CT findings and analysis for misdiagnosis of female pelvic tuberculosis

Abstract

PurposeTo analyze the computed tomography (CT) findings and the reasons for misdiagnosis of female pelvic tuberculosis. MethodsThe clinical and CT features of 32 cases of female pelvic tuberculosis identified over a five-year period (2010–2015) were retrospectively analyzed. The CT features were analyzed for nature, range and extent of the various pathological patterns. ResultsBecause of the non-specific clinical and CT features, 20 of 32 cases were misdiagnosed either as ovarian tumor, or chocolate cyst, or PID preoperatively and received surgery. The mean age of the patients was 29.97 years (age range 15–67 years). Elevated levels of serum CA125 were found in 29 patients (90.62%, 29/32). The CT findings were as follows: 1. Pelvic mass (87.5%, 28/32): unilateral adnexal mass was in 15 cases, bilateral in 13 cases, 8 masses were cystic, 10 were solid, 23 were mixed, 24 masses showed multilocular caseous necrotic enhancement; 2. Ascites (40.62%, 13/32): 8 of 13 cases showed high density ascites (CT value > 18 HU); 3. Thickening and enhancement of peritoneum (37.5%, 12/32): nodulously thickened in 7 cases, smoothly in 5 cases; 4. Adhesion in the abdominopelvic cavity (28.12%, 9/32); 5. Lymphadenopathy (21.87%, 7/32): calcified in 4 cases, low attenuation necrotic lymph nodes with ring enhancement in 2 cases; 6. Thickening and enhancement of bowel wall (15.62%, 5/32). ConclusionsIntegrated with clinical history and laboratory tests, pelvic tuberculosis should be considered in young female patients with elevated CA125 and CT findings of adnexal mixed (solid and cystic) mass with multilocular caseous necrotic enhancement, high density ascites, thickened and enhanced peritoneum. Early diagnosis of the disease is a key consideration for early institution of anti-TB therapy to avoid misdiagnosis and surgical explorations.