Imaging of Tuberculosis

Evaluation of intestinal tuberculosis by multi-slice computed tomography enterography

BACKGROUND

Multi-slice computed tomography enterography (MSCTE) is now widely used to diagnose and monitor intestinal disease. Preliminary studies suggest that MSCTE may be useful in detecting intestinal tuberculosis (ITB). We sought to assess the use of MSCTE for the diagnosis of ITB in our medical center.

METHODS

In this retrospective study, 15 patients (11 males and 4 females, 6 to 65 years old) were enrolled and diagnosed with ITB by MSCTE. Diagnosis were confirmed by pathology or clinical criteria. Two experienced abdominal radiologists evaluated the images and defined the location, number, shape, edge, surrounding tissue alterations of ITB and other associated changes in the peritoneum, mesentery and solid abdominal organs.

RESULTS

The interval between the onset of symptoms and diagnosis varied from 20 days to 10 years. The most common symptom was abdominal pain (80 %). The ileocecum was the most common site affected by ITB (87 %). Morphological MSCTE findings were variable and included multi-segmental symmetric intestinal mural thickening found in 6 patients (40 %), solid masses found in 9 patients (60 %), and enlarged lymph nodes (LNs) found in 13 (87 %) patients. Non-enhancing central necrosis and rim enhancement were noted in 10 patients (67 %).

CONCLUSIONS

Characteristic MSCTE findings of ITB include solid mass or multi-segmental symmetric mural thickening involving the ileocecal area and rim enhanced LNs. Knowledge of these features in combination with a high index of suspicion can be useful in early diagnosis of ITB.

Tuberculous peritonitis

Tuberculous peritonitis is a serious condition with rising prevalence in recent years. It is especially common in those patients with risk factors such as an immunocompromised state, chronic kidney disease, or cirrhosis/liver disease. Spread is typically hematogenous from pulmonary foci. We report on a 34-year-old man who presented with initial complaints of cough, low-grade fevers, abdominal pain, and nausea/vomiting. Chest x-ray showed a cluster of nodular opacities on the right upper lobe, and a CT scan showed diffuse thickening and nodularity of the omentum with prominent mesenteric lymph nodes, consistent with tuberculous peritonitis.

Computerized tomography-based predictive model for differentiation of Crohn's disease from intestinal tuberculosis

BACKGROUND

Intestinal tuberculosis (ITB) and Crohn's disease (CD) have clinical, radiological, endoscopic, and histological resemblance. There is paucity of literature regarding differentiation of CD and ITB based on radiology using computed tomography (CT).

AIMS

The present study was designed to compare CT features of ITB and CD and develop a predictive model to differentiate ITB and CD.

METHODS

Patients with ITB and CD, who underwent CT enteroclysis/CT enterography/CT abdomen before starting treatment, were recruited. Specific findings were noted by a radiologist who was blinded to the diagnosis. A predictive model was developed based on the features which were significantly different in these diseases.

RESULTS

Fifty-four patients with CD and 50 patients with ITB were compared. On univariate analysis, left colonic involvement, ileocecal involvement, long-segment involvement, comb sign, presence of skip lesions, involvement of ≥3 segments and ≥1-cm sized lymph nodes were significantly different between CD and ITB. On multivariate analysis, ileocecal involvement, long-segment involvement and the presence of lymph node ≥1 cm were statistically significant. Based upon the latter three variables, a risk score (with values ranging from 0 to 3) was generated, with scores 0 and 1 having specificity of 100 % and 87 %, respectively, and positive predictive values (PPV) of 100 % and 76 %, respectively, for ITB and scores 2 and 3 having specificity of 68 % and 90 %, respectively, and PPV of 63 % and 80 %, respectively, for CD.

CONCLUSIONS

A predictive model based on the presence of long-segment involvement, ileocecal involvement and lymph nodes sized ≥1 cm on CT could differentiate ITB and CD with good specificity and PPV.

Splenic tuberculosis presenting as fever of unknown origin with severe neutropenia

Fever of undetermined origin always poses a challenging problem to the physician. Tuberculosis is an important health problem in developing countries. It is mostly seen in immune-compromised patients. And it is one of the common causes of fever of unknown origin. I am reporting a case of a splenic tuberculosis in 48 years old male who is not known of any immune deficiency state, he was presented with 3 weeks history of fever and found to have severe neutropenia and with negative work up for all hematological, rheumatological and malignant causes. A computerized tomography scan of the abdomen confirmed splenic enlargement with multiples hypo dense lesions consist with either splenic infection or splenic lymphoma so exploratory splenectomy was performed. Histological examination revealed granulomatouse inflammation with numerous acid fast bacilli consist with tuberculosis. He was started on four anti-tuberculouse drugs. in less than one week his fever subside with normalization of his neutrophilic count

Tuberculous epididymitis presenting as huge scrotal tumor

Genitourinary tract tuberculosis is a specific chronic granulomatous infection. However, epididymal tuberculosis presented as a huge scrotal mass is uncommon. We report one case of epididymal tuberculosis that was noted 5 months after the prostate biopsy and was managed with unilateral simple epidymo-orchiectomy. Antituberculous drugs have been given as the medical treatment of tuberculosis postoperatively. Urinalysis became normalized and the scrotal ultrasonography showed normal left epididymis and testicle at 6-month follow up.

Fever of unknown origin caused by tuberculosis

Tuberculosis is an important cause of fever of unknown origin. Travel, age, dialysis, diabetes, birth in a country with a high prevalence of tuberculosis, and immunoincompetence are among the most salient risks. Associated physical findings, radiologic evaluation, and hematologic and endocrinologic abnormalities may provide clues to the diagnosis. Both noninvasive and invasive diagnostic modalities are reviewed. Because diagnosis may be elusive, therapeutic and diagnostic trials of antituberculous therapy should be considered in all patients with fever of unknown origin who defy diagnosis.

Tuberculose multiviscérale avec complication aortique chez un sujet immunocompétent

The medical and imaging data of a 59 year old male is reported. The patient presented with cough, fever, night sweats and weight loss, for which a final diagnosis of multivisceral tuberculosis (with peritoneal involvement and mycotic aneurysm) was made, by means of CT, MRI and laparoscopic findings. This disease is uncommon in developed countries with subjects lacking the usual risk factors. Because delayed treatment may be lethal, especially with such serious vascular complication, the authors review the value and limitations of CT and MRI along with the suggestive features.

Computed tomography findings of peritoneal tuberculosis

OBJECTIVE

The aim of this study was to describe the computed tomography (CT) findings in patients with demonstrated peritoneal tuberculosis (TB) and their concordance with the three types from the traditional classification (wet, fibrotic, and dry plastic).

METHODS

We reviewed the CT images of all patients with microbiologically proven peritoneal tuberculosis over a 6-year period (1996-2001).

RESULTS

Seven patients were included. Ascites was present in 5 patients (free ascites in 3 patients and loculated in 2). Involvement of the mesentery was found in 5 patients, the omentum in 4, and the parietal peritoneum in 3. Tuberculous lymphadenitis was the most common associated finding (6 patients). Two patients had hepatic lesions. The fibrotic type was found in all the patients, and 5 patients had an association of the fibrotic and wet types. None of the patients had lesions consistent with the dry plastic type.

CONCLUSION

Peritoneal tuberculosis is best described as a combination of ascites, peritoneal lesions, and lymphadenopathy, rather than the three types from the traditional classification.

Peritoneal Calcification:Causes and Distinguishing Features on CT

OBJECTIVE

We undertook this study to determine the causes of peritoneal calcification seen on CT and to investigate which CT features distinguish benign from malignant peritoneal calcification.

MATERIALS AND METHODS

Seventeen patients with peritoneal calcification were identified through retrospective review of reports from 74765 abdominopelvic CT examinations performed during a 7-year period. We determined the cause of peritoneal calcification by examining medical and histopathologic records. Calcification morphology was classified as nodular or sheetlike on the basis of the consensus interpretation by two independent radiologists. The radiologists also recorded the presence or absence of associated soft-tissue components or lymph node calcification. The association between the CT findings and the cause of calcification was assessed using chi-square analysis.

RESULTS

Peritoneal calcification was due to peritoneal dialysis (n = 4), prior peritonitis (n = 3), cryptogenic origin (n = 1), or peritoneal spread of ovarian carcinoma (n = 9). Sheet-like calcification was more common in patients with benign calcification (seven of eight patients) than in those with malignant calcification (two of nine patients, p < 0.05). Nodal calcification was seen only in patients with malignant calcification (five of nine patients vs none of eight, p < 0.05).

CONCLUSION

Common causes of peritoneal calcification are dialysis, prior peritonitis, or ovarian cancer; sheetlike calcification indicates a benign cause, whereas associated lymph node calcification strongly suggests malignancy.

Abdominal tuberculosis with pancreatic involvement: a case report

A case of abdominal tuberculosis with pancreatic involvement is described. A 27-year-old Italian male, with no known cause of immunodeficiency and with no evidence of pulmonary tuberculosis, was admitted to our division because of acute pancreatitis. Abdominal imaging revealed a large 'tumour-like' mass in the pancreas head compressing the distal choledochous, and multiple adenopathy. Histological examination of multiple specimens removed during explorative laparotomy revealed granulomas with giant cells, caseous necrosis, and positive Ziehl-Neelsen staining. Tissue culture was positive for Mycobacterium tuberculosis. Once specific medical treatment was started, the pancreatic damage completely resolved.

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.