Advertisement

Abdominal Radiology

, Volume 44, Issue 1, pp 11–21 | Cite as

Computed tomographic features of abdominal tuberculosis: unmask the impersonator!

  • Sneha Satish DeshpandeEmail author
  • Anagha Rajeev Joshi
  • Saurabh Satish Deshpande
  • Soyaf A. Phajlani
Article
  • 252 Downloads

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Abdominal tuberculosis Peritoneal thickening Necrotic nodes Ileocecal tuberculosis Hepatic and splenic microabscesses 

Notes

Compliance with ethical standards

Funding

Sources of financial support-none.

Conflicts of interest

None.

References

  1. 1.
    Organization WH (2016) Global tuberculosis report 2016Google Scholar
  2. 2.
    Sharma MP, Bhatia V (2004) Abdominal tuberculosis. Indian J Med Res 120(4):305Google Scholar
  3. 3.
    Hopewell PC (1995) A clinical view of tuberculosis. Radiol Clin North Am 33(4):641–653Google Scholar
  4. 4.
    McGuinness FE (2000) Tuberculosis of the gastrointestinal tract and peritoneum. In: McGuinness F (ed) Clinical imaging in non-pulmonary tuberculosis. Berlin: Springer, pp 107–137CrossRefGoogle Scholar
  5. 5.
    Ihekwaba FN (1993) Abdominal tuberculosis: a study of 881 cases. J R Coll Surg Edinb 38(5):293–295Google Scholar
  6. 6.
    Uygur-Bayramiçli O, Dabak G, Dabak R (2003) A clinical dilemma: abdominal tuberculosis. World J Gastroenterol WJG 9(5):1098CrossRefGoogle Scholar
  7. 7.
    Kapoor VK (1998) Abdominal tuberculosis. Postgrad Med J. 74(874):459–467CrossRefGoogle Scholar
  8. 8.
    Sinan T, Sheikh M, Ramadan S, Sahwney S, Behbehani A (2002) CT features in abdominal tuberculosis: 20 years experience. BMC Med Imaging 2(1):3.  https://doi.org/10.1186/1471-2342-2-3 CrossRefGoogle Scholar
  9. 9.
    Joshi AR, Basantani AS, Patel TC (2014) Role of CT and MRI in abdominal tuberculosis. Curr Radiol Rep 2(10):66.  https://doi.org/10.1007/s40134-014-0066-8 CrossRefGoogle Scholar
  10. 10.
    Debi U, Ravisankar V, Prasad KK, Sinha SK, Sharma AK (2014) Abdominal tuberculosis of the gastrointestinal tract: revisited. World J Gastroenterol 20(40):14831–14840.  https://doi.org/10.3748/wjg.v20.i40.14831 CrossRefGoogle Scholar
  11. 11.
    Na-ChiangMai W, Pojchamarnwiputh S, Lertprasetsuke N, Chitapanarux T (2008) CT findings of tuberculous peritonitis. Singap Med J 49(6):488Google Scholar
  12. 12.
    Smiti S, Rajagopal KV (2010) CT mimics of peritoneal carcinomatosis. Indian J Radiol Imaging 20(1):58CrossRefGoogle Scholar
  13. 13.
    Pickhardt PJ, Bhalla S (2005) Primary neoplasms of peritoneal and sub-peritoneal origin: CT findings. Radiographics 25(4):983–995CrossRefGoogle Scholar
  14. 14.
    da Rocha EL, Pedrassa BC, Bormann RL, et al. (2015) Abdominal tuberculosis: a radiological review with emphasis on computed tomography and magnetic resonance imaging findings. Radiol Bras. 48(3):181–191.  https://doi.org/10.1590/0100-3984.2013.1801 CrossRefGoogle Scholar
  15. 15.
    Pereira JM, Madureira AJ, Vieira A, Ramos I (2005) Abdominal tuberculosis: imaging features. Eur J Radiol 55(2):173–180CrossRefGoogle Scholar
  16. 16.
    Pombo F, Candamio MJD, Rodriguez E, Pombo S (1998) Pancreatic tuberculosis: CT findings. Abdom Imaging 23(4):394–397CrossRefGoogle Scholar
  17. 17.
    Mukesh GH, Theresa CM, Jo-Anne OS, et al. (2000) Tuberculosis from head to toe. RadioGraphics 20:449–470CrossRefGoogle Scholar
  18. 18.
    Zhang G, Yang Z, Yao J, et al. (2015) Differentiation between tuberculosis and leukemia in abdominal and pelvic lymph nodes: evaluation with contrast-enhanced multidetector computed tomography. Clinics 70(3):162–168CrossRefGoogle Scholar
  19. 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. 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
  21. 21.
    Lundstedt C, Myman R, Brismar J, Hugosson C, Kagevi I (1996) Imaging of tuberculosis II. Abdominal manifestations in 112 patients. Acta Radiol 37:489–495CrossRefGoogle Scholar
  22. 22.
    Balthazar EJ, Gordon R, Hulnick D (1990) Ileocecal tuberculosis: CT and radiologic evaluation. AJR Am J Roentgenol .  https://doi.org/10.2214/ajr.154.3.2106212 Google Scholar
  23. 23.
    Underwood MJ, Thompson MM, Sayers RD, Hall AW (1992) Presentation of abdominal tuberculosis to general surgeons. Br J Surg .  https://doi.org/10.1002/bjs.1800791030 Google Scholar
  24. 24.
    Aston NO, de Costa AM (1990) Abdominal tuberculosis. Br J Clin Pharmacol 44:492–499Google Scholar
  25. 25.
    Alvares JF, Devarbhavi H, Makhija P, Rao S, Kottoor R (2005) Clinical, colonoscopic, and histological profile of colonic tuberculosis in a tertiary hospital. Endoscopy 37(4):351–356CrossRefGoogle Scholar
  26. 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
  27. 27.
    Horvath KD, Whelan RL (1998) Intestinal tuberculosis: return of an old disease. Am J Gastroenterol 93(5):692–696CrossRefGoogle Scholar
  28. 28.
    Fernandes T, Oliveira MI, Castro R, et al. (2014) Bowel wall thickening at CT: simplifying the diagnosis. Insights Imaging 5(2):195–208.  https://doi.org/10.1007/s13244-013-0308-y CrossRefGoogle Scholar
  29. 29.
    Macari M, Megibow AJ, Balthazar EJ (2007) A pattern approach to the abnormal small bowel: observations at MDCT and CT enterography. Am J Roentgenol 188(5):1344–1355CrossRefGoogle Scholar
  30. 30.
    Balthazar EJ (1991) CT of the gastrointestinal tract: principles and interpretation. AJR Am J Roentgenol 156(1):23–32CrossRefGoogle Scholar
  31. 31.
    Buckley JA, Fishman EK (1998) CT evaluation of small bowel neoplasms: spectrum of disease. Radiographics. 18(2):379–392CrossRefGoogle Scholar
  32. 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. 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
  34. 34.
    Kakkar C, Polnaya AM, Koteshwara P, et al. (2015) Hepatic tuberculosis: a multimodality imaging review. Insights Imaging 6(6):647–658.  https://doi.org/10.1007/s13244-015-0440-y CrossRefGoogle Scholar
  35. 35.
    Karaosmanoglu AD, Onur MR, Sahani DV, Tabari A, Karcaaltincaba M (2016) Hepatobiliary Tuberculosis: Imaging Findings. Am J Roentgenol 207(4):694–704.  https://doi.org/10.2214/AJR.15.15926 CrossRefGoogle Scholar
  36. 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
  37. 37.
    Lam KY, Lo CY (2001) A critical examination of adrenal tuberculosis and a 28-year autopsy experience of active tuberculosis. Clin Endocrinol 54(5):633–639CrossRefGoogle Scholar
  38. 38.
    Akhan O, Pringot J (2002) Imaging of abdominal tuberculosis. Eur Radiol 12(2):312–323.  https://doi.org/10.1007/s003300100994 CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Sneha Satish Deshpande
    • 1
    Email author
  • Anagha Rajeev Joshi
    • 1
  • Saurabh Satish Deshpande
    • 1
  • Soyaf A. Phajlani
    • 1
    • 2
  1. 1.Department of RadiologyLokmanya Tilak Municipal Medical College and General HospitalMumbaiIndia
  2. 2.Department of RadiologyGovernment Medical CollegeNagpurIndia

Personalised recommendations