Differentiation of peritoneal tuberculosis from peritoneal carcinomatosis by the Omental Rim sign. A new sign on contrast enhanced multidetector computed tomography

Ramanan, Rochita Venkata; Venu, Vadanika

doi:10.1016/j.ejrad.2019.02.019

Cited by 16 publications

(17 citation statements)

References 14 publications

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“…The omental rim sign on CT imaging has also been shown to have a radiological role in distinguishing between peritoneal TB and peritoneal carcinomatosis. In a prospective study of 85 peritoneal TB patients and 168 peritoneal carcinomatosis patients, the sign was found to be both sensitive and specific for peritoneal TB [15] .…”

Section: Discussionmentioning

confidence: 98%

Asymptomatic peritoneal tuberculosis in a patient with a non-remitting fever and isolated pulmonary symptoms: a case report and literature review

Ahmadi

Tapper

Al-Obudi

et al. 2021

Radiology Case Reports

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Tuberculosis (TB) remains one of the leading causes of death globally. Although abdominal or peritoneal TB is a recognised site for extrapulmonary TB to manifest, the diagnosis is often delayed due to the non-specific nature of the presenting clinical features. We present the diagnostically challenging case of a 32-year-old patient with recurrent episodes of fever and a non-productive cough that was initially treated as community-acquired pneumonia with oral antibiotics. A computed tomography scan of the thorax was unrevealing, aside from a large volume of ascites within the partially imaged upper abdomen. The patient did not report any abdominal symptoms and the abdominal examination was unremarkable. Subsequently, a transvaginal ultrasound, a contrast-enhanced computed tomography scan of the abdomen and pelvis, and magnetic resonance imaging of the abdomen and pelvis confirmed a large volume of ascites in the absence of any definite aetiology. A peritoneal biopsy was required before the diagnosis of peritoneal TB was eventually confirmed. This case highlights the importance of considering peritoneal TB in patients presenting with treatment-resistant chest symptoms and persistent pyrexia of undetermined aetiology, even in the absence of abdominal signs and symptoms.

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Section: Discussionmentioning

confidence: 98%

Asymptomatic peritoneal tuberculosis in a patient with a non-remitting fever and isolated pulmonary symptoms: a case report and literature review

Ahmadi

Tapper

Al-Obudi

et al. 2021

Radiology Case Reports

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“…In addition, computed tomography (CT) helps in establishing the diagnosis and determining the treatment plan. [ 16 , 17 ] However, since there is a wide variety of omental tumors that have different properties and at different stages of malignancy, the interpretation of ultrasonographic findings may be affected by the presence of intestinal gas and sound energy attenuation, which complicates the diagnosis of omental tumors. Therefore, when omental tumors are suspected, ultrasonography must be performed carefully.…”

Section: Discussionmentioning

confidence: 99%

Primary liposarcoma of the omentum

et al. 2022

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Rationale: Omental liposarcoma is extremely rare, and only a few reports have been published in the literature. Due to the rarity of the disease, establishing a clear diagnosis and formulating a treatment plan may be challenging for clinicians. Patient concerns: The patient was a 51-year-old woman who presented with a protruding mass and pain in the lower abdomen. Diagnosis: Magnetic resonance imaging revealed a tumor measuring 15 cm in diameter in the pelvis. Ovarian cancer was suspected based on pre-operative imaging findings. Interventions: An exploratory laparotomy was performed. Intra-operative analysis of the frozen section suggested a benign tumor. Outcomes: Postoperative histopathological analysis confirmed the diagnosis of omental liposarcoma. The patient recovered well after surgery. Lesson: This case report helps clinical oncologists to develop a comprehensive understanding of this disease and treat it accordingly.

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“…However, none of these findings (except for necrotic lymph nodes) were pathognomonic of a particular diagnosis [18]. Certain other CT findings, which could suggest a diagnosis of abdominal TB, include the presence of pulmonary involvement (15% to 25% cases), omental line or rim (thick uniformly enhancing outer rim of thickened omentum) and low visceral fat to subcutaneous fat ratio (< 0.63) [36,45,46]. Concomitant genitourinary involvement, especially in females with salpingitis, hydrosalpinx, adnexal lesions and tubo-ovarian masses, could suggest underlying TB [47].…”

Section: Increased Certainty Of Diagnosismentioning

confidence: 99%

Evidence-based approach to diagnosis and management of abdominal tuberculosis

Jha

Pathiyil

Sharma

2023

Indian J Gastroenterol

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Abdominal tuberculosis is an ancient problem with modern nuances in diagnosis and management. The two major forms are tuberculous peritonitis and gastrointestinal tuberculosis (GITB), while the less frequent forms are esophageal, gastroduodenal, pancreatic, hepatic, gallbladder and biliary tuberculosis. The clinicians need to discriminate the disease from the close mimics: peritoneal carcinomatosis closely mimics peritoneal tuberculosis, while Crohn's disease closely mimics intestinal tuberculosis. Imaging modalities (ultrasound, computed tomography, magnetic resonance imaging and occasionally positron emission tomography) guide the line of evaluation. Research in diagnostics (imaging and endoscopy) has helped in the better acquisition of tissue for histological and microbiological tests. Although point-of-care polymerase chain reaction-based tests (e.g. Xpert Mtb/Rif) may provide a quick diagnosis, these have low sensitivity. In such situations, ancillary investigations such as ascitic adenosine deaminase and histological clues (granulomas, caseating necrosis, ulcers lined by histiocytes) may provide some specificity to the diagnosis. A diagnostic trial of antitubercular therapy (ATT) may be considered if all diagnostic armamentaria fail to clinch the diagnosis, especially in TB-endemic regions. Objective evaluation with clear endpoints of response is mandatory in such situations. Early mucosal response (healing of ulcers at two months) and resolution of ascites are objective criteria for early response assessment and should be sought at two months. Biomarkers, especially fecal calprotectin for intestinal tuberculosis, have also shown promise. For most forms of abdominal tuberculosis, six months of ATT is sufficient. Sequelae of GITB may require endoscopic balloon dilatation for intestinal strictures or surgical intervention for recurrent intestinal obstruction, perforation or massive bleeding.

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Differentiation of peritoneal tuberculosis from peritoneal carcinomatosis by the Omental Rim sign. A new sign on contrast enhanced multidetector computed tomography

Cited by 16 publications

References 14 publications

Asymptomatic peritoneal tuberculosis in a patient with a non-remitting fever and isolated pulmonary symptoms: a case report and literature review

Asymptomatic peritoneal tuberculosis in a patient with a non-remitting fever and isolated pulmonary symptoms: a case report and literature review

Primary liposarcoma of the omentum

Evidence-based approach to diagnosis and management of abdominal tuberculosis

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