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Update: abdominal tuberculosis--unusual findings on CT.

To update our knowledge of abdominal tuberculosis as manifested on computed tomography (CT), we reviewed the CT scans of 12 patients with proven abdominal tuberculosis. The nature, range and extent of abdominal involvement was determined. The CT findings were compared to those reported in the literature. The aetiologic agent was Mycobacterium tuberculosis in all patients. One patient had an increased risk because of AIDS. In nine patients, tuberculosis was limited to the abdomen, and three patients had previously unknown thoracic tuberculous disease. Characteristic features in our patients included low density ascites and uncommon patterns of adenopathy. Findings reported to be typical in abdominal tuberculosis were present in only five of our 12 patients. Unusual findings in our patients included solitary and multiple pelvic, adrenal, splenic and hepatic lesions. In six of 12 patients, those findings mimicked malignancy. We conclude that knowledge and early recognition of these unusual manifestations of abdominal tuberculosis should help to optimize clinical management of the disease and avoid misdiagnosis.

Abdominal Pain↗

TB or not TB?

These 3 cases illustrate what we believe to be unusual presentations of tuberculosis. In no case was there conclusive proof of infection with Mycobacterium tuberculosis using histological, microbiological or radiological techniques. All were treated empirically with anti-tuberculous medication, with complete recovery. With the re-emergence of tuberculosis, there may be a rise in such cases, and the importance of their recognition and empirical treatment is discussed.

Adult↗

Active tuberculosis unrecognised until necropsy.

12 of the 24 cases of active tuberculosis which came to necropsy in Dundee hospitals from 1968 to 1975 were diagnosed after death. The overall distribution of anatomical types was similar to that in previous surveys, but in those diagnosed at necropsy there was an excess of psoas abscess and miliary, colonic, and adrenal lesions. Class-IV patients and a history of steroid therapy were also more common in cases diagnosed at necropsy. None of these differences is statistically significant.

Adrenal Gland Diseases↗

[Esophageal tuberculosis in an immunocompetent patient].

We present the case of a 68-year-old man who presented dysphagia and weight loss over the previous three months. Esophageal transit showed extreme stenosis suspicious for neoplasia but which was revealed to be a granulomatous inflammatory lesion. Culture of the lesion revealed Mycobacterium tuberculosis. Chest x-ray showed pulmonary tuberculosis. Esophageal tuberculosis should be considered in patients with dysphagia and pulmonary tuberculosis.

Aged↗

[Pseudotumoral form of abdominal tuberculosis: report of four cases].

PURPOSE: To report the imaging features of four cases of pseudo-tumoral abdominal tuberculosis in order to demonstrate diagnostic difficulties, even in endemic areas, despite expanding imaging modalities. MATERIAL AND METHODS: We have retrospectively reviewed four cases investigated in our hospital between 1998 and 2002. The first case concerned a 2 year and 6 month old boy admitted for a right iliac fossa mass. The other patients were 43 and 48 year old women admitted for epigastric mass and persistent epigastric pain with past history of treated tuberculosis respectively. The last was an 86 year old man investigated because progressive worsening of general health. Sonography (US) and computed tomography (CT) were performed in all four cases. RESULTS: Involvement of the ileocaecal region was noted in three cases. Large intestinal hypervascular mass in the pediatric case, heterogeneous mass with porta hepatis lymph node in the patient with past history of treated tuberculosis, pseudotumoral caecal wall thickening in the third case. The multiloculated pattern of the epigastric mass and its location initially suggested a diagnosis of pancreatic tumor. CONCLUSION: Abdominal tuberculosis is rare even in endemic areas. This diagnosis must be considered when imaging modalities depict a hypervascular soft tissue mass on Doppler examination with peripheral enhancement on CT scan.

Abdomen↗

[Imaging of pancreatic and hepatic tuberculosis in an infant presenting with jaundice].

The incidence of abdominal tuberculosis has increased over the last decade and can mimic any other disease. Pancreatic involvement is an uncommon cause of jaundice in children. A case of obstructive jaundice due to pancreatic tuberculosis in an infant, with hepatic involvement is reported. The sonographic and computed-tomographic features are described.

Child↗

[Anti-TNF alpha monoclonal antibodies (infliximab) and tuberculosis: apropos of 3 cases].

INTRODUCTION: Monoclonal TNF alpha antibodies are a new treatment of severe rheumatoid arthritis. One of the possible side effects is the appearance of opportunistic infections. We report here on three cases of disseminated tuberculosis observed in patients undergoing treatment with infliximab. EXEGESIS: A 45-year-old woman, treated with infliximab, was hospitalised after five infusions for fever and dyspnoea. The exams showed pulmonary and peritoneal tuberculosis. The second case is a 75-year-old woman whose symptoms were fever, cough and cervical adenopathy after three infliximab infusions. Diagnosis was disseminated tuberculosis. The third case is a 59-year-old man who was hospitalised for an infectious syndrome with dyspnoea, after two infliximab infusions. We discovered pulmonary tuberculosis. CONCLUSION: These three cases added to the 68 cases of tuberculosis registered with the treatment of infliximab. This confirms the risk of severe opportunist infectious side effects. TNF alpha is a cytokine which has anti-infectious properties. These tuberculoses are severe and generalized. It is recommended to search for an active or latent tuberculosis before beginning treatment with infliximab, and to check these patients frequently.

Aged↗

Dysphagia caused by esophageal tuberculosis.

This report describes two patients with dysphagia who appeared to have esophageal tuberculosis. One patient had a fistula draining into a mediastinal mass. Both patients responded promptly to treatment with tuberculostatics. Surgery was not required. Esophageal tuberculosis is a rare entity.

Adult↗

[Crohn disease and abdominal tuberculosis: complications related to a diagnostic error].

INTRODUCTION: We report the case of a patient with abdominal tuberculosis initially treated as Crohn disease. CASE: A 50-year-old man, diagnosed with Crohn disease, was admitted to the intensive care unit for acute respiratory failure. After a new diagnosis of pulmonary and ileocecal tuberculosis and appropriate treatment for it, he improved. DISCUSSION: It is difficult - but essential - to differentiate intestinal tuberculosis and Crohn disease, for the immune suppression necessary to treat the latter can induce severe complications of the former. Management of intestinal tuberculosis is primarily medical, with surgery reserved for complications such as obstruction, fistulization, perforation, and bleeding.

Antitubercular Agents↗

CT findings of abdominal tuberculosis in 12 patients.

Our purpose was to evaluate the Computed Tomography (CT) findings of the abdominal tuberculosis (TBC) retrospectively which was diagnosed histopatologically. This study included 12 patients. All patients were evaluated by abdominal CT study. Most findings of CT studies were mesenteric calcified or noncalcified lymphadenopathies, ascites, thickened intestinal wall located on the right lower quadrant of abdomen, thickening of peritoneum, mottled soft-tissue densities in omentum and mesenterium. In addition, one of the patients had bilateral calcified adrenal glands and one of them had calcified mass in adrenal gland. If peritoneal thickening, ascites, abdominal lymphadenophaties and thickened intestinal walls are obtained, TBC should be considered in differential diagnosis in developing countries.

Adolescent↗