Tuberculous osteomyelitis of the scapula masquerading as metastasis

Abstract

Tuberculosis (TB) of the scapula is an unusual presentation of musculoskeletal tuberculosis. In an endemic area, this rare presentation may become more frequent. The indolent nature of tuberculous bone and joint disease often leads to delayed or missed diagnosis. It is not uncommon for this disease to mimic malignancy. Therefore, the prompt recognition of distinguishing features is vital for correct diagnosis. In particular, imaging is a key tool in helping to make the diagnosis, through the recognition of certain key radiological patterns. However, as there are no pathognomonic imaging findings, the diagnosis rests on histopathological and microbiological confirmation. We report a case of tuberculous osteomyelitis of the scapula.This entity has not received much attention in literature. Pure tuberculous osteomyelitis involving flat membranous bone, as depicted in this report, is rare. Our patient also had an ovarian malignancy, which had decreased our index of suspicion. We therefore present this case as tuberculosis masquerading a cystic scapular metastases.