Tuberculosis of the gallbladder is extremely rare. To date, less than 50 cases have been reported in the world literature.' This is the first report in the literature of ultrasound and computed tomography appearances of gallbladder tuberculosis, with sonographic follow-up showing resolution of the gallbladder lesions after antitubercular chemotherapy.
CASE REPORTA 63-year-old man was initially seen with a 1.5-year history of fever, anorexia, and weight loss (40%). The patient also had had ascites and edema of the legs for 8 months. On examination, he was emaciated and moribund. There was no evidence of jaundice, peripheral lymphadenopathy, or splenomegaly. Laboratory investigations were as follows: hemoglobin: 9.7 g%; leukocyte count: 3,800; differential leukocyte count: N56 L40; erythrocyte sedimentation rate: 46 mm 1st hour. Chest x-ray did not reveal any evidence of tuberculosis.Ultrasound and CT of the abdomen revealed ascites, mesenteric thickening as well as mesenteric and retroperitoneal lymphadenopathy. The gallbladder was massively enlarged and thickwalled. The lumen of the gallbladder was filled with a varigated, soft-tissue mass (predominantly echogenic with US and iso-attenuating with the liver parenchyma with nonenhanced CT) Figures 1 and 2). Within the mass was a large calculus. Ultrasound-guided core biopsies were obtained from the gallbladder mass and mesenteric lymph nodes. Histopathology from both sites revealed mainly necrotic material with chronic inflammaFrom the Departments of *Radiodiagnosis and tGastroenterology, All
Intestinal tuberculosis is still common in developing countries. In 186 patients with intestinal tuberculosis, clinical features, radiological findings and complications were carefully recorded and compared with those from earlier studies with a view to study any possible changes after the liberal use of antitubercular drugs. Sixty two percent of the patients in the present series had had prior exposure to antitubercular drugs. The incidence of systemic symptoms like fever and anorexia, alternating diarrhoea and constipation, peritoneal and lymph node involvements and associated pulmonary lesions were less frequently observed. On the other hand, an indolent and complicated course with intestinal obstruction (47%) and lower gastrointestinal bleeding (5.5%) and frequent colonic involvement (19%) often necessitating surgical intervention appeared to have become more frequent than reported in earlier series. Awareness of these changes in the clinical profile of intestinal tuberculosis should be helpful in the diagnosis and management of the condition.
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