Usefulness of ultrasound in the diagnosis of peritoneal tuberculosis

Sebastiana Atzori,Gianpaolo Vidili,Giuseppe Delitala

doi:10.3855/jidc.2654

Abstract

The peritoneum is one of the most common extrapulmonary sites of tuberculous infection. We report a case of peritoneal tuberculosis (TB) in a 25-year-old man. In this case, ultrasound of the abdomen played an important role in the diagnostic process. The diagnosis of this disease, however, remains a challenge because of its insidious nature, the variability of its presentation, and the limitations of available diagnostic tests. A high index of suspicion should be considered, particularly in high-risk patients with unexplained ascites. In our case ultrasound guided the diagnosis by rapidly identifying abnormal signs, which in high-prevalence settings are extremely suggestive of peritoneal tuberculosis.

Highlights

The peritoneum and its reflections are common sites of tuberculous involvement of the abdomen
We focused our diagnostic hypothesis on peritoneal tuberculosis
Skin test with PPD, Quantiferon test, urine, fecal, and ascitic fluid cultures were negative for Mycobacterium tuberculosis infection

Summary

Introduction

The peritoneum and its reflections are common sites of tuberculous involvement of the abdomen. Ultrasound examination of the abdomen (Acuson Sequoia 512, 4C1 and 8L5 probes, Siemens, Mountain View, California, USA) showed the presence of interloop ascitic fluid with septations, thickening of the abdominal wall and the visceral peritoneum of the mesentery, increased echogenity of mesenteric fat, conglomerated loops and enlarged lymph nodes in the small bowel mesentery (Figure 1). Ultrasound examination of the abdomen showed the presence of interloop ascitic fluid with fibrotic branch (panel A).

Results

Conclusion