CT Appearances in Treated Abdominal Tuberculosis: A Radiologist's Dilemma

Abstract

Objective To study the CT appearances of the abdomen after completion of antitubercular therapy (ATT) in adult patients. Methods Multidetector CT scan abdomen was done in 20 adults within 1 month of completing ATT. CT appearances were compared with pretreatment scans which were available in 7 cases. Results We found that residual ileocecal wall thickening and enhancement was significant (p < 0.05) after treatment in cases of ileocecal tuberculosis (TB). Mild decrease in wall thickness and diameter of the involved dilated small bowel loops was seen. Numerous large, matted nodes with necrosis persisted in the mesentery and retroperitoneum in treated TB, but reduction in the size of nodes was appreciated. Conclusion Our results help to fill the vacuum in the database of CT appearances in treated abdominal TB. Persistence of bowel changes and lymph nodes should not be mistaken for recurrence of TB or residual disease.

Imaging in Abdominal Tuberculosis

“…However, bowel wall thickening, homogeneous wall enhancement, and lymphadenopathy can persist post-ATT, and these do not necessarily indicate active disease. 71 In fact, tubercular strictures, especially colonic ones, are particularly resilient to ATT, with response seen in only a quarter to two-thirds of patients. 72,73 Therefore, rather than relying on imaging findings alone, the decision to continue or stop ATT should be made in conjunction with clinical and endoscopic evidence of disease activity.…”