Journal of Postgraduate Medicine
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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




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


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 2020 Nov 29 ];47:54-54
Available from: https://www.jpgmonline.com/text.asp?2001/47/1/54/232


Full Text

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.


  ::   DiscussionTop


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.
2Benbouazza 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.
3Manazaneque 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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