Presentation
Young expatriate female worker. Two weeks of increasing abdominal distension. No fever. Highly elevated CA-125.
Patient Data
![](https://prod-images-static.radiopaedia.org/images/24069984/3ff36d9d42d3e3d38b48e0c927c761_big_gallery.jpeg)
Thickened enhancing peritoneum.
Ascites.
Omental cake.
Bilateral pleural effusions.
An 18G ultrasound guided biopsy of the omentum was performed.
![](https://prod-images-static.radiopaedia.org/images/23889532/dba82699d586228284feb0b07c8ec6_big_gallery.jpeg)
The report was conclusive of peritoneal TB over the chief differential of an ovarian adenocarcinoma.
Case Discussion
Thickened enhancing peritoneum, ascites and omental stranding through to omental cake are imaging features of peritoneal tuberculosis.
This case was proven by biopsy, with caseating granulomas and mycobacterium identified.
The CA-125 was very elevated in this patient, who had neither a fever nor any clinical or radiological evidence of pulmonary TB.
Learning point: Although it is becoming increasingly untrendy to provide succinct clinical information and correlation with all other tests, it is vital in establishing a definitive diagnosis, as in this case.