Isolated tuberculosis of the liver: a diagnostic challenge

Malik, Momin; Kurban, Lutfi; Murray, Graeme I.; Alkari, Bassam

doi:10.1136/bcr.12.2010.3654

Cited by 11 publications

(5 citation statements)

References 7 publications

(5 reference statements)

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“…No resection of these lesions is warranted, as the disease is managed by drug therapy. 25,26 Laparoscopy may be required to obtain suitable tissue for culture (or highly sensitive polymerized chain reaction) in a patient suspected on imaging of having tuberculous peritonitis but becomes dangerous when there are multiple adhesions and bowel matting. 7,10,13,25 In this situation, open laparotomy and biopsy are preferred to avoid injury and subsequent fistulization.…”

Section: Role Of Radiological and Surgical Intervention In Managementmentioning

confidence: 99%

Abdominal Tuberculosis in Children—Imaging and Intervention

Kilborn

Wieselthaler

Nondela

et al. 2017

J Pediatr Infect Dis

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The global burden of tuberculosis (TB) is a health care challenge in both the developing and developed world. Children represent a high-risk group for acquiring the disease, but despite this, abdominal TB (ATB) remains uncommon. ATB includes infection of the gastrointestinal tract, peritoneum, mesentery, lymph nodes, and solid organs. Mycobacterium tuberculosis accounts for most cases but Mycobacterium bovis has also been implicated. The clinical manifestations of ATB are nonspecific leading to diagnostic delay that results in significant morbidity and mortality. Imaging plays a crucial role in the early diagnosis of TB, guides biopsy, evaluates response to treatment, and identifies complications. In this article, we review the imaging findings of ATB with particular reference to modalities that avoid the use of radiation in pediatric patients. The role of interventional radiology and surgery in the diagnosis and management of ATB is also described.

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Section: Role Of Radiological and Surgical Intervention In Managementmentioning

confidence: 99%

Abdominal Tuberculosis in Children—Imaging and Intervention

Kilborn

Wieselthaler

Nondela

et al. 2017

J Pediatr Infect Dis

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“…Rarely, a honeycomb appearance has been found on CT. MR images showed low signal intensity on both T1-and T2-weighted images (Murata et al 1996;Fan et al 1998). Large mass lesions, sometimes exceeding 10 cm in diameter, mimic primary hepatic cancer (giant tuberculoma; Chan and Pang 1989;Achem et al 1992;Brookes et al 2006;Malik et al 2011) or gallbladder cancer (Bikhchandani et al 2005). Tuberculoma located to the porta hepatis can clinically and radiologically resemble Klatskin tumor (Arora et al 2008).…”

Section: Hepatic Tuberculoma (Macronodular Hepatic Tuberculosis)mentioning

confidence: 99%

Tumor-Like Lesions of the Hepatobiliary Tract Caused by Mycobacterial Infections: Tuberculosis and Lepra

Zimmermann¹

2016

Tumors and Tumor-Like Lesions of the Hepatobiliary Tract

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Primary and secondary tuberculosis of the liver can result in several types of tumor-like lesions. A common manifestation of hepatic tuberculosis is miliary hepatic tuberculosis and granulomatous hepatitis. Tumor-like lesions mainly include local forms of hepatic tuberculosis, with conglomerate tubercles, tuberculomas (macronodular tuberculosis), and nodular tuberculous pseudotumors. Hepatobiliary tuberculosis can also involve the biliary tract proper, with ulcerating and granulomatous cholangitis resulting in significant strictures. The infection also causes distinct vascular changes, such as granulomatous vasculitis and tuberculous pylephlebitis. A second mycobacterial infection that may involve the liver is leprosy, causing granulomatous hepatitis and the formation of so-called lepromas.

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“…[ 2 ] However, isolated hepatic TB is a rare entity and poorly described in the literature, even in countries with a high prevalence of tuberculosis. [ 3 ] Patients always have non-specific clinical findings. Isolated hepatic TB responds well to anti-tubercular treatment.…”

Section: Introductionmentioning

confidence: 99%

Primary isolated hepatic tuberculosis mimicking small hepatocellular carcinoma

Yang¹,

Liu²,

Ling³

et al. 2020

Medicine

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Rationale: Mycobacterium tuberculosis (TB) remains a serious threat in developing countries. Primary isolated hepatic tuberculosis is extremely rare. Because of its non-specific imaging features, noninvasive preoperative imaging diagnosis of isolated hepatic tuberculoma remains challenging. Patient concerns: A 48-year-old man was admitted to our hospital due for suspected liver neoplasm during health examination. Diagnoses: The tests for blood, liver function, and tumor markers were within normal range. Preoperative ultrasonography (US) showed a hypoechoic lesion with a longitudinal diameter of 2.5 cm in segment six of liver. It exhibited early arterial phase hyperenhancement and late arterial phase rapid washout in contrast-enhanced US. It demonstrated hyperintensity in T2-weighted magnetic resonance imaging and partly restricted diffusion in diffusion-weighted imaging. For this nodule, the preoperative diagnosis was small hepatocellular carcinoma (HCC). Interventions: Laparoscopic hepatectomy was performed. Intraoperative extensive adhesion in the abdominal cavity and liver was found. The lesion had undergone expansive growth. Outcomes: Microscopically, a granuloma with some necrosis was detected. With both acid-fast staining and TB fragment polymerase chain reaction showing positive results, TB was the final histology diagnosis. After surgery, the patient declined any anti-TB medication. During the follow-up, he had no symptoms. In the sixth month after surgery, he underwent an upper abdominal US. It showed no lesions in the liver. Lessons: Because of non-specific imaging findings and non-specific symptoms, a diagnosis of isolated hepatic TB is difficult to make, especially for small lesions. A diagnosis of HCC should be made cautiously when small isolated lesions in the liver are encountered, especially in patients without a history of hepatitis and with negative tumor markers.

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Isolated tuberculosis of the liver: a diagnostic challenge

Cited by 11 publications

References 7 publications

Abdominal Tuberculosis in Children—Imaging and Intervention

Abdominal Tuberculosis in Children—Imaging and Intervention

Tumor-Like Lesions of the Hepatobiliary Tract Caused by Mycobacterial Infections: Tuberculosis and Lepra

Primary isolated hepatic tuberculosis mimicking small hepatocellular carcinoma

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