Ileocecal tuberculosis is the most common site of gastrointestinal tuberculosis, which in turn is the third most common site of extrapulmonary tuberculosis.
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Pathology
Three morphological types of ileocecal tuberculosis are known:
ulcerative
hypertrophic
ulcerohypertrophic
Radiographic features
Ultrasound
Ultrasound is non-specific but may show cecal wall thickening and/or lymphadenopathy.
Fluoroscopy
Barium study
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acute-to-subacute stage
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narrowing of the terminal ileum
thickening and gaping of the ileocecal valve
thickening and hypermotility of the cecum
Stierlin sign: acute-on-chronic
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chronic stage
ileocecal valve appears fixed, rigid and incompetent
cecum appears conical in shape and shrunken in size
pulled-up cecum (away from the right iliac fossa) due to fibrotic changes in the mesocolon
CT
circumferential wall thickening of terminal ileum and cecum
asymmetric thickening of the ileocecal valve
mesenteric lymphadenopathy with central low attenuation areas
involvement of other organs (e.g. lung)
Differential diagnosis
General imaging differential considerations include:
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more terminal ileal involvement compared with tuberculosis, which has more pronounced cecal involvement
less/no ascites
vascular engorgement and fibrofatty proliferation of mesentery
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cecal carcinoma (colorectal carcinoma)
eccentric cecal wall thickening
evidence of metastatic disease
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very thick (>2 cm thickness) bowel wall
lack of stricturing
associated lymphadenopathy +/- hepatosplenomegaly
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