RSS-Feed abonnieren

DOI: 10.1055/s-0044-1787837
Imaging in Abdominal Tuberculosis
Funding None.

Abstract
Diagnosis of abdominal tuberculosis is challenging due to its variable imaging appearance, which can mimic several other conditions. This review covers the imaging spectrum of tubercular involvement of abdominal lymph nodes, peritoneum, solid abdominal viscera, and the gastrointestinal tract. Tubercular lymphadenitis is the most frequent manifestation of abdominal tuberculosis and may show necrosis. Peritoneal tuberculosis is the next most commonly involved site in the abdomen and can be of wet, fibrotic, and dry forms. The ileocecal region is the most common site of involvement in gastrointestinal tuberculosis. Solid visceral involvement mostly affects the liver and spleen causing hepatosplenomegaly with a micronodular or macronodular imaging pattern. Awareness of the spectrum of imaging manifestations and a high index of suspicion is required to reach the correct diagnosis.
Keywords
abdominal tuberculosis - peritoneal tuberculosis - intestinal tuberculosis - hepatosplenic tuberculosis - computed tomography - ultrasound - barium studies - enterographyPublikationsverlauf
Artikel online veröffentlicht:
31. Juli 2024
© 2024. Indographics. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 World Health Organization. Global Tuberculosis report 2023. Accessed February 11, 2024 at: https://iris.who.int/bitstream/handle/10665/373828/9789240083851-eng.pdf?sequence=1
- 2 Sharma R, Madhusudhan KS, Ahuja V. Intestinal tuberculosis versus Crohn's disease: clinical and radiological recommendations. Indian J Radiol Imaging 2016; 26 (02) 161-172
- 3 Mandavdhare HS, Singh H, Sharma V. Recent advances in the diagnosis and management of abdominal tuberculosis. EMJ Gastroenterol 2017; 6 (01) 52-60
- 4 Pratap Mouli V, Munot K, Ananthakrishnan A. et al. Endoscopic and clinical responses to anti-tubercular therapy can differentiate intestinal tuberculosis from Crohn's disease. Aliment Pharmacol Ther 2017; 45 (01) 27-36
- 5 Gupta A, Pratap Mouli V, Mohta S. et al. Antitubercular therapy given to differentiate Crohn's disease from intestinal tuberculosis predisposes to stricture formation. J Crohn's Colitis 2020; 14 (11) 1611-1618
- 6 Leder RA, Low VH. Tuberculosis of the abdomen. Radiol Clin North Am 1995; 33 (04) 691-705
- 7 De Backer AI, Mortelé KJ, Deeren D, Vanschoubroeck IJ, De Keulenaer BL. Abdominal tuberculous lymphadenopathy: MRI features. Eur Radiol 2005; 15 (10) 2104-2109
- 8 Vanhoenacker FM, De Backer AI, Op de BB. et al. Imaging of gastrointestinal and abdominal tuberculosis. Eur Radiol 2004; 14 (Suppl. 03) E103-E115
- 9 Ladumor H, Al-Mohannadi S, Ameerudeen FS, Ladumor S, Fadl S. TB or not TB: a comprehensive review of imaging manifestations of abdominal tuberculosis and its mimics. Clin Imaging 2021; 76: 130-143
- 10 Joshi AR, Basantani AS, Patel TC. Role of CT and MRI in abdominal tuberculosis. Curr Radiol Rep 2014; 2: 66
- 11 Akhan O, Pringot J. Imaging of abdominal tuberculosis. Eur Radiol 2002; 12 (02) 312-323
- 12 Suarez T, Garcia V, Estrada T, Acosta F. Imaging in abdominal tuberculosis. Rev Colomb Radiol. 2010; 21 (04) 1-11
- 13 Suri S, Gupta S, Suri R. Computed tomography in abdominal tuberculosis. Br J Radiol 1999; 72 (853) 92-98
- 14 Na-ChiangMai W, Pojchamarnwiputh S, Lertprasertsuke N, Chitapanarux T. CT findings of tuberculous peritonitis. Singapore Med J 2008; 49 (06) 488-491
- 15 Ha HK, Jung JI, Lee MS. et al. CT differentiation of tuberculous peritonitis and peritoneal carcinomatosis. AJR Am J Roentgenol 1996; 167 (03) 743-748
- 16 Pang Y, Li Y, Xu D, Sun X, Hou D. Differentiating peritoneal tuberculosis and peritoneal carcinomatosis based on a machine learning model with CT: a multicentre study. Abdom Radiol (NY) 2023; 48 (04) 1545-1553
- 17 Singhal M, Krishna S, Lal A. et al. Encapsulating peritoneal sclerosis: the abdominal cocoon. Radiographics 2019; 39 (01) 62-77
- 18 Balthazar EJ, Gordon R, Hulnick D. Ileocecal tuberculosis: CT and radiologic evaluation. AJR Am J Roentgenol 1990; 154 (03) 499-503
- 19 Sharma MP, Ahuja V. Abdominal (gastrointestinal tract) tuberculosis in adult. In: Schaaf HS, Zumla AI, Grange JM. eds. Tuberculosis: A Comprehensive Clinical Reference. Edinburgh: Saunders/Elsevier; 2009: 424-431
- 20 Gupta P, Kumar S, Sharma V. et al. Common and uncommon imaging features of abdominal tuberculosis. J Med Imaging Radiat Oncol 2019; 63 (03) 329-339
- 21 Yang G, Zhang W, Yu T. et al. The features of intestinal tuberculosis by contrast-enhanced ultrasound. Jpn J Radiol 2015; 33 (09) 577-584
- 22 Kalra N, Agrawal P, Mittal V. et al. Spectrum of imaging findings on MDCT enterography in patients with small bowel tuberculosis. Clin Radiol 2014; 69 (03) 315-322
- 23 Bhatt S, Roy S, Bhardwaj N. et al. Kaleidoscopic view of bowel tuberculosis on multi- detector computed tomography (CT) enterography - a novel technique unfolding an archaic disease. Pol J Radiol 2017; 82: 783-791
- 24 Krishna S, Kalra N, Singh P. et al. Small-bowel tuberculosis: a comparative study of MR enterography and small-bowel follow-through. AJR Am J Roentgenol 2016; 207 (03) 571-577
- 25 Sharma SK, Mohan A. Extrapulmonary tuberculosis. Indian J Med Res 2004; 120 (04) 316-353
- 26 Kedia S, Sharma R, Vuyyuru SK. et al. Addition of computed tomography chest increases the diagnosis rate in patients with suspected intestinal tuberculosis. Intest Res 2022; 20 (02) 184-191
- 27 Choudhury A, Dhillon J, Sekar A, Gupta P, Singh H, Sharma V. Differentiating gastrointestinal tuberculosis and Crohn's disease- a comprehensive review. BMC Gastroenterol 2023; 23 (01) 246
- 28 Kedia S, Madhusudhan KS, Sharma R. et al. Combination of increased visceral fat and long segment involvement: development and validation of an updated imaging marker for differentiating Crohn's disease from intestinal tuberculosis. J Gastroenterol Hepatol 2018; 33 (06) 1234-1241
- 29 Khan MS, Maan MHA, Sohail AH, Memon WA. Primary esophageal tuberculosis mimicking esophageal carcinoma on computed tomography: a case report. World J Gastrointest Surg 2019; 11 (09) 373-380
- 30 Lee KH, Kim HJ, Kim KH, Kim HG. Esophageal tuberculosis manifesting as submucosal abscess. AJR Am J Roentgenol 2003; 180 (05) 1482-1483
- 31 Nagi B, Lal A, Kochhar R. et al. Imaging of esophageal tuberculosis: a review of 23 cases. Acta Radiol 2003; 44 (03) 329-333
- 32 Debi U, Ravisankar V, Prasad KK, Sinha SK, Sharma AK. Abdominal tuberculosis of the gastrointestinal tract: revisited. World J Gastroenterol 2014; 20 (40) 14831-14840
- 33 Padma V, Anand NN, Rajendran SM, Gurukal S. Primary tuberculosis of stomach. J Indian Med Assoc 2012; 110 (03) 187-188
- 34 Pereira JM, Madureira AJ, Vieira A, Ramos I. Abdominal tuberculosis: imaging features. Eur J Radiol 2005; 55 (02) 173-180
- 35 Bhatti A, Hussain M, Kumar D, Samo KA. Duodenal tuberculosis. J Coll Physicians Surg Pak 2012; 22 (02) 111-112
- 36 Dahiya D, Garg M, Kaman L, Rana S, Rao C, Behera A. Duodenal tuberculosis–a rare case report and review of literature. Pol Przegl Chir 2013; 85 (08) 464-466
- 37 Nagi B, Lal A, Gupta P, Kochhar R, Sinha SK. Radiological findings in duodenal tuberculosis: a 15-year experience. Abdom Imaging 2015; 40 (05) 1104-1109
- 38 Chavhan GE, Ramakantan R. Duodenal tuberculosis: radiological features on barium studies and their clinical correlation in 28 cases. J Postgrad Med 2003; 49 (03) 214-217
- 39 Nagi B, Kochhar R, Bhasin DK, Singh K. Colorectal tuberculosis. Eur Radiol 2003; 13 (08) 1907-1912
- 40 Mukewar S, Mukewar S, Ravi R, Prasad A. S Dua K, Colon tuberculosis: endoscopic features and prospective endoscopic follow-up after anti-tuberculosis treatment. Clin Transl Gastroenterol 2012; 3 (10) e24
- 41 Verma K, Pai VD, Patil PS, Bal M, Saklani AP. Isolated colorectal tuberculosis masquerading as malignancy: a case series. Trop Gastroenterol 2016; 37 (03) 227-230
- 42 Azadi A, Jafarpour Fard P, Sagharjoghi Farahani M, Khodadadi B, Almasian M. Anal tuberculosis: a non-healing anal lesion. IDCases 2018; 12: 25-28
- 43 Pandit K, Khanal S, Bhatta S, Trotter AB. Anorectal tuberculosis as a chronic rectal mass mimicking rectal prolapse in a child-a case report. Ann Med Surg (Lond) 2018; 36: 264-266
- 44 Choi YS, Kim DS, Lee JB. et al. Clinical features of tuberculous versus Crohn's anal fistulas, in Korea. J Crohn's Colitis 2015; 9 (12) 1132-1137
- 45 Makanjuola D, al Orainy I, al Rashid R, Murshid K. Radiological evaluation of complications of intestinal tuberculosis. Eur J Radiol 1998; 26 (03) 261-268
- 46 Coccolini F, Ansaloni L, Catena F, Lazzareschi D, Puviani L, Pinna AD. Tubercular bowel perforation: what to do?. Ulus Travma Acil Cerrahi Derg 2011; 17 (01) 66-74
- 47 Gayathre SP, Kudiyarasu, Kannan R, Shajini N. A rare complication of the great mimicker: free tubercular ileal perforation. Int Surg J 2021; 8 (04) 1366-1369
- 48 Dong P, Chen JJ, Wang XZ, Wang YQ. Intraperitoneal tuberculous abscess: computed tomography features. World J Radiol 2015; 7 (09) 286-293
- 49 Vetri R, Kannichamy V, Jacob VA, Sainath S. Abdominal tuberculosis presenting as an umbilical sinus: a case report. Cureus 2022; 14 (11) e31184
- 50 Singh H, Mandavdhare H, Sharma V. All that fistulises is not Crohn's disease: multiple entero-enteric fistulae in intestinal tuberculosis. Pol Przegl Chir 2019; 91 (01) 35-37
- 51 Wu P, Zeng J, Yang L. Case report: vesicorectal fistula caused by intestinal tuberculosis complicated with systemic lupus erythematosus. Infect Drug Resist 2022; 15: 6237-6243
- 52 Bavunoglu I, Ayan F, Karabicak I. et al. Selective jejunal artery pseudoaneurysm embolization in a patient with massive gastrointestinal bleeding due to intestinal tuberculosis. J Emerg Med 2006; 31 (04) 391-394
- 53 Karaosmanoglu AD, Onur MR, Sahani DV, Tabari A, Karcaaltincaba M. Hepatobiliary tuberculosis: imaging findings. AJR Am J Roentgenol 2016; 207 (04) 694-704
- 54 Venkatesh SK, Tan LK, Siew EP, Putti TC. Macronodular hepatic tuberculosis associated with portal vein thrombosis and portal hypertension. Australas Radiol 2005; 49 (04) 322-324
- 55 Yu RS, Zhang SZ, Wu JJ, Li RF. Imaging diagnosis of 12 patients with hepatic tuberculosis. World J Gastroenterol 2004; 10 (11) 1639-1642
- 56 Jain N, Rissam HK, Puri SK, Chauhan U. The “frosted liver” appearance in hepatic tuberculosis: a rare presentation. BJR Case Rep 2016; 2 (04) 20150367
- 57 Israrahmed A, Agarwal S, Singh S, Lal H. 'Frosted liver' appearance in serohepatic variant of hepatic tuberculosis. BMJ Case Rep 2021; 14 (03) e241643
- 58 Ray S, Das K, Mridha AR. Pancreatic and peripancreatic nodal tuberculosis in immunocompetent patients: report of three cases. JOP 2012; 13 (06) 667-670
- 59 Dou Y, Liang Z. Pancreatic tuberculosis: a computed tomography imaging review of thirteen cases. Radiol Infect Dis 2019; 6: 31-37
- 60 De Backer AI, Mortelé KJ, Bomans P, De Keulenaer BL, Vanschoubroeck IJ, Kockx MM. Tuberculosis of the pancreas: MRI features. AJR Am J Roentgenol 2005; 184 (01) 50-54
- 61 Gupta A, Gupta A, Anjum R, Agrawal S, Mallik D. A comprehensive review on primary gallbladder tuberculosis. Pol Przegl Chir 2018; 90 (02) 10-12
- 62 Xu XF, Yu RS, Qiu LL, Shen J, Dong F, Chen Y. Gallbladder tuberculosis: CT findings with histopathologic correlation. Korean J Radiol 2011; 12 (02) 196-202
- 63 Runner GJ, Corwin MT, Siewert B, Eisenberg RL. Gallbladder wall thickening. AJR Am J Roentgenol 2014; 202 (01) W1-W12
- 64 Kritika SR, Tiwari T, Goyal S. CT evaluation of different forms of abdominal tuberculosis: a series of multiple cases. Japanese J Gastroenterol Res. 2022; 2 (09) 1090
- 65 Naeem M, Zulfiqar M, Siddiqui MA. et al. Imaging manifestations of genitourinary tuberculosis. Radiographics 2021; 41 (04) 1123-1143
- 66 Guo YK, Yang ZG, Li Y. et al. Addison's disease due to adrenal tuberculosis: contrast-enhanced CT features and clinical duration correlation. Eur J Radiol 2007; 62 (01) 126-131
- 67 Zhang XC, Yang ZG, Li Y. et al. Addison's disease due to adrenal tuberculosis: MRI features. Abdom Imaging 2008; 33 (06) 689-694
- 68 Gupta S, Ansari MAM, Gupta AK, Chaudhary P, Bansal LK. Current approach for diagnosis and treatment of adrenal tuberculosis-our experience and review of literature. Surg J (NY) 2022; 8 (01) e92-e97
- 69 Kedia S, Das P, Madhusudhan KS. et al. Differentiating Crohn's disease from intestinal tuberculosis. World J Gastroenterol 2019; 25 (04) 418-432
- 70 Ma L, Zhu Q, Li Y. et al. The potential role of CT enterography and gastrointestinal ultrasound in the evaluation of anti-tubercular therapy response of intestinal tuberculosis: a retrospective study. BMC Gastroenterol 2019; 19 (01) 106
- 71 Rathi V, Yadav V, Deep BS, Bhatt S, Giri S. CT appearances in treated abdominal tuberculosis: a radiologist's dilemma. J Gastrointestinal Abdominal Radiol ISGAR 2022; 5: 30-36
- 72 Aggarwal P, Kedia S, Sharma R. et al. Tubercular intestinal strictures show a poor response to anti-tuberculous therapy. Dig Dis Sci 2017; 62 (10) 2847-2856
- 73 Jena A, Mohindra R, Rana K. et al. Frequency, outcomes, and need for intervention in stricturing gastrointestinal tuberculosis: a systematic review and meta-analysis. BMC Gastroenterol 2023; 23 (01) 46
- 74 Sasi A, Ahuja V, Das CJ. et al. Assessment of CT perfusion indices of the clinicoradiological response to anti-tubercular therapy in patients with intestinal tuberculosis. Clin Radiol 2023; 78 (12) e1081-e1086
- 75 Mathur P, Sharma R, Kandasamy D, Kedia S, Gamanagatti S, Ahuja V. Can ADC be used as a surrogate marker of response to therapy in intestinal tuberculosis?. Abdom Radiol (NY) 2019; 44 (09) 3006-3018
- 76 Tian G, Xiao Y, Chen B, Xia J, Guan H, Deng Q. FDG PET/CT for therapeutic response monitoring in multi-site non-respiratory tuberculosis. Acta Radiol 2010; 51 (09) 1002-1006
- 77 Jha DK, Pathiyil MM, Sharma V. Evidence-based approach to diagnosis and management of abdominal tuberculosis. Indian J Gastroenterol 2023; 42 (01) 17-31
- 78 Suri R, Gupta S, Gupta SK, Singh K, Suri S. Ultrasound guided fine needle aspiration cytology in abdominal tuberculosis. Br J Radiol 1998; 71 (847) 723-727