Radiation semiotics of tuberculous lesions of the hip joint

Abstract

Specific tuberculous lesion of the hip joint is the second most common lesion among all forms of osteoarticular tuberculosis. Diagnosis of this lesion causes significant difficulties both in the presence and absence of the pulmonary process. This is due to the non-specificity of clinical and anamnestic signs, which leads to the erroneous diagnosis, viz. degenerative joint damage (coxarthrosis), and prolonged unjustified monitoring and treatment of such patients. Over the past 10 years, the widespread introduction of modern high-tech methods of radiation examination (such as computer tomography and magnetic
resonance imaging) into clinical practice allows for more detailed imaging of specific and non-specific changes in the hip joint, in contrast to radiography. The article presents the long-term experience of the Saint-Petersburg State Research Institute of Phthisiopulmonology, Ministry of Healthcare, Russian Federation, modern diagnostics of tuberculosis lesions of the hip joint, describes the features of the pathomorphology of the joint lesion (including in children of different age groups) which is the basis for radiation imaging of pathology. In adults, the primary localization of tuberculous granuloma is in
the bones forming the acetabulum, where the red bone marrow is preserved, while in children, TB granuloma is formed in any of the bones forming the hip joint. The possibilities of modern radiological methods of visualization of this pathology are described for their correct selection by the treating physicians in case of suspected hip tuberculous lesion. Differential diagnostic signs of the most common hip diseases are presented: non-specific coxitis, aseptic necrosis of the femoral head, coxarthrosis, which will allow treating physicians and radiologists to correctly interpret the changes detected by radiation imaging
methods when assessing changes in the hip joint.