Hepatic and splenic tuberculosis

Hepatic and splenic tuberculosis refers to tuberculosis affecting the liver and the spleen. It generally occurs due to hematogenous spread from the primary site of infection, commonly from pulmonary tuberculosis.

Pathology

Two types of lesions are known:

• micronodular (common)

• macronodular (rare)

Radiographic features

Ultrasound

Non-specific features are usually seen, including hepatosplenomegaly and abscesses ³.

There may be small hypoechoic nodules (miliary type) or larger hypoechoic mass-like areas ^2,3.

CT

• micronodular (miliary) type ¹:

  • multiple

  • small low attenuation areas with central enhancement (acute stage)

  • calcification (chronic stage)

• macronodular type ^1,4:

  • single or multiple tumor-like masses

    • rarely >3 cm in diameter

  • target sign

  • diffuse hepatosplenomegaly

MRI

• T1: lesions are usually isointense when compared to the background parenchyma

• T2: mixed signal with hyperintense areas

• T1 C+ (Gd): variable, reflecting the phases of the disease

Differential diagnosis

• for micronodular type:

  • lymphoma

  • fungal infection

  • metastases

  • sarcoidosis

• for macronodular type:

  • abscess

  • metastases

  • primary malignancy​