Editor's note: Dr. Pate was assisted by John Forrest, MD, radiology professor at UC San Diego, in writing this article.
Tuberculosis (TB) is increasing to epidemic proportions in many major cities of the U.S. and Europe, particularly in AIDS patients. Although we do not treat this condition, it is critical to refer the patient for proper care if we suspect TB. Patients with cavitary TB are contagious and can infect anyone they are near. One of my colleagues was exposed to a patient with TB. He was the first to suspect the condition and referred the patient for treatment, unfortunately he and one of his staff were infected and needed treatment.
We may discover TB on spine films when the infection has caused a paraspinal abscess or destruction of an intervertebral disc. This is the TB we remember from our school days, but it is rather uncommon. The more common form of the disease is seen on a chest film or a poorly collimated thoracic spine film.
Radiographic appearances of pulmonary TB will differ depending on whether it is primary or secondary infection. Primary infection appears as enlarged hilar or mediastinal lymph nodes, often with associated pleural effusion and/or infiltrate. The hallmark is enlarged lymph nodes which help distinguish it from pneumonia. These patients often will have few symptoms. Secondary (re-infection or post primary) disease generally involves the apical region of the lungs, often bilateral, with cavitation, scarring and nodules. Calcification, volume loss and dense scarring are seen in burnt out cases.
Early detection of TB may save the patient a debilitating, permanently damaging illness. It will also prevent spread of this serious disease to others. The astute chiropractor can be invaluable in detecting the disease before these serious sequelae.
Deborah Pate, DC, DACBR
San Diego, California
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
