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IMAGES IN RADIOLOGY
Year : 2001  |  Volume : 47  |  Issue : 1  |  Page : 54

Tuberculosis of pubic symphysis presenting with hypogastric mass.


Department of General Surgery, LTMMC and LTMG Hospital, Sion, Mumbai - 400 022, India., India

Correspondence Address:
D J Balsarkar
Department of General Surgery, LTMMC and LTMG Hospital, Sion, Mumbai - 400 022, India.
India
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Source of Support: None, Conflict of Interest: None


PMID: 11590297

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Keywords: Adult, Case Report, Diagnosis, Differential, Human, Male, Pubic Symphysis, microbiology,radiography,Tuberculosis, Osteoarticular, diagnosis,radiography,


How to cite this article:
Balsarkar D J, Joshi M A. Tuberculosis of pubic symphysis presenting with hypogastric mass. J Postgrad Med 2001;47:54

How to cite this URL:
Balsarkar D J, Joshi M A. Tuberculosis of pubic symphysis presenting with hypogastric mass. J Postgrad Med [serial online] 2001 [cited 2019 Nov 16];47:54. Available from: http://www.jpgmonline.com/text.asp?2001/47/1/54/232


A 28-year-old male patient presented with a swelling in the hypogastrium since one and a half months associated with a history of chronic cough, anorexia and weight loss. There was no history of tuberculosis in self or contact with patient with tuberculosis. On examination there was a 5 x 5 cms soft, intrapariet al swelling in the hypogastrium. A clinical diagnosis of haemangioma of the pariet al wall of the hypogastrium was made.

X-ray of the pubic bones showed bony erosion of the public symphysis [Figure - 1]. Ultrasonography showed a 5 x 4 cms intrapariet al swelling in the hypograstric region. Computerised tomographic (CT) scan of the abdomen showed a 5 x 5 cms intrapariet al swelling in the hypograstrium with erosion of the public symphysis [Figure - 2]. CT guided needle aspiration of pus showed presence of acid fast bacilli. Fluid adenosine deaminase level was 284 U/L (normal of 0.1-22 U/L). Patient was started on antituberculous drugs and he showed good response. The hypogastric mass disappeared three months after treatment.


  ::   Discussion Top


Pubic bone is an exceptional site of tuberculous infection.[1],[2] Early diagnosis is essential before destructive changes set in.[2] Clinical signs noted are inflammatory pain in the pubic region and a hypogastric cystic mass.[2],[3]

Present case had a hypogastric lump. X-ray of local part shows irregular osteolysis of pubic bone, as was noted in reported case.[2] CT scan helps in confirming the diagnosis by demonstrating the presence of cystic mass with destruction or erosion of the pubic bone, as was well documented in the present case.[3] Confirmatory diagnosis is by demonstration of acid fast bacilli from pubic foci-aspirate.[2] Raised fluid adenosine de-aminase levels help in supporting the diagnosis of tuberculosis. The treatment of choice is a short course of anti-tuberculous drugs for six months.[2]

Diagnosis of pubic tuberculous osteoarthritis should be considered in unexplained causes of pubic pain especially in endemic countries.

 
 :: References Top

1. Tsay MH, Chen MC, Juang GY, Pang KK, Chen BF. Atypical skelet al tuberculosis mimiciking tumor metastases: report of a case. J Formos Med Assoc 1995; 94:428-431.  Back to cited text no. 1    
2.Benbouazza K, Allali F, Bezza A, el Hassani S, el Maghraoui A, Lazark N, et al. Pubic tuberculous osteo-arthritis. Apropos of 2 cases. Rev Chir Orthop Reparatrice Appar Mot 1997;83:670-672.  Back to cited text no. 2    
3.Manazaneque L, Marin I, Garcia-Bragado F, Beizteugi A, Dastis C, Sanchez-Matas P. Osteoarticular tuberculosis of the symphysis pubic presenting as a hypogastric mass in a woman with primary sjogrens syndrome. Br J Rheumatol 1992; 31:495-496.   Back to cited text no. 3    


    Figures

[Figure - 1], [Figure - 2]

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1 Advanced imaging of tuberculosis arthritis
Moore, S.L., Rafii, M.
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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
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