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PubMed1998

Ultrasound guided fine needle aspiration cytology in abdominal tuberculosis.

Although barium studies and CT are useful in assessing abdominal pathology in tuberculosis, imaging findings are not always specific and a histopathological or bacteriological confirmation is often required. The aim of the present study was to evaluate the role of ultrasound (US) guided fine needle aspiration cytology (FNAC) in the diagnosis of abdominal tuberculosis in patients with non-palpable lesions detected on US/CT. FNAC was performed on 31 sites in 30 patients. The sites included enlarged lymph nodes (n = 14), focal lesions in liver (n = 2) and spleen (n = 8), and thickened bowel in the ileocaecal region (n = 7). The results were classified cytomorphologically into four groups: (1) definite evidence of tuberculosis; (2) presumptive evidence of tuberculosis; (3) suggestive of tuberculosis; and (4) negative for tuberculosis. 18 of the 31 FNACs (58%) revealed a positive diagnosis of tuberculosis (definite evidence in nine patients and presumptive evidence in nine patients). 13 of the 31 FNACs (42%) showed either necrosis alone (n = 4) or negative results (n = 9). Zeihl-Neelson staining for acid-fast bacilli on direct smear was positive in only nine patients (29%). Splenic and lymph nodal FNAC had a high sensitivity (87.5% and 78.6%, respectively) in the diagnosis of tuberculosis. None of the bowel and liver FNACs was diagnostic. No complications were encountered. US guided FNAC offers a safe and accurate method of achieving a diagnosis in patients with suspected abdominal tuberculosis who present with radiologically demonstrable but non-palpable lesions, especially those involving lymph nodes and spleen.

Abdomen↗
PubMed1999

Computed tomography in abdominal tuberculosis.

The diagnosis of abdominal tuberculosis is often difficult because of its protean clinical manifestations and non-specific laboratory investigations. In the abdomen, tuberculosis may affect the intestinal tract, lymph nodes, peritoneum and solid viscera in varying combinations. CT, with its ability to provide a comprehensive overview of abdominal structures, is the imaging modality of choice for evaluation of such patients. This pictorial review illustrates the spectrum of CT appearances of abdominal tuberculosis which includes intestinal, lymph nodal, peritoneal, mesenteric, hepatic, splenic and pancreatic disease.

AIDS-Related Opportunistic Infections↗
PubMed1989

Mycobacterium avium infection through the alimentary tract in mice.

Intestinal infection by Mycobacterium avium was investigated in C57BL/6 and BALB/c mouse strains. Single intragastric administration of a massive dose (10(8] or multiple administration of a lower dose (10(7), 10 times) established infection principally in the mesenteric lymph-node (MLN); a continuous or intermittent fecal excretion of the bacilli was detected by 6-8 weeks after the administration. Based on three criteria--isolation of the organisms from the MLN and from feces, and detection of acid-fast bacilli in sections of the MLN--germ-free (GF) BALB/c mice exhibited clearer dose-effect relations than the flora-bearing (FB) counterparts. After intragastric administration, the organisms were probably trapped in the Peyer's patch and then transferred to the MLN at an early period (by 4-7 days), persistent infection thus being established in the MLN. Systemic involvement evolved both in athymic and euthymic mice after a prolonged period of time (more than 40 weeks) showing far more severe involvement in the former regardless of the presence of floral organisms.

Animals↗
PubMed2006

Diagnosis and conservative treatment of tubercular rectoprostatic fistula.

OBJECTIVE: To present our experience with three cases of rectoprostatic fistula with special emphasis on diagnosis and conservative management. PATIENTS AND METHODS: Three middle-aged men presented to us differently. All had spontaneous rectoprostatic fistulas. Biopsy showed tuberculosis though three consecutive urine samples for acid-fast bacilli were negative. None of the patients were immunocompromised. Their upper tracts were normal and all had a past history of pulmonary tuberculosis. They were started on antitubercular drugs and urinary diversion with or without faecal diversion. RESULTS: All fistulae healed completely within 6 weeks of starting antitubercular treatment. One patient healed with bladder neck stenosis that required bladder neck incision. Voiding was normal on 1-year follow-up. CONCLUSION: Spontaneous tubercular rectoprostatic fistulae are rare. There should be a strong clinical suspicion in endemic areas. Prostatic biopsy proves the diagnosis. Conservative management with antitubercular drugs and urinary diversion with or without faecal diversion has a high success rate and should be the first line of treatment even if urine is negative for acid-fast bacilli.

Adult↗
PubMed1979

Tuberculosis of the transverse colon.

Segmental tuberculosis of the transverse colon is very rare and when present is usually associated with active pulmonary tuberculosis. These patients may have initial symptoms suggestive of neoplasm or of Crohn's disease. Radiographically the lesion manifests itself as a fairly long area of narrowing with nodular and ulcerated mucosa. Sinuses and fistulae may arise from the area of involvement. These changes are not specific for tuberculosis. The lesion is unpredictable. It may respond to medical therapy, but complications such as bleeding and sinus tract formation may require surgical intervention.

Adolescent↗
PubMed1985

Abdominal CT findings of disseminated Mycobacterium avium-intracellulare in AIDS.

Disseminated infection from Mycobacterium avium-intracellulare (MAI) has recently been recognized as a common and serious complication of the acquired immunodeficiency syndrome (AIDS). The authors report the computed tomographic (CT) findings of 17 patients with AIDS and disseminated MAI referred for abdominal CT examination. Multiple large retroperitoneal and mesenteric lymph nodes were demonstrated in 14 patients (82%). MAI involvement was confirmed within abdominal lymph nodes in six patients by fine-needle percutaneous aspiration (five patients) or postmortem examination (one patient) and within enlarged peripheral lymph nodes in two other patients. The authors concluded that large, bulky, intraabdominal adenopathy in AIDS patients should suggest the diagnosis of MAI infection as well as other known causes of adenopathy, including lymphoma and metastatic Kaposi sarcoma. The authors recommend percutaneous aspiration of enlarged intraabdominal lymph nodes to establish the correct diagnosis.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Still the great mimicker: abdominal tuberculosis.

Since the mid 1980s, a resurgence of tuberculosis has occurred. The disease is and will remain a serious public health threat worldwide. The clinical and radiologic features of abdominal tuberculosis may mimic those of many diseases. Radiologists evaluating abdominal images should consider the diagnosis of abdominal tuberculosis in immigrants from areas endemic for tuberculosis, in immunocompromised patients, and in high-risk patients such as the homeless. Imaging features that suggest the correct diagnosis are cecal amputation, ileocecal thickening and inflammation, shortening of the ascending colon, gaping of the ileocecal valve, mesenteric adenopathy, a misty mesentery, diffuse omental infiltration, loculate high-density ascites, an enhancing peritoneum with or without an omental line, nodularity of the surface of the mesenteric leaves, and transperitoneal permeation.

Adult↗
PubMed1998

Abdominal tuberculosis. A case report.

Tuberculous involvement of the abdominal parenchymatous organs is usually a diffuse process. The macronodular form of hepatosplenic tuberculosis and focal involvement of the pancreas are extremely rare. This report describes CT findings of abdominal parenchymatous organ involvement in a patient with pulmonary and vertebral tuberculosis. Although CT does not confirm a diagnosis of abdominal tuberculosis, it is a valuable examination that can support the diagnosis and define the extent of disease.

Abdomen↗
PubMed2004

Diagnosis of abdominal tuberculosis: experience from 11 cases and review of the literature.

AIM: To analyze the experience within our hospital and to review the literature so as to establish the best means of diagnosis of abdominal tuberculosis. METHODS: The records of 11 patients (4 males, 7 females, mean age 39 years, range 18-65 years) diagnosed with abdominal tuberculosis in Harran University Hospital between January 1996 and October 2003 were analyzed retrospectively and the literature was reviewed. RESULTS: Ascites was present in all cases. Other common findings were weight loss (81%), weakness (81%), abdominal mass (72%), abdominal pain (72%), abdominal distension (63%), anorexia (45%) and night sweat (36%). The average hemoglobin was 8.2 g/dL and the average ESR was 50 mm/h (range 30-125). Elevated levels of cancer antigen CA-125 were determined in four patients. Abdominal ultrasound showed abnormalities in all cases: ascites in all, tuboovarian mass in five, omental thickening in 3, and enlarged lymph nodes (mesenteric, para-aortic) in 2. CT scans showed ascites in all, pelvic mass in 5, retroperitoneal lymphadenopathy in 4, mesenteric stranding in 4, omental stranding in 3, bowel wall thickening in 2 and mesenteric lymphadenopathy in 2. Only one patient had a chest radiograph suggestive of a new TB lesion. Two had a positive family history of pulmonary TB. None had acid-fast bacilli (AFB) in the sputum and the tuberculin test was positive in only two. Laparotomy was performed in 6 cases, laparoscopy in 4 and ultrasound-guided fine needle aspiration in 2. In those patients subjected to operation, the findings were multiple diffuse involvement of the visceral and parietal peritoneum, white 'miliary nodules' or plaques, enlarged lymph nodes, ascites, 'violin string' fibrinous strands, and omental thickening. Biopsy specimens showed granulomas, while ascitic fluid showed numerous lymphocytes. Both were negative for acid-fast bacilli by staining. PCR of ascitic fluid was positive for Mycobacterium tuberculosis (M. tuberculosis) in all cases. CONCLUSION: Abdominal TB should be considered in all cases with ascites. Our experience suggests that PCR of ascitic fluid obtained by ultrasound-guided fine needle aspiration is a reliable method for its diagnosis and should at least be attempted before surgical intervention.

Abdomen↗
PubMed2006

Diagnostic dilemma of abdominal tuberculosis in non-HIV patients: an ongoing challenge for physicians.

AIM: To assess the clinical features, yield of the diagnostic tests and outcome of abdominal tuberculosis in non-HIV patients. METHODS: Adult patients with discharge diagnosis of abdominal tuberculosis (based upon; positive microbiology, histo-pathology, imaging or response to trial of anti TB drugs) during the period 1999 to 2004 were analyzed. Patient's characteristics, laboratory investigations, radiological, endoscopic and surgical findings were evaluated. Abdominal site involved (intestinal, peritoneal, visceral, and nodal) and response to treatment was also noted. RESULTS: There were 209 patients enrolled. One hundred and twenty-three (59%) were females. Symptoms were abdominal pain 194 (93%), fever 134 (64%), night sweats 99 (48%), weight loss 98 (47%), vomiting 75 (36%), ascites 74 (35%), constipation 64 (31%), and diarrhea 25 (12%). Sub-acute and acute intestinal obstruction was seen in 28 (13%) and 12 (11%) respectively. Radiological evidence of pulmonary tuberculosis was found in 134 (64%) patients. Basis of diagnosis of abdominal tuberculosis were radiology (Chest and barium X-Rays, Ultrasound and CT scan abdomen) in 111 (53%) and histo-pathology (tissue obtained during surgery, colonoscopy, CT or ultrasound guided biopsy, laparoscopy and upper gastro intestinal endoscopy) in 87 (42%) patients. Mycobacterium culture was positive in 6/87 (7%) patients and response to therapeutic trial of anti tubercular drugs was the basis of diagnosis in 5 (2.3%) patients. Predominant site of involvement by abdominal TB was intestinal in 103 (49%) patients, peritoneal in 87 (42%) patients, solid viscera in 10 (5%) and nodal in 9 (4%) patients. Response to medical treatment was found in 158 (76%) patients and additionally 35 (17%) patients also underwent surgery. In a 425 +/- 120 d follow-up period 12 patients died (eight post operative) and no case of relapse was noted. CONCLUSION: Abdominal TB has diverse and non- specific symptomatology. No single test is adequate for diagnosis of abdominal tuberculosis in all patients. Abdominal TB in non-HIV patients remains an ongoing diagnostic dilemma requiring a high index of clinical suspicion.

Adolescent↗