Abdominal visceral tuberculosis: a malignancy mimic

Abstract

The purpose is to discuss abdominal tuberculosis mimicking malignancy involving the abdominal viscera. TB of the abdominal viscera is common, especially in countries where tuberculosis is endemic and in pockets of non-endemic countries. Diagnosis is challenging as clinical presentations are often non-specific. Tissue sampling may be necessary for definitive diagnosis. Awareness of the early and late disease imaging appearances of abdominal tuberculosis involving the viscera that can mimic malignancy can aid detecting TB, providing a differential diagnosis, assessing extent of spread, guiding biopsy, and evaluating response. Graphical abstract

Comments and Illustrations of Ultrasound Findings in Extrapulmonary Tuberculosis Manifestations

“…Liver involvement in active tuberculosis is rarely reported, with a frequency of approximately 1% [51,52]. It is more common with concomitant HIV disease at 18% [5,6,52]. Isolated tuberculosis of the liver is very rare, and has been described in just 1% of all cases [53,54].…”

“…Important differential diagnoses are those of metastases, other granulomatous diseases with liver involvement, or other abscesses (mycotic, brucellosis). In the case of pre-existing liver disease, regenerative nodules and HCC must be included [6]. (g) (h) Figure 3.…”

“…If large bile ducts are affected, wall thickening, and bile duct dilatation may be present. Intrahepatic strictures and bile duct dilatations indicate involvement of the intrahepatic bile ducts [6,[65][66][67][68]. Diffuse miliary calcification along the course of the bile ducts has been described as a typical feature of tubercular cholangitis [56].…”

“…The most important differential diagnoses are primary sclerosing cholangitis, secondary sclerosing cholangitis, and cholangiocarcinoma [6,56]. The lesion is hyperenhanced in the arterial phase at the edge of the CEUS; the center is nonenhanced with the exception of some enhanced septa (c).…”

“…The extrapulmonary manifestations can occur in both immunocompetent and immunocompromised patients, but the simultaneous presence of an HIV infection significantly increases the probability. HIV patients are at risk of reactivating a tuberculosis infection and are more likely to develop disseminated disease [5][6][7][8]. The disease is endemic in areas with difficult socio-economic standards.…”