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      Pictorial essay: Orbital tuberculosis

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          Abstract

          Tuberculosis of the orbit is rare, even in places where tuberculosis is endemic. The disease may involve soft tissue, the lacrimal gland, or the periosteum or bones of the orbital wall. Intracranial extension, in the form of extradural abscess, and infratemporal fossa extension has been described. This pictorial essay illustrates the imaging findings of nine histopathologically confirmed cases of orbital tuberculosis. All these patients responded to antituberculous treatment.

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          Most cited references17

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          Ocular tuberculosis.

          In recent years tuberculosis has reemerged as a serious public health problem, raising the possibility that tuberculous eye disease may also become more prevalent. The predominant route by which tubercle bacilli reach the eye is through the bloodstream, after infecting the lungs. The pulmonary loci might not be evident clinically or radiographically. The most common manifestation of ocular tuberculosis in patients with pulmonary tuberculosis is choroiditis. Retinal periphlebitis is rarely caused by direct invasion of the retina by tubercle bacilli. Retinal tuberculosis is usually, but not always, secondary to an underlying choroiditis. Tuberculoprotein hypersensitivity may have a role in the pathogenesis of phlyctenulosis and Eales' disease. Both ocular and orbital tuberculosis are usually unilateral. Skin testing should be performed in selected patients based on the clinical presentation and/or a history of exposure to tuberculosis. The specificity of the PPD skin test for Mycobacterium tuberculosis increases with larger skin reactions and with a history of exposure to an active case of tuberculosis. Because of the potential for serious drug toxicities, empiric treatment with antituberculous chemotherapy should be reserved only for those cases that have an identifiable risk of tuberculous disease.
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            Tuberculosis of the orbit.

            Two cases of orbital tuberculosis in white Canadians are reported. The two patients did not suffer from pulmonary tuberculosis, the orbital disease was associated with tuberculosis sinusitis in the first case and blood-borne from constrictive tuberculous pericarditis in the second case. Acid-fast bacilli are difficult to detect in the pathological specimens and the diagnosis is usually based on the following: (1) the positive tuberculin skin test; (2) the caseating granulomatous inflammatory lesion on histopathology, which is highly suggestive of active tuberculosis; (3) the positive culture for Mycobacterium tuberculosis if the specimens are obtained early in the course of the disease; and (4) the complete resolution of the disease with the specific antituberculous medications.
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              Orbital Tuberculoma Extending into the Cranium

              Orbital tuberculoma is not uncommon in the developing countries, but intracranial extension of orbital tuberculoma is extremely rare. Our case, a 14-year-old girl, presented with proptosis and progressive painless diminution of vision eventually leading to loss of vision. MRI showed a mass with peripheral enhancement of contrast, separate from the optic nerve and extending into the cranium through the optic foramen. Early decompression and chemotherapy resulted in marked visual recovery. Histopathology of the excised lesion confirmed tuberculosis. The case is reported to highlight both the rare presentation as well as remarkable visual recovery in a patient with orbital tuberculosis.
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                Author and article information

                Journal
                Indian J Radiol Imaging
                IJRI
                The Indian Journal of Radiology & Imaging
                Medknow Publications (India )
                0971-3026
                1998-3808
                February 2010
                : 20
                : 1
                : 6-10
                Affiliations
                Department of Radiodiagnosis, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani and Kalawati Hospitals, New Delhi - 110 001, India
                Author notes
                Correspondence: Dr. Mahender K. Narula, Department of Radiodiagnosis, Lady Hardinge Medical College and associated hospitals, New Delhi - 110 001, India. E-mail: drmknarula@ 123456gmail.com
                Article
                IJRI-20-6
                10.4103/0971-3026.59744
                2844753
                20351984
                52b0444d-15fc-4031-95e5-1cc2e7dcfb05
                © Indian Journal of Radiology and Imaging

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Tuberculosis

                Radiology & Imaging
                computed tomography,orbital tuberculosis,lacrimal gland
                Radiology & Imaging
                computed tomography, orbital tuberculosis, lacrimal gland

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