Mahajan A, Santhoshkumar GV, Kawthalkar AS, Vaish R, Sable N, Arya S, Desai S. Case of victims of modern imaging technology: Increased information noise concealing the diagnosis. World J Radiol 2017; 9(12): 454-458 [PMID: 29354211 DOI: 10.4329/wjr.v9.i12.454]
Corresponding Author of This Article
Abhishek Mahajan, MRes, MD, Radiodiagnosis, Fellowship in Cancer Imaging, Associate professor, Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Room No. 127, Dr E Borges Road, Parel, Mumbai 400012, India. mahajana@tmc.gov.in
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Radiol. Dec 28, 2017; 9(12): 454-458 Published online Dec 28, 2017. doi: 10.4329/wjr.v9.i12.454
Case of victims of modern imaging technology: Increased information noise concealing the diagnosis
Abhishek Mahajan, G V Santhoshkumar, Ameya Shirish Kawthalkar, Richa Vaish, Nilesh Sable, Supreeta Arya, Subhash Desai
Abhishek Mahajan, G V Santhoshkumar, Ameya Shirish Kawthalkar, Richa Vaish, Nilesh Sable, Supreeta Arya, Subhash Desai, Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai 400012, India
Author contributions: All authors contributed to study concepts/study design, data acquisition or data analysis/interpretation, manuscript drafting or manuscript revision for important intellectual content, manuscript final version approval, literature research,manuscript editing and integrity of the data/ the accuracy of the data analysis.
Informed consent statement: Participant gave informed consent for data sharing.
Conflict-of-interest statement: I confirm that this manuscript is not published anywhere else and on behalf of all authors, I state that there is no conflict of interests (including none for related to commercial, personal, political, intellectual, or religious interests).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Abhishek Mahajan, MRes, MD, Radiodiagnosis, Fellowship in Cancer Imaging, Associate professor, Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Room No. 127, Dr E Borges Road, Parel, Mumbai 400012, India. mahajana@tmc.gov.in
Telephone: +91-99-20210811
Received: September 13, 2017 Peer-review started: September 19, 2017 First decision: October 23, 2017 Revised: November 9, 2017 Accepted: November 27, 2017 Article in press: November 27, 2017 Published online: December 28, 2017 Processing time: 103 Days and 10.4 Hours
ARTICLE HIGHLIGHTS
Case characteristics
A case of tubercular arthritis who underwent a number of investigations in suspicion of malignancy, each one adding to the confusion rather than helping in arriving diagnosis.
Clinical diagnosis
Infective arthritis of hand.
Differential diagnosis
Rheumatoid arthritis; Septic arthritis; Primary or secondary malignancy.
Laboratory diagnosis
Demonstration of Mycobacterium tuberculosis on culture of bone tissue/positive Ziehl-Neelsen staining/rapid PCR DNA detection.
Imaging diagnosis
Radiography: Juxta-articular osteopenia, subarticular erosions and joint space narrowing, with or without soft tissue component. MRI: Synovitis, joint effusion, subarticular erosions, active and chronic pannus, abscesses, hypo-intense synovium and bone chips.
Pathological diagnosis
Features favoring tubercular infection as granulomas with caseous necrosis in synovial tissue and bone.
Treatment
Skeletal tuberculosis including arthritis are treated with 9-12 mo of anti-tubercular drug regimen.
Related reports
Several cases of tubercular involvement of small joints of hand are reported in literature. In most of the cases, septic and rheumatoid arthritis were considered as differential diagnosis. Two cases of tubercular arthritis mimicking neoplasm have been reported.
Term explanation
VOMIT: Victims of modern imaging technology; Phemister’s triad: Juxta-articular osteopenia, subarticular erosions and joint space narrowing.
Experiences and lessons
Following standardized guidelines reduces the errors in diagnostic and treatment workflow. While making of provisional diagnosis, a radiologist should think of common disease over uncommon diseases. A free and open discussion among clinicians, radiologists and pathologists should be encouraged.
