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NEURORADIOLOGY Table of Contents   
Year : 2005  |  Volume : 15  |  Issue : 3  |  Page : 343-344
Calavarial tuberculosis with direct intracranial extension-imaging findings


Department of Radiology and Imaging, Neurosurgery and Gastro surgery, India

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Keywords: Calavarial tuberculosis, plain X-ray, CT, MR

How to cite this article:
Sharma A, Chibber S, Puri S, Sharma A, Mishra P K. Calavarial tuberculosis with direct intracranial extension-imaging findings. Indian J Radiol Imaging 2005;15:343-4

How to cite this URL:
Sharma A, Chibber S, Puri S, Sharma A, Mishra P K. Calavarial tuberculosis with direct intracranial extension-imaging findings. Indian J Radiol Imaging [serial online] 2005 [cited 2020 Dec 4];15:343-4. Available from: https://www.ijri.org/text.asp?2005/15/3/343/29150

   Introduction Top


Calavarial tuberculosis is a rare manifestation of extra pulmonary tuberculosis with few reports in the literature [1],[2]. The radiological picture can vary, either with an osteolytic or sclerotic lesion. Osteolytic lesion is generally circumscribed or of spreading type [3].

CT picture is not very specific in the present case but MR findings showed cold abscess with peripheral rim enhanhancement, with dural extension and calavarial defect.


   Case report Top


A 14 -year old Muslim patient presented with swelling in right parietal scalp region for the last 4 months. The swelling was slowly progressing and patient had altered sensorium and headache for the last 15 days. Examination revealed it as a soft tissue swelling and it was neither hot nor pulsatile.Investigation revealed raised ESR i.e. 45 mm.X-ray skull showed ill-defined osteolytic lesion in the tempro-parietal region [Figure - 1].CT scan revealed

soft tissue density lesion of CT value 58H[Figure - 2].Bone window showed an evidence of lytic lesion [Figure - 3].No evidence of intracranial extension could be documented on CT.On T1 well-defined hypo intense area with narrow hypo intense neck extending intracranially was documented [Figure - 4].On T2, lesion was hyper intense [Figure - 5].On GD enhanced image ,there was marked rim enhancement with intracranial enhancement of the dura[Figure - 6].In view of all radiological investigations, a diagnosis of cold abscess-?tubercular with intracranial extension was considered. The lesion was exposed after

taking incision around the swelling. The whole lesion was excised piecemeal up to normal bony margin. The contents of lesion resembled that of casseous material. The defect in the calavarial bone repaired.Histopathological examination confirmed that the lesion was tubercular osteomellitus.HIV status was checked and was found to be negative. Patient was put on ATT.and showed marked improvement.


   Discussion Top


Isolated calavarial tuberculosis is rare[3] but can be seen in association with pulmonary tuberculosis,tuberculous osteomellitus involving other bones, cervical lymadenitis,renal and intestinal tuberculosis. However, in the present case it was an isolated lesion of calavarial bone. The frontal and parietal bones ,having greater area of diploic space and cancellous bone are more vulnerable [4].The tubercular process reaches the vault bones possibly through the blood stream. Concentrically placed fibroblasts proliferate and encircle the tubercular granulation tissue and prevents its extension through the bone; which when deficient ,extension occurs through the inner or outer or both tables [5].Sutures are not a strong barrier to spread but dura usually prevents intradural extension, however in the present case dura is also involved. The extensive area of destruction occurs before clinical presentation. The radiological picture can vary as is seen in present case .However MR picture was quite diagnostic in the present case. We should keep the differential diagnosis of pyogenic osteomellitus,calavarial metastases,myeloma,hemangioma,giant cell tumor or even an ABC and Langerhans cell histiocytosis[5].The criterion for diagnosis is isolation of tubercular bacilli, which in most of the time is not possible. Histological features of casseous granuloma are often helpful,alongwith radiological features. We recommend that to document intracranial extension contrast enhanced MR examination may be added in the armentarium of radiological investigations.

 
   References Top

1.Strauss DC.Tuberculosis of flat bones of the vault of skull. Surg Gynecol Obstet 1933; 57:384-98.  Back to cited text no. 1    
2.Barton CJ.Tuberculosis of the vault of the skull.Br J Radiol 1961 ;34:286-90  Back to cited text no. 2  [PUBMED]  
3.Jadhav RN, Palande DA, et al.Calavarial tuberculosis. Neurosurgery 1999; 45:1345-50.  Back to cited text no. 3    
4.Gupta PK, Kolluri VRS et al.Calavarial tuberculosis: A report of two Cases. Neurosurgery 1989; 25:830-3  Back to cited text no. 4    
5.Patankar T,Varma et al. Radiographic findings in tuberculosis of the calavarium. Neuroradiology 2000; 42:518-21.  Back to cited text no. 5    

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Correspondence Address:
A Sharma
C 10 Kendriya Vihar Sector 51 NOIDA 201307
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.29150

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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]



 

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