Computed tomographic features of abdominal tuberculosis: unmask the impersonator!
- 212 Downloads
Abdominal tuberculosis (ATB) mimics various infectious, inflammatory, and neoplastic conditions and hence requires a high index of suspicion for accurate diagnosis, especially in low prevalence areas. It is difficult to consistently establish a histopathological diagnosis of ATB which underlines the importance of supportive evidences for institution of prompt empirical therapy to prevent associated morbidity and mortality.
We retrospectively evaluated clinical and imaging features of 105 ATB cases and classified their CT findings based on peritoneal, lymph node, bowel, and solid organ involvement. Concomitant pulmonary and extra-pulmonary involvement was assessed.
Abdominal pain (78.1%) followed by fever (42.9%) were the commonest presenting symptoms. Peritoneal TB (77.14%) most commonly presented with a mix of ascites (49.38%), peritoneal (28.40%), and omental involvement (27.16%). Lymphadenopathy (57.1%) most commonly presented as necrotic nodes (81.67%) at mesenteric, peripancreatic, periportal, and upper paraaortic regions. Commonest site of bowel involvement (cumulative of 62.85%) was ileocecal region, with the commonest pattern of involvement being circumferential bowel wall thickening without bowel stratification with mild luminal narrowing. Hepatic (13.33%) and splenic (16.2%) involvement predominantly presented as multiple microabscesses. Adrenal and pancreatic involvement was noted in 4.7% and 1.9% of patients, respectively. 38.1% patients showed concomitant pulmonary and extra-pulmonary TB.
ATB has varied radiological features; however, peritoneal involvement in the form of mild ascites, smooth peritoneal thickening, smudgy omentum, multi-focal bowel involvement, necrotic nodes, and multiple visceral microabscesses point towards a diagnosis of ATB in appropriate clinical setting.
KeywordsAbdominal tuberculosis Peritoneal thickening Necrotic nodes Ileocecal tuberculosis Hepatic and splenic microabscesses
Compliance with ethical standards
Sources of financial support-none.
Conflicts of interest
- 1.Organization WH (2016) Global tuberculosis report 2016Google Scholar
- 2.Sharma MP, Bhatia V (2004) Abdominal tuberculosis. Indian J Med Res 120(4):305Google Scholar
- 3.Hopewell PC (1995) A clinical view of tuberculosis. Radiol Clin North Am 33(4):641–653Google Scholar
- 5.Ihekwaba FN (1993) Abdominal tuberculosis: a study of 881 cases. J R Coll Surg Edinb 38(5):293–295Google Scholar
- 11.Na-ChiangMai W, Pojchamarnwiputh S, Lertprasetsuke N, Chitapanarux T (2008) CT findings of tuberculous peritonitis. Singap Med J 49(6):488Google Scholar
- 19.Pongpornsup S, Eksamutchai P, Teerasamit W (2013) Differentiating between abdominal tuberculous lymphadenopathy and lymphoma using multidetector computed tomography (MDCT). J Med Assoc Thail 96(9):1175–1182Google Scholar
- 20.Cohan RH, Dunnick NR (1994) The retroperitoneum. In: Siegel MJ (ed) Computed tomography and magnetic resonance imaging whole body. St Louis: Mosby-Year Book, Inc., pp 1292–1326Google Scholar
- 24.Aston NO, de Costa AM (1990) Abdominal tuberculosis. Br J Clin Pharmacol 44:492–499Google Scholar
- 26.Das HS, Rathi P, Sawant P, et al. (2000) Colonic tuberculosis: colonoscopic appearance and clinico-pathologic analysis. J Assoc Phys India 48(7):708–710Google Scholar
- 32.Welzel TM, Kawan T, Bohle W, et al. (2010) An unusual cause of dysphagia: esophageal tuberculosis. J Gastrointest Liver Dis 19(3):321–324Google Scholar
- 33.Chetri K, Prasad KK, Jain M, Choudhuri G (2000) Gastric tuberculosis presenting as non-healing ulcer: case report. Trop Gastroenterol Off J Dig Dis Found 21(4):180–181Google Scholar
- 36.Sharma SK, Smith-Rohrberg D, Tahir M, Mohan A, Seith A (2007) Radiological manifestations of splenic tuberculosis: a 23-patient case series from India. Indian J Med Res 125(5):669Google Scholar