Extra Pulmonary Tuberculosis, Clinical and Imaging Overview

Abstract

Objective: Extrapulmonary tuberculosis is the tuberculosis of the organs other than lungs,caused by mycobacterium 
tuberculosis. It is endemic in Kingdom of Saudi Arabia (KSA), especially in Makkah as Asian / Southeast people 
are more here.   
Design of Study: Experimental study. 
Place and Duration of Study: This study was conducted at King Abdul Aziz Hospital, Makkah during 1st Jan.2007 
to 31 Dec. 2008. 
Patients and Methods: In our study 13 cases where examined, diagnosed (by both imaging and laboratory work up) 
and treated for extra pulmonary tuberculosis in King Abdul Aziz Hospital, Makkah. Diagnosis of extra pulmonary 
tuberculosis is often difficult, especially where lungs are not involved. Radiological findings,especially C.T. were of 
great help in the diagnosis of extra pulmonary tuberculosis. Final diagnosis was made by histopathological 
examination and culture for most of the patients. Predominantly (82 %) two systems were involved. 44 % 
lymphadenopathy, mainly cervical and mediastinal while musculoskeletal system was involved (with involvement 
of vertebrae and paraspinal muscles) in 38 %. Diagnosis of extra pulmonary tuberculosis requires high clinical 
suspicion, different imaging work up and special staining / culture media for diagnosis of mycobacterium 
tuberculosis bacilli (acid-fast bacilli). Patient’s delay (average 2 months) and Doctor’s delay time (average 7 days) 
was also observed in individual cases. Various patterns of extra pulmonary tuberculosis (EPT) in Makkah in Saudi 
and Non-Saudi patients also compared with other parts of KSA by reviewing the literature.  
Results: The results showed that disease pattern has changed along with increase incidence rate of EPT in KSA over 
the last few years. True rates may be higher as there may be incomplete reporting or the patients may be referred to 
other areas of Kingdom. 
Conclusion: The clinical and radiological features of extra-pulmonary tuberculosis may clue to the diagnosis as 
many other diseases can mimic the imaging. The patterns of extrapulmonary tuberculosis may vary due to extent of 
disease involvement otherwise inclination of region involvement is same everywhere. Extrapulmonary tuberculosis 
is relatively less in Saudi patients (from 1:2 to 1:3 depending upon regions) as compared to non Saudi patients.