Transabdominal ultrasound as a screening stage for the diagnosis of tuberculous peritonitis

Abstract

In recent years, the incidence of tuberculous peritonitis increased. Peritoneal tuberculosis is difficult to diagnose, and often the diagnosis is verified with significant delay. In clinical practice, a quick and affordable diagnostic radiology method, ultrasonography (USG), is proposed for patients with suspected tuberculous peritonitis. The study was aimed to describe the sonographic semiology of tuberculous peritonitis, to create the integrated scale for the individual peritoneal tuberculosis sonographic symptoms significance assessment, and to determine the role of ultrasound imaging in the diagnosis verification. Retrospective study of the invasive and ultrasound investigation results of 37 patients with confirmed tuberculous peritonitis was carried out in 2009–2019. Similar data obtained by investigation of 28 patients with the disorders which often mimic the tuberculous peritonitis (peritoneal carcinomatosis and sarcoidosis, non-specific ascites) were used as a comparison group. Direct and indirect signs of peritoneal lesion in patients with tuberculosis were identified. On the basis of that, an integral scale for the individual sonographic symptoms significance assessment was created. Each sonographic symptom received a 0–3 score. Assessment of those sonographic signs visualization allowed us to evaluate the probability of the disorder’s tuberculous etiology. The following data were obtained: score under 4 corresponded to low probability, score 5–8 corresponded to medium probability, and score over 9 corresponded to high probability of tuberculous peritonitis based on the visualization of all described songraphic symptoms. The proposed integrated scale for the sonographic signs assessment allows the clinician to verify the tuberculous peritonitis diagnosis based on the ultrasound imaging data or to select the further tactics of diagnosis.