Tuberculous arthritis with Phemister triad

Discussion:

This case shows the classic features of tuberculous arthritis, demonstrating Phemister triad with a marginal erosion at the lateral femoral head neck junction, juxta-articular osteopenia and late loss of joint space. Identifying the erosion at the femoral head neck junction in isolation could be misleading, as an apple core deformity is most often seen with synovial osteochondromatosis, but may also be seen with PVNS. Rarely, amyloidosis or rheumatoid arthritis may also lead to an "apple core" erosion pattern. 

A quote I like to keep in mind when reading chest radiographs: "There is no radiographic appearance [on chest radiographs] that is inconsistent with the diagnosis of tuberculosis infection." 

This case is courtesy of Deborah M. Forrester, MD

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