Spondylolisthesis coexisting with tuberculosis is rarely reported. There is a controversy whether spondylolisthesis coexists or precedes tuberculosis. Few cases of pathological spondylolisthesis secondary to tuberculous spondylodiscitis have been reported in the lumbar and lumbosacral spine. All cases in the literature presented as anterolisthesis, except one which presented as posterolisthesis of lumbar spine. Spondylolisthesis in the cervical spine is mainly degenerative and traumatic. Spondylolisthesis due to tuberculosis is not reported in the lower cervical spine. The exact mechanism of such an occurrence of spondylolisthesis with tuberculosis is sparsely reported in the literature and inadequately understood. We report a rare case of high grade pathological posterolisthesis of the lower cervical spine due to tubercular spondylodiscitis in a 67-year-old woman managed surgically with a three-year follow-up period. This case highlights the varied and complex presentation of tuberculosis of the lower cervical spine and gives insight into its pathogenesis, diagnosis, and management.
Aged ; *Cervical Vertebrae/pathology/radiography ; Female ; Humans ; *Spondylolisthesis/etiology/radiography ; *Tuberculosis, Osteoarticular/complications/diagnosis/pathology

Pancreatic tuberculosis is a rare clinical entity, presenting as malignancy mimicking pancreatic mass. Therefore, it represents a diagnostic challenge. To date, ten cases have been reported in Korea. I report an additional case and review all Korean reports about pancreatic tuberculosis. A 57-year-old woman presented with abdominal pain. Abdominal computed tomography (CT) revealed a 2.2x1.2 cm cystic mass in pancreatic body. She was followed for nine months, at which time a cystic mass was enlarged to 3.3x2.2 cm in size on the CT. An exploratory laparotomy was performed for the accurate diagnosis and to rule out the possibility of malignant change. Pathological examination of the resected specimen revealed chronic granulomatous inflammation with caseous necrosis and multinucleated giant cells, which was compatible with tuberculosis. Among the 11 cases of pancreatic tuberculosis, five cases were combined with pulmonary tuberculosis. The pancreatic tuberculosis frequently presented with multicystic pancreatic mass (81%) and the most common anatomic locations were the head (73%), tail (18%), and body (9%). Three cases were diagnosed by using US or EUS guided fine needle aspiration biopsy (FNAB), and all cases were medically cured without exploratory laparotomy. In summary, pancreatic tuberculosis, despite its rarity, should be considered for differential diagnosis of pancreatic cystic mass in endemic countries. Clinical suspicion and accurate diagnostic approach including FNAB of pancreatic tuberculosis are needed to avoid performing unnecessary laparotomy.
Diagnosis, Differential ; Female ; Humans ; Middle Aged ; Pancreatic Diseases/*diagnosis/pathology/radiography ; Pancreatic Neoplasms/diagnosis ; Tomography, X-Ray Computed ; Tuberculosis/*diagnosis/pathology/radiography

Although recently, there have been introduced many new diagnostic tools such as renal scanning and renogram, intravenous urogram remains to be one of the most useful method of urological diagnosis. Therefore it seems warranted to review 363 cases of intravenous urograms performed in the department of urology, St. Mary's hospital, Catholic Medical College during the period of January, 1962 to June, 1964. Among others, especial attention was paid to 60 cases of nonvisualizing kidneys. Of 60 nonvisualizing kidneys, renal tuberculosis occupied 27 cases(45%); ureteral and renal stones 13(21.6%); hydronephrosis 9(15%) (metastatic carcinoma 6(10%)and surgical manipulation 3(5%); Wilms' tumor 5 (8.3%) chronic atrophic pyelonephritis 3(5%) ; One case each of renal cell carcinoma, cystic kidney and thrombosis of the renal artery. Inasmuch as the present study revealed renal tuberculosis to be the most common cause of nonvisualizing kidneys, it is felt that one should always consider the possibility of tuberculosis in the diagnosis of nonvisualizing kidneys in Korea. This fact should be stressed because nontuberculous pathology such as chronic pyelonephritis has been implicated to be the most frequent cause of nonvisualizing kidneys by American authors.
Carcinoma, Renal Cell ; Diagnosis ; Hydronephrosis ; Kidney Diseases, Cystic ; Kidney* ; Korea ; Pathology ; Pyelonephritis ; Radiography* ; Renal Artery ; Thrombosis ; Tuberculosis ; Tuberculosis, Renal ; Ureter ; Urology ; Wilms Tumor

Mediastinal tuberculous lymphadenitis is rare in adults, and it is even rarer for dysphagia to be the presenting symptom of mediastinal tuberculous lymphadenitis. Mediastinal tuberculous lymphadenitis with esophageal symptoms has been presented as esophageal ulceration, mucosal or submucosal mass with ulceration, fistula or sinus formation, extrinsic compression, or displacement of the esophagus. An exaggerated form of extrinsic compression may be presented as a submucosal tumor, radiologically or endoscopically. A barium esophagography of a 34 year-old woman with painful dysphagia revealed a large submucosal tumor-like mass on the mid-esophagus. The symptom was spontaneously improved over a 3-week period together with reduction of the mass size. A computed tomography of the chest disclosed an enlarged subcarinal lymph node and histologic examination of the specimen obtained by thoracoscopic biopsy brought about a diagnosis of tuberculosis. We herein report a case of mediastinal tuberculosis with unusual manifestations.
Adult ; Case Report ; Deglutition Disorders/*etiology ; Diagnosis, Differential ; Esophageal Neoplasms/*diagnosis ; Esophagoscopy ; Esophagus/pathology/radiography ; Female ; Human ; Mediastinal Diseases/*complications/*diagnosis ; Radiography, Thoracic ; Tomography, X-Ray Computed ; Tuberculosis, Lymph Node/*complications/*diagnosis

Undifferentiated sarcoma is an uncommon primary malignant tumor of the liver typically occurring in older children. It is also referred to as malignant mesenchymoma, fibromyxosarcoma, or mesenchymal sarcoma. We experienced a case of undifferentiated sarcoma in 72-year-old male. Contrast enhanced liver CT scan revealed a 3.4 cm heterogeneously enhancing, ill-defined, and low attenuated mass in the left liver and subtle intrahepatic duct dilatation. And, in tubogram, there were segmental stenosis and occlusion from the hilum to the proximal common bile duct. We did ultrasonography guided liver biopsy. The pathologic finding revealed infiltrative growth of atypical cells with rhabdoid features. Some atypical cells showed clear cytoplasm, but no organoid pattern was identified. The stroma around atypical cells was filled with eosinophilic hyaline material. These tumor cells were positive for vimentin only, and the tumor was consistent with undifferentiated sarcoma of the liver.
Aged ; Bile Ducts, Intrahepatic/pathology ; Diagnosis, Differential ; Dilatation, Pathologic ; Humans ; Klatskin's Tumor/diagnosis ; Liver Neoplasms/*diagnosis/pathology/ultrasonography ; Male ; Positron-Emission Tomography ; Sarcoma/*diagnosis/pathology/ultrasonography ; Tomography, X-Ray Computed ; Tuberculosis/drug therapy/radiography ; Vimentin/metabolism

Pulmonary tuberculosis is still serious, one of the great public health problems in Korea. Recently, the increase in the aged population, human immunodeficiency virus coinfection, and drug-resistant tuberculosis have reinforced the need for improved rapid diagnostics and better treatment strategies. The basic principles of care for persons with, or suspected of having, pulmonary tuberculosis are the same worldwide. The standard guidelines and recent advances in diagnosis and treatment are summarized in this article. Prompt, accurate diagnosis of pulmonary tuberculosis should be established using chest radiography, sputum microscopy, and culture in liquid and solid medium. The further evaluation of chest imaging, histopathological examination of biopsy samples, nucleic acid amplification tests, immunological evaluation, and new molecular diagnostic tests supplement earlier, improved diagnosis, especially in patients with smear-negative pulmonary tuberculosis. Standardized treatment regimens of proven efficacy should be used with appropriate patient education and treatment support. The response to treatment and the presence of side effects of antituberculosis drugs should be monitored regularly. In addition, essential public health responsibilities and public-private collaboration must be carried out for effective patient care and pulmonary tuberculosis control.
Biopsy ; Coinfection ; Cooperative Behavior ; Diagnosis* ; HIV ; Humans ; Korea ; Microscopy ; Nucleic Acid Amplification Techniques ; Pathology, Molecular ; Patient Care ; Patient Education as Topic ; Public Health ; Radiography ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary*

Pulmonary tuberculosis (PTB) is a common infectious disease worldwide. However, mediastinal tuberculous lymphadenitis complicated by oesophageal involvement and oesophago-respiratory fistula is now uncommon due to improved anti-tuberculous regimes and better general awareness. The overall incidence of acquired oesophago-respiratory fistula due to infection is low, and therefore, the lesion is not often a frontrunner in differential diagnosis. Still, tuberculous oesophago-respiratory fistulae can potentially occur in patients with retroviral disease, as they tend to have atypical and more virulent manifestations. In this study, we report the case of multiple oesophago-respiratory fistulae in a patient with PTB and retroviral disease, and highlight the computed tomography features of these lesions as an atypical presentation of PTB in retroviral disease. Clinicians should suspect oesophago-respiratory fistulae if patients present with Ono’s sign, and remain particularly vigilant for patients with underlying PTB and retroviral disease, as early diagnosis and treatment could help to reduce mortality.
Adult ; Diagnosis, Differential ; Esophagus ; physiopathology ; Fistula ; diagnosis ; Humans ; Lung ; pathology ; Male ; Radiography, Thoracic ; Retroviridae ; metabolism ; Tomography, X-Ray Computed ; Trachea ; physiopathology ; Treatment Outcome ; Tuberculosis, Lymph Node ; Tuberculosis, Pulmonary ; complications ; diagnosis

Adrenal Cortex Hormones ; therapeutic use ; Antiviral Agents ; therapeutic use ; Diagnosis, Differential ; Granulomatosis with Polyangiitis ; diagnosis ; Humans ; Lung Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; Lymphomatoid Granulomatosis ; diagnostic imaging ; drug therapy ; pathology ; Prognosis ; Radiography ; Sarcoidosis ; diagnosis ; Tuberculosis, Pulmonary ; diagnosis

Spinal tuberculosis characteristically involves the paradiscal area of vertebral bodies with a narrowing of the disc space. In this study, we reported four atypical forms of Pott's disease, including one hundred and eighty-four patients treated between 1985 and 1998. Two cases presented with noncontiguous multilevel involvement, where one case had transverse process involvement alone and the other had involvement of the neural arch. Atypical tuberculosis of the spine was found in 2.1% of the patients.
Adolescence ; Adult ; Case Report ; Human ; Magnetic Resonance Imaging ; Male ; Middle Age ; Spine/radiography ; Spine/pathology ; Tomography, X-Ray Computed ; Tuberculosis, Spinal/diagnosis*

OBJECTIVETo explore the clinical value of CT-guided percutaneous needle biopsy (PCNB) for diagnosis of atypical pulmonary tuberculosis.

METHODSThe data from 15 patients undergoing diagnostic PCNB for pulmonary tuberculosis were retrospectively analyzed. Prior to PCNB, definitive diagnosis failed to be obtained from other examinations including sputum smear in 10 cases, fiberoptic bronchoscopy in 12, chest X-ray in 13, CT scan in 15, and position emission tomography (PET) with CT examination in 1 case.

RESULTSSputum smears and fiberoptic bronchoscopy both failed to produce positive results and pulmonary and/or mediastinal lesions were shown by chest X-ray, CT, and PET-CT. Pulmonary tuberculosis were diagnosed in the 15 cases by histopathological examination following PCNB, and pneumothorax in relation to PCNB occurred in 3 cases and hemoptysis in 1 case.

CONCLUSIONPCNB provides a safe and accurate means for diagnosis of pulmonary tuberculosis when imaging and other diagnostic modalities fail to result.

Adolescent ; Adult ; Biopsy, Needle ; methods ; Female ; Humans ; Male ; Middle Aged ; Radiography, Interventional ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary ; diagnosis ; diagnostic imaging ; pathology