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Radiological Case of the Month

John L. Gwinn, MD; Fred A. Lee, MD; Michael R. Weir, MC, USA; Duangsuda Dharmasakti, MD
Am J Dis Child. 1973;125(5):713-714. doi:10.1001/archpedi.1973.04160050063012.
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Clinical History.  —A 2-year-old Thai girl had a three-month history of swelling of the right wrist, left elbow, and left ankle. There was a purulent discharge from the right wrist. Cough and dyspnea had been present for ten days prior to evaluation.

Physical Examination.  —The child was alert but irritable and malnourished. She was afebrile. Rales were heard bilaterally in the lungs. Small fluctuant areas were present in what was otherwise rather firm soft tissue swelling without erythema about the above described joints. Roentgenograms of the chest and skeleton were obtained.The admission chest roentgenograph revealed bilateral perihilar infiltrates, a large paravertebral mass with destruction involving three vertebral bodies, and a cystic expansile lesion involving the posterior right fifth rib (Fig 1). Expansile destructive lesions involving the metaphyseal areas of the radius, ulnar, and calcaneus were also noted. The soft tissue was swollen in these areas (Fig 2 and 3). The tuberculin skin test was positive and a gastric aspirate yielded Mycobacterium tuberculosis. Biopsy of the right wrist lesion revealed caseation and giant cells. The child responded to antituberculous therapy of aminosalicylic, isoniazid, and streptomycin. A body spica was applied for vertebral stabilization.


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