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| IMAGES IN RADIOLOGY |
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| Year : 2001 | Volume
: 47
| Issue : 1 | Page : 54 |
Tuberculosis of pubic symphysis presenting with hypogastric mass.
DJ Balsarkar, MA Joshi
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
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 11590297 
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 |
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.
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 | |  |
| 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.  |
| 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. |
| 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.
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Figures
[Figure - 1], [Figure - 2]
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