Gallbladder tuberculosis: Sonographic appearance

Abstract

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

Gallbladder Tuberculosis Mimicking Carcinoma Gallbladder : A Case Report

“…[1,2] About 70% of GT cases are accompanied by gallstones. [2] In a study of 280 patients with hepatobiliary tuberculosis, only one patient had gallbladder involvement.…”

“…The routes of infection in GBTB can be canalicular, lymphatic or hematogenous. [1], [5] GT often occurs in association with other intra-abdominal tuberculosis, and usually in women over 30 years of age. [2] Histologically, the lesion may be in the form of a localized ulceration or there may be typical tuberculous nodules of varied sizes and numbers in the gallbladder wall.…”

“…[1,2] Only very few cases have been reported in the medical literature. [1] A correct preoperative diagnosis of GT is unusual, and the condition is frequently confused with other gallbladder diseases like gallbladder carcinoma.…”

“…DISCUSSION: The gallbladder is highly resistant to tuberculous infection, and the presence of cholelithiasis and cystic duct obstruction is essential for the development of GT. [1,2] About 70% of GT cases are accompanied by gallstones. [2] GT often occurs in association with other intra-abdominal tuberculosis, and usually in women over 30 years of age.…”

“…[2] A correct diagnosis of GT is difficult, and it is usually made after cholecystectomy. [1] The differential diagnosis of GT includes acute and chronic cholecystitis, polypoid lesions and gallbladder carcinoma. [2] CONCLUSION: Gallbladder tuberculosis can mimic gallbladder carcinoma.…”