CASE 8941 Published on 27.10.2010

Peritoneal tuberculosis (ESGAR 2010 Case of the day)

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

Melidis D, Voudouri P, Hatzigeorgiadis A, Michailidou V, Velnidou A.

Patient

18 years, male

Categories
Area of Interest Abdomen ; Imaging Technique CT
Clinical History
An 18 year old man presented with a week’s history of fever and abdominal distension. On clinical examination, there was tenderness in the abdomen. The CRP was 400,00 mg/l, and WBC was 8.9 K /Ul. The chest X-ray was clear. A spiral CT study was performed to evaluate the abdomen.
Imaging Findings
An abdominal CT scan showed high-density (38 H) askites with "stellate" mesenteric appearance and thickening in the small bowel and colon. Also showed omental nodules and a smudge pattern. The histology of the peritoneal nodule revealed granulomatous inflammation, with follicles made up of epitheloid cells and Langhans type giant cells, with some areas of central necrosis.
Discussion
Peritoneal TB is the most common form of abdominal TB and involves the peritoneal cavity, the mesentery and the omentum. Three types of peritoneal TB are described. A wet type presents as free or loculated ascites with septae. The fixed fibrotic type may present as an omental and mesenteric mass, with matted bowel loops, and the dray plastic type can show thickened peritoneum and necrotic lymph nodes, though there is often an overlap between these two types. In many series evidence of disease outside the abdomen is often not present and in about half the cases, the chest X-ray is normal.
A laparoscopic examination of the abdomen showed that the peritoneum was studded with nodules. Similar nodules were also present on the surface of the viscera. Adhensions were present between the anterior abdominal wall and the viscera. Granulomatous inflammation with groups of epitheloid histiocytes and Langhans giant cells was confirmed by histologic examination. Treatment with antituberculous drugs led to an uneventful and complete recovery.
Differential Diagnosis List
Peritoneal tuberculosis
Peritoneal carcinomatosis
Peritoneal lymphomatosis
Primary peritoneal mesothelioma
Acute peritonitis
Final Diagnosis
Peritoneal tuberculosis
Case information
URL: https://www.eurorad.org/case/8941
DOI: 10.1594/EURORAD/CASE.8941
ISSN: 1563-4086