Abstract :
Isolated tuberculosis of the flat bone is very rare. Only a few such cases involve the scapular bone, and spine of the scapula is rarely involved. This condition is mostly misdiagnosed and wrongly treated. Scapular involvement in tuberculosis leads to decreased range of motion, clinically mimicking the frozen shoulder. Because of the presence of lytic lesions with marginal sclerosis, radiologically, it mimics tumors, which results in misdiagnosis. Moreover, lack of constitutional symptoms is the cause of delayed diagnosis. Isolated tuberculosis can be managed successfully with excellent prognosis without any complications if identified and treated early.Here, we report a very rare case of tuberculosis of the spine of the scapula in a 22-year-old female. The patient presented with pain and swelling in right scapular region from 6 months without any constitutional symptoms. Initially, the condition was misdiagnosed as traumatic hematoma. X-ray showed osteomyelitic changes in the spine of scapula and ultra-sonograph showed collection in the trapezius muscle. On magnetic resonance imaging, focal osteomyelitis of the medial part of the spine of scapula, with collection and multiple axillary lymph nodes involvement, was noted. The patient was managed with anti-tubercular drugs along with surgical debridement and curettage and the diagnosis was confirmed with biopsy. On serial follow-up, the patient recovered completely without any complications or recurrence.Although rare, tuberculosis should be suspected in patients presenting with a chronic swelling without constitutional symptoms in the scapular region, particularly in the developing countries. Early diagnosis and treatment result in excellent prognosis and outcome without any complication. This case highlights the salient features of scapular tuberculosis.
Keyword :
Scapula, Tubercular osteomyelitis, Flat bone, Isolated, Antitubercular treatment