Radio imaging features of hip tuberculosis; journey from ancient to modern concept, and its mimickers

Abstract

Hip tuberculosis (TB) is second to the spine and only hence, the majority of cases visit the medical clinic annually. In the early stages of hip TB, there is a diagnostic perplexity when plain X-rays are negative. Currently, diagnostic modalities have advanced compared to ancient times and, radio imaging features have become the backbone in proper diagnosis. When the disease has progressed gradually, definite radiological changes reveal on plain X-ray with the advent of time. Advanced diagnostic facilities such as ultrasonography (USG), magnetic resonance imaging (MRI), computed tomography (CT) scan as well as, nuclear medicine (in some instance), is universally established. Many radiologists referred hip TB as a double-edged sword in clinical practice as making a false diagnosis is potentially as harmful as missing the diagnosis in genuine cases. The incorrect diagnosis of hip TB results in the futile treatment as well as, the toxic side effects due to administered antitubercular drugs. A range of clinical situations mimics hip TB such as pyogenic arthritis (septic arthritis), transient synovitis, juvenile rheumatoid arthritis, and so on. Without radio imaging findings, it is extremely troublesome to make an accurate diagnosis. This review delineates radio imaging feature of hip TB and its mimickers, as well as, by the time, advancements in radio imaging concept of hip TB.