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Moradi B, Hejazian SS, Tahamtan M, Ghorani H, Karami S. Imaging the post-treatment pelvis with gynecologic cancers. Abdom Radiol (NY) 2024; 49:1248-1263. [PMID: 38340181 DOI: 10.1007/s00261-023-04163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 02/12/2024]
Abstract
Gynecological malignancies, such as ovarian cancers, cervical cancers, and endometrial cancers, have a significant global impact. Women with gynecologic malignancies may receive a single or a combination of treatments, including surgery, chemotherapy, and radiation-based therapies. Radiologists utilize various diagnostic imaging modalities to provide the surgeon with relevant information about the diagnosis, prognosis, optimal surgical strategy, and prospective post-treatment imaging. Computerized Tomography (CT) and magnetic resonance imaging (MRI) may be used initially to evaluate and detect post-treatment complications. Although CT is primarily used for staging, MRI is commonly used for a more accurate evaluation of a tumor's size and detection of local invasion. Complications such as hematoma, abscess, inclusion cyst, seroma, tumor thrombosis, anorectovaginal fistula, and gossypiboma may occur after the three primary treatments, and systems such as the genitourinary, gastrointestinal, neurological, and musculoskeletal may be affected. In order to distinguish between early-onset and late-onset complications following gynecological treatment, radiological findings of the most common post-treatment complications will be presented in this review.
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Affiliation(s)
- Behnaz Moradi
- Department of Radiology, Women's Yas Hospital, Tehran, Iran
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Sina Hejazian
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammadreza Tahamtan
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Ghorani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Karami
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.
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Revzin MV, Mathur M, Dave HB, Macer ML, Spektor M. Pelvic Inflammatory Disease: Multimodality Imaging Approach with Clinical-Pathologic Correlation. Radiographics 2016; 36:1579-1596. [PMID: 27618331 DOI: 10.1148/rg.2016150202] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Pelvic inflammatory disease (PID) is a common medical problem, with almost 1 million cases diagnosed annually. Historically, PID has been a clinical diagnosis supplemented with the findings from ultrasonography (US) or magnetic resonance (MR) imaging. However, the diagnosis of PID can be challenging because the clinical manifestations may mimic those of other pelvic and abdominal processes. Given the nonspecific clinical manifestations, computed tomography (CT) is commonly the first imaging examination performed. General CT findings of early- and late-stage PID include thickening of the uterosacral ligaments, pelvic fat stranding with obscuration of fascial planes, reactive lymphadenopathy, and pelvic free fluid. Recognition of these findings, as well as those seen with cervicitis, endometritis, acute salpingitis, oophoritis, pyosalpinx, hydrosalpinx, tubo-ovarian abscess, and pyometra, is crucial in allowing prompt and accurate diagnosis. Late complications of PID include tubal damage resulting in infertility and ectopic pregnancy, peritonitis caused by uterine and/or tubo-ovarian abscess rupture, development of peritoneal adhesions resulting in bowel obstruction and/or hydroureteronephrosis, right upper abdominal inflammation (Fitz-Hugh-Curtis syndrome), and septic thrombophlebitis. Recognition of these late manifestations at CT can also aid in proper patient management. At CT, careful assessment of common PID mimics, such as endometriosis, adnexal torsion, ruptured hemorrhagic ovarian cyst, adnexal neoplasms, appendicitis, and diverticulitis, is important to avoid misinterpretation, delay in management, and unnecessary surgery. Correlation with the findings from complementary imaging examinations, such as US and MR imaging, is useful for establishing a definitive diagnosis. (©)RSNA, 2016.
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Affiliation(s)
- Margarita V Revzin
- From the Department of Diagnostic Radiology (M.V.R., M.M., H.B.D., M.S.) and Department of Obstetrics and Gynecology and Reproductive Sciences (M.L.M.), Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Mahan Mathur
- From the Department of Diagnostic Radiology (M.V.R., M.M., H.B.D., M.S.) and Department of Obstetrics and Gynecology and Reproductive Sciences (M.L.M.), Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Haatal B Dave
- From the Department of Diagnostic Radiology (M.V.R., M.M., H.B.D., M.S.) and Department of Obstetrics and Gynecology and Reproductive Sciences (M.L.M.), Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Matthew L Macer
- From the Department of Diagnostic Radiology (M.V.R., M.M., H.B.D., M.S.) and Department of Obstetrics and Gynecology and Reproductive Sciences (M.L.M.), Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Michael Spektor
- From the Department of Diagnostic Radiology (M.V.R., M.M., H.B.D., M.S.) and Department of Obstetrics and Gynecology and Reproductive Sciences (M.L.M.), Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
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Ha HK, Lim GY, Cha ES, Lee HG, Ro HJ, Kim HS, Kim HH, Joo SW, Jee MK. MR Imaging of Tubo-Ovarian Abscess. Acta Radiol 2016. [DOI: 10.1177/028418519503600439] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose, and Material and Methods: MR findings of 9 surgically proven tubo-ovarian abscesses were analyzed in 8 patients. The images were evaluated for signal intensity characteristics and morphologic appearance of the mass, and presence of secondary changes in adjacent pelvic organs and structures. Results: The signal intensity of the lesions on T1-weighted images was hypointense to the surrounding muscle and myometrium in 5 patients, isointense in 3 and hyperintense in 1. On T2-weighted images the signal intensity was hyperintense (n=6) or heterogeneous (n = 3). A thin rim (1–3 mm) with hyperintensity on T1-weighted images was noted in the innermost aspect of the masses. Other findings were ill-defined margin, thickened wall, multiple internal septa, shading and gas collection. “Mesh-like” linear strands were noted in the pelvis in all patients, with involvement of adjacent pelvic organs in 7 and lymphadenopathy in 3. Conclusions: In this limited number of cases MR imaging showed great potential for demonstrating the extent of the disease, characterizing the lesions and making a specific diagnosis.
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Affiliation(s)
- H. K. Ha
- Department of Diagnostic Radiology, Catholic University Medical College, Seoul, Korea
| | - G. Y. Lim
- Department of Diagnostic Radiology, Catholic University Medical College, Seoul, Korea
| | - E. S. Cha
- Department of Diagnostic Radiology, Catholic University Medical College, Seoul, Korea
| | - H. G. Lee
- Department of Diagnostic Radiology, Catholic University Medical College, Seoul, Korea
| | - H. J. Ro
- Department of Diagnostic Radiology, Catholic University Medical College, Seoul, Korea
| | - H. S. Kim
- Department of Diagnostic Radiology, Catholic University Medical College, Seoul, Korea
| | - H. H. Kim
- Department of Diagnostic Radiology, Catholic University Medical College, Seoul, Korea
| | - S. W. Joo
- Department of Diagnostic Radiology, Catholic University Medical College, Seoul, Korea
| | - M. K. Jee
- Department of Clinical Pathology, Catholic University Medical College, Seoul, Korea
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Bilateral Tubo-Ovarian Abscess Mimics Ovarian Cancer on MRI and (18)F-FDG PET/CT. Nucl Med Mol Imaging 2011; 45:223-8. [PMID: 24900009 DOI: 10.1007/s13139-011-0089-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 06/02/2011] [Accepted: 06/03/2011] [Indexed: 10/18/2022] Open
Abstract
A 20-year-old woman, who presented with a several-week history of abdominal pain, was referred for magnetic resonance imaging (MRI) and (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) after an ultrasound showed complex cystic masses arising from both ovaries. The MRI and (18)F-FDG PET/CT imaging characteristics of the ovarian masses were strongly suspicious for malignancy, and the masses were surgically removed. Histopathological evaluation revealed a bilateral tubo-ovarian abscess, with no evidence of malignancy. This case highlights a potentially serious pitfall in the evaluation of suspicious pelvic masses by (18)F-FDG PET/CT, whereby a complex bilateral tubo-ovarian abscess may mimic the PET/CT imaging characteristics of an ovarian or pelvic malignancy.
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Yitta S, Hecht EM, Slywotzky CM, Bennett GL. Added Value of Multiplanar Reformation in the Multidetector CT Evaluation of the Female Pelvis: A Pictorial Review. Radiographics 2009; 29:1987-2003. [DOI: 10.1148/rg.297095710] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tubo-ovarian abscess: CT and pathological correlation. Clin Imaging 2007; 31:414-8. [DOI: 10.1016/j.clinimag.2007.04.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Accepted: 04/13/2007] [Indexed: 11/22/2022]
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Kim SH, Kim SH, Yang DM, Kim KA. Unusual causes of tubo-ovarian abscess: CT and MR imaging findings. Radiographics 2005; 24:1575-89. [PMID: 15537966 DOI: 10.1148/rg.246045016] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Actinomycosis, tuberculosis, and xanthogranulomatous inflammation are rare but specific causes of tubo-ovarian abscess (TOA). TOAs with these causes are frequently misdiagnosed as ovarian malignancies due to their unusual appearances at computed tomography (CT) and magnetic resonance (MR) imaging. Tubo-ovarian actinomycosis frequently has a predominantly solid appearance. A linear, solid, well-enhancing lesion extending directly from the mass is a characteristic CT and MR imaging finding. Small rim-enhancing lesions in the solid part of the mass are also suggestive of actinomycosis. Tuberculous TOAs usually mimic peritoneal carcinomatosis from ovarian cancers. The granulomatous and fibrotic nature of this infection may be reflected in the CT and MR imaging appearances, which can help in differentiation. TOAs from xanthogranulomatous inflammation demonstrate more nonspecific imaging findings than actinomycotic or tuberculous TOAs, although multiple xanthogranulomas in the mass may be seen on MR images. Knowledge of these characteristics can help one make the correct diagnosis and treat the patients appropriately.
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Affiliation(s)
- Sun Ho Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Seshadri S, Kirwan J, Neal T. Perimenopausal pneumococcal tubo-ovarian abscess--a case report and review. Infect Dis Obstet Gynecol 2004; 12:27-30. [PMID: 15460193 PMCID: PMC1784586 DOI: 10.1080/1064744042000210366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND: Genital tract infections in females secondary to Streptococcus pneumoniae (pneumococcus) are unusual. Tubo-ovarian abscess resulting from such an infection is a rare occurrence and diagnosis is not always easy. This report demonstrates the problems of recognizing this condition and summarizes the pathomechanism, investigations leading to a diagnosis and the subsequent management. CASE: A rare case of a tubo-ovarian abscess caused by pneumococcus, occurring in a previously healthy 48-year-old woman, is presented. The tubo-ovarian abscess may have developed insidiously and probably had an acute exacerbation prior to presentation. CONCLUSION: This case is unusual in that there were no identifiable initiating events for the source of the pneumococcal infection. Early recognition of a tubo-ovarian abscess is important in order to prevent the associated morbidity and mortality. This condition has the propensity to mimic a neoplasm.
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Affiliation(s)
- Srividya Seshadri
- Department of Obstetrics and Gynaecology, Liverpool Women's Hospital, Liverpool, UK.
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Sam JW, Jacobs JE, Birnbaum BA. Spectrum of CT findings in acute pyogenic pelvic inflammatory disease. Radiographics 2002; 22:1327-34. [PMID: 12432105 DOI: 10.1148/rg.226025062] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pelvic inflammatory disease (PID) is a common medical problem, affecting nearly 1 million women each year. Although the radiology literature is replete with discussions of the sonographic manifestations of PID, little has been published regarding the computed tomographic (CT) appearances of this entity. CT findings in early PID include obscuration of the normal pelvic floor fascial planes, thickening of the uterosacral ligaments, cervicitis, oophoritis, salpingitis, and accumulation of simple fluid in the endometrial canal, fallopian tubes, and pelvis. As the disease progresses, this simple fluid may become complex and the inflammatory changes may progress to frank tubo-ovarian or pelvic abscesses. Reactive inflammation of adjacent structures is common and can manifest as small or large bowel ileus or obstruction, hydroureter and hydronephrosis, right upper quadrant inflammation (Fitz-Hugh-Curtis syndrome), or peritonitis. Familiarity with the CT appearances of these manifestations is important for timely diagnosis and treatment of PID and its complications.
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Affiliation(s)
- Joseph W Sam
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, USA
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Ueda H, Togashi K, Kataoka ML, Koyama T, Fujiwara T, Fujii S, Konishi J. Adnexal Masses Caused by Pelvic Inflammatory Disease: MR Appearance. Magn Reson Med Sci 2002; 1:207-15. [PMID: 16082146 DOI: 10.2463/mrms.1.207] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To describe the morphologic and signal intensity characteristics of inflammatory adnexal masses in magnetic resonance (MR) images. MATERIALS AND METHODS MR images of 15 patients with a total of 20 confirmed inflammatory adnexal masses were analyzed retrospectively. RESULTS The findings obtained from MR imaging were as follows: lesions have ill-defined borders; ill-defined areas of high intensity signals surround the masses on T(2)-weighted images; a "rim" at the innermost layer of the cyst wall exhibits high signal intensity on T(1)-weighted images and low intensity on T(2)-weighted images; secondary changes in the surrounding fat plane and bowel loops are extensive; and adhesions are dense. These findings reflect the basic characteristics of the inflammatory process, which are edema caused by increased permeability and highly vascularized granulation tissue caused by the strong tendency to repair. CONCLUSION MR imaging findings well reflect the basic pathological process of inflammation, and inflammatory adnexal masses are associated with relatively specific appearances in MR images. MR imaging can be a problem-solving alternative in the diagnosis of inflammatory adnexal masses.
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Affiliation(s)
- Hiroyuki Ueda
- Department of Nuclear Medicine and Diagnostic Imaging, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto 606-8507, Japan
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Abstract
Helical computed tomography (CT) allows rapid, cost-effective evaluation of patients with acute abdominal pain. Tailoring the examination to the working clinical diagnosis by optimizing constituent factors (eg, timing of acquisition, contrast material used, means and rate of contrast material administration, collimation, pitch) can markedly improve diagnostic accuracy. Rapid (>/=3 mL/sec) intravenous injection of contrast material is required for optimal assessment of acute pancreatitis, ischemic bowel, aortic aneurysm, and aortic dissection. Narrow collimation and small reconstruction intervals can help detect calculi in the biliary system and genitourinary tract. Tailored helical CT in patients with acute pyelonephritis usually involves several acquisitions through the kidneys during various phases of renal enhancement. In patients with suspected renal infarction, CT protocol must include an acquisition during the corticomedullary phase. Helical CT with 5-mm collimation through the lower abdomen and pelvis is used to evaluate patients with suspected diverticulitis. Use of both oral and intravenous contrast material can help localize small bowel perforation and characterize related complications. Tailored helical CT for assessment of abdominal hemorrhage consists of initial unenhanced CT followed by optional contrast material-enhanced CT. Clear communication between the radiologist, the patient, and the referring physician is essential for narrowing the differential diagnosis into a working diagnosis prior to helical CT.
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Affiliation(s)
- B A Urban
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 600 N Wolfe St, Baltimore, MD 21287, USA.
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Meyer JS, Harmon CM, Harty MP, Markowitz RI, Hubbard AM, Bellah RD. Ovarian torsion: clinical and imaging presentation in children. J Pediatr Surg 1995; 30:1433-6. [PMID: 8786481 DOI: 10.1016/0022-3468(95)90399-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ovarian torsion is uncommon and has a nonspecific clinical presentation. To determine the impact of imaging on clinical management, the authors reviewed their recent experience with 12 children who had a total of 13 episodes of ovarian torsion. Three children presented as neonates, six were premenarchal, and three were postmenarchal. Ultrasound was the imaging study of choice. In all three neonates, ultrasonography showed complex abdominopelvic cysts indicating the need for surgery. In five of 10 episodes in older patients, ultrasonography showed a solid mass with an appearance strongly suggestive of torsion. Same-day surgery was performed in three patients, and the involved ovary was salvaged in one. Another patient had a small piece of normal-appearing ovary left in situ. This low rate of ovarian salvage is attributable to the combination of delay in patient presentation and surgical delay owing to the often nonspecific clinical and imaging presentation of ovarian torsion. A high level of clinical suspicion, expeditious imaging, and familiarity with the varied clinical and imaging presentations of ovarian torsion should decrease the surgical delay and improve the likelihood of ovarian salvage.
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Affiliation(s)
- J S Meyer
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia 19104, USA
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HELICAL (SPIRAL) CT OF THE FEMALE PELVIS. Radiol Clin North Am 1995. [DOI: 10.1016/s0033-8389(22)00631-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Taourel P, Pradel J, Fabre JM, Cover S, Senéterre E, Bruel JM. Role of CT in the acute nontraumatic abdomen. Semin Ultrasound CT MR 1995; 16:151-64. [PMID: 7794605 DOI: 10.1016/0887-2171(95)90007-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The diagnostic workup of the acute abdomen always begins with a precise clinical history, a complete physical examination, and careful reading of plain films. Commonly performed additional imaging studies include contrast examination and, more recently, ultrasound. CT offers the advantage of allowing a comprehensive diagnostic evaluation of both solid and hollow viscera in neoplastic as well as in inflammatory and vascular disorders.
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Affiliation(s)
- P Taourel
- Department of Radiology, Hôpital Saint-Eloi, Montpellier, France
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Bankier AA, Fleischmann D, Wiesmayr MN, Putz D, Kontrus M, Hübsch P, Herold CJ. Update: abdominal tuberculosis--unusual findings on CT. Clin Radiol 1995; 50:223-8. [PMID: 7729118 DOI: 10.1016/s0009-9260(05)83474-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
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.
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Affiliation(s)
- A A Bankier
- Department of Radiology, University of Vienna, Austria
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