"Caught by the eye of sound" : epigastric swelling due to xiphisternal tuberculosis

doi:10.12659/PJR.899329

"Caught by the eye of sound" : epigastric swelling due to xiphisternal tuberculosis

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"Caught by the eye of sound" : epigastric swelling due to xiphisternal tuberculosis

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title:	"Caught by the eye of sound" : epigastric swelling due to xiphisternal tuberculosis
author:	Grover Shabnam Bhandari, Arora Sumit, Kumar Amit, Grover Hemal, Katyan Amit, Nair Deepthi Mohan
journal title:	Polish Journal of Radiology
volume:	82
date of publication :	2017
pages:	41-45
ISSN:	1733-134X
eISSN:	1899-0967
DOI:	10.12659/PJR.899329
notes:	Bibliogr. s. 45
language:	English
journal language:	English
abstract in English:	BACKGROUND: Common causes of an epigastric mass include hepatomegaly, pancreatic pseudocyst and epigastric hernia, less common causes being carcinoma of the stomach or pancreas, whereas diseases of the sternum presenting as an epigastric swelling is extremely uncommon. We report a case of tubercular infection of the sternum located in the xiphoid process resulting in its presentation as an epigastric swelling. CASE REPORT: A 30-year-old immunocompetent woman with complaints of an epigastric swelling and undocumented pyrexia for four months was referred for sonographic evaluation with a clinical suspicion of an incompletely treated liver abscess. The patient was examined with ultrasound, sternal radiographs, CT and MRI. Ultrasound revealed a heterogeneous epigastric collection with linear echogenic components suggestive of bone fragments. These appearances suggested chronic infective osteomyelitis of the xiphoid process of the sternum. Lateral chest radiograph demonstrated lytic destruction of the xiphisternum. Tubercular etiology was considered and further evaluation with Multidetector Computed tomography (MDCT) and Magnetic Resonance Imaging (MRI) demonstrated erosive osteomyelitis of the xiphoid process with enhancing inflammation and collection in the adjoining soft tissue. Ultrasound-guided aspiration, PCR and Amplified Mycobacterium tuberculosis DNA test confirmed tubercular infection. CONCLUSIONS: We report a new case of osteo-articular tuberculosis localized to the xiphisternum, a rare clinical entity with an extremely unusual clinical presentation as an epigastric mass. The role of ultrasound in primary diagnosis and as an interventional diagnostic modality for guided aspiration is highlighted.
keywords in English:	magnetic resonance imaging, multidetector computed tomography, sternum, osteoarticular, tuberculosis, ultrasonography, xiphoid bone
type:	journal article
subtype:	academic paper

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