoulikha
authors.initials: Z
authors.lastname: Malek
authors.forename: Marc
authors.initials: M
authors.lastname: Bertocchi
authors.forename: Owonayo
authors.initials: O
authors.lastname: Oniankitan
authors.forename: Xavier
authors.initials: X
authors.lastname: Chevalier
authors.forename: Michel
authors.initials: M
authors.lastname: Meignan
mesh_terms: D000352:Africa, Northern / Q000208:ethnology; D001132:Arm; D001416:Back Pain / Q000209:etiology; D044963:Biopsy, Fine-Needle; D048909:Diabetes Complications; D003937:Diagnosis, Differential; D020802:Epidural Abscess / Q000209:etiology / Q000382:microbiology; D005188:False Negative Reactions; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D010014:Osteolysis / Q000209:etiology; D010243:Paralysis / Q000209:etiology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012008:Recurrence; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging; D012447:Sacrum / Q000000981:diagnostic imaging*; D013125:Spinal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000556:secondary*; D013166:Spondylitis / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000473:pathology; D013669:Technetium Tc 99m Medronate / Q000031:analogs & derivatives*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000382:microbiology; D014375:Tuberculoma / Q000000981:diagnostic imaging / Q000473:pathology; D014394:Tuberculosis, Osteoarticular / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000473:pathology
chemical_list: D019275:Radiopharmaceuticals; C024226:technetium Tc 99m hydroxymethylene diphosphonate; D013669:Technetium Tc 99m Medronate