Knee Ankyloses Associated with Tuberculosis from the Medieval Hungary – Differential Diagnosis Based on Medical Imaging Techniques

Authors

  • L. Paja,

    Corresponding author
    1. Department of Biological Anthropology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
    2. National Heritage Protection Centre, Hungarian National Museum, Szeged, Hungary
    3. Laboratoire de Paléoanthropologie de l'EPHE, École Pratique des Hautes Études, Talence, France
    • Correspondence to: László Paja, Department of Biological Anthropology, University of Szeged, H-6722, Egyetem utca 2, Szeged, Hungary.

      e-mail: pajalaca2000@yahoo.com

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  • H. Coqueugniot,

    1. UMR 5199 – PACEA, Talence, France
    2. Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
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  • O. Dutour,

    1. Laboratoire de Paléoanthropologie de l'EPHE, École Pratique des Hautes Études, Talence, France
    2. Department of Anthropology, University of Toronto, Toronto, Canada
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  • R. Willmon,

    1. Laboratoire de Paléoanthropologie de l'EPHE, École Pratique des Hautes Études, Talence, France
    2. Department of Anthropology, University of Western Ontario, London, Canada
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  • G. L. Farkas,

    1. Department of Biological Anthropology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
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  • A. Palkó,

    1. Department of Radiology, University of Szeged, Szeged, Hungary
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  • G. Pálfi

    1. Department of Biological Anthropology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
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Abstract

Osseous ankylosis of large joints that occurs secondary to infection is rarely described in developed countries, thanks to diagnostic techniques that allow early detection and treatment of the underlying infection. Evidence of the natural history and progression of the disease is now primarily studied through the observation and analysis of osteoarcheological specimens, and medical reports or books dating from the pre-antibiotic era. This report illustrates several cases where modern medical imaging techniques and ancient medical literature were successfully interpreted to diagnose rare, advanced-stage tuberculous alterations in osteoarcheological specimens.

Two skeletons from the Bátmonostor cemetery (Hungary) demonstrate complete unilateral ankylosis of the knee. Macroscopic and radiographic examinations were undertaken to assess the extent of skeletal changes and determine their cause. Data obtained from computed tomography (CT) were constructed in 2D and 3D. The 2D CT images revealed cavities involving both the metaphyses and the epiphyses. The 3D reconstructions allowed us to reconstruct the more precise volumetric morphology of the circumscribed lytic lesions, as well as clear ‘image-mirror’ lacunar volumes. On the basis of the macroscopic and radiological analyses, extra-spinal tuberculous infection seems to have been the most probable etiology of these two cases. Copyright © 2012 John Wiley & Sons, Ltd.

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