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Disseminated tuberculosis
ARTICLES
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Spatial epidemiology: methods and applications. Oxford: Oxford University Press, 2000: 68–84. Department of Health. Quality and performance in the NHS. Performance indicators: July, 2000. www.doh.gov.uk/ nhsperformanceindicators/index.htm (accessed July 3, 2001). Mohammed MA, Cheng KK, Rouse A, Marshall T. Bristol, Shipman, and clinical governance: Shewhart’s forgotten lessons. Lancet 2001; 357: 463–67. The inquiry into the management of care of children receiving complex heart surgery at the Bristol Royal Infirmary. Interim report: removal and retention of human material. www.bristolinquiry.org.uk/interim/index.htm (accessed July 3, 2001). Horton R. The real lessons from Harold Frederick Shipman. Lancet 2001; 357: 82–83.
19 Ramsay S. Surgeon struck off in Canada, disgraced in UK. Lancet 2000; 356: 403. 20 Secretary of State for Health. The new NHS. London: Stationery Office, 1997 (Cm 3807). 21 National Institute for Clinical Excellence. www.nice.org.uk/nice-web/ (accessed July 3, 2001). 22 Commission for Health Improvement. www.chi.nhs.uk/ (accessed July 3, 2001). 23 NHS Executive. The NHS Performance Assessment Framework. www.doh.gov.uk/nhsexec/nhspaf.htm (accessed July 3, 2001). 24 Select Committee on Science and Technology. Human genetic databases: challenges and opportunities. London: Stationery Office, 2001 (HL Paper 57).
Clinical picture: Disseminated tuberculosis Bohdan Bybel, Randall C Starling, Richard C Brunken
During investigations for ischaemic cardiomyopathy, a 58-year-old middle-eastern man underwent 18-Fluoro-2-deoxy-glucose (FDG) positron emission tomography (PET) of the chest. Unexpectedly, multiple foci of intense lung and bony thorax uptake (figure, left) were noted. Diagnostic possibilities included hypermetabolic neoplastic lesions, active non-infectious granulomatous disease, or acute infection. Magnetic resonance imaging of the lumbar spine suggested osteomyelitis with abscess formation (figure, middle). The chest radiograph (figure, right) demonstrated right upper paravertebral and left retrocrural soft tissue masses (arrows). A computed tomography-guided aspiration of the paraspinous fluid collection showed Mycobacterium tuberculosis. Usually used to evaluate single pulmonary nodules and other suspected malignant diseases, FDG-PET clarifies equivocal findings. However, positive FDG-PET studies need to be interpreted with caution. Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 (B Bybel R Starling MD, R C Brunken MD)
THE LANCET • Vol 358 • July 21, 2001
FRCPS,
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For personal use. Only reproduce with permission from The Lancet Publishing Group.
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Spatial epidemiology: methods and applications. Oxford: Oxford University Press, 2000: 68–84. Department of Health. Quality and performance in the NHS. Performance indicators: July, 2000. www.doh.gov.uk/ nhsperformanceindicators/index.htm (accessed July 3, 2001). Mohammed MA, Cheng KK, Rouse A, Marshall T. Bristol, Shipman, and clinical governance: Shewhart’s forgotten lessons. Lancet 2001; 357: 463–67. The inquiry into the management of care of children receiving complex heart surgery at the Bristol Royal Infirmary. Interim report: removal and retention of human material. www.bristolinquiry.org.uk/interim/index.htm (accessed July 3, 2001). Horton R. The real lessons from Harold Frederick Shipman. Lancet 2001; 357: 82–83.
19 Ramsay S. Surgeon struck off in Canada, disgraced in UK. Lancet 2000; 356: 403. 20 Secretary of State for Health. The new NHS. London: Stationery Office, 1997 (Cm 3807). 21 National Institute for Clinical Excellence. www.nice.org.uk/nice-web/ (accessed July 3, 2001). 22 Commission for Health Improvement. www.chi.nhs.uk/ (accessed July 3, 2001). 23 NHS Executive. The NHS Performance Assessment Framework. www.doh.gov.uk/nhsexec/nhspaf.htm (accessed July 3, 2001). 24 Select Committee on Science and Technology. Human genetic databases: challenges and opportunities. London: Stationery Office, 2001 (HL Paper 57).
Clinical picture: Disseminated tuberculosis Bohdan Bybel, Randall C Starling, Richard C Brunken
During investigations for ischaemic cardiomyopathy, a 58-year-old middle-eastern man underwent 18-Fluoro-2-deoxy-glucose (FDG) positron emission tomography (PET) of the chest. Unexpectedly, multiple foci of intense lung and bony thorax uptake (figure, left) were noted. Diagnostic possibilities included hypermetabolic neoplastic lesions, active non-infectious granulomatous disease, or acute infection. Magnetic resonance imaging of the lumbar spine suggested osteomyelitis with abscess formation (figure, middle). The chest radiograph (figure, right) demonstrated right upper paravertebral and left retrocrural soft tissue masses (arrows). A computed tomography-guided aspiration of the paraspinous fluid collection showed Mycobacterium tuberculosis. Usually used to evaluate single pulmonary nodules and other suspected malignant diseases, FDG-PET clarifies equivocal findings. However, positive FDG-PET studies need to be interpreted with caution. Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 (B Bybel R Starling MD, R C Brunken MD)
THE LANCET • Vol 358 • July 21, 2001
FRCPS,
187
For personal use. Only reproduce with permission from The Lancet Publishing Group.