Abdominal tuberculosis and appendicitis

Case contributed by Sachin Phakey

Presentation

RIF pain, febrile, with episodes of hemoptysis and night sweats.

Patient Data

Age: 30 years
Gender: Female
CT

CT Abdomen

The terminal ileum appears diffusely abnormal with dilatation, prominent wall thickening and wall enhancement. No evidence of bowel obstruction.

There are multiple ring-enhancing lesions with central low attenuation measuring up to 9.2cm x 2.5 cm (axial plane) within the central mesentery extending into the right iliac fossa, suggestive of the presence of multiple necrotic lymph nodes. Mildly enlarged inguinal lymph nodes bilaterally.

The appendix is dilated (measuring up to 12 mm) and lies within the right paracolic gutter with its tip abutting the inferior border of the right liver lobe. The appendix has fat stranding and demonstrates prominent wall enhancement. No appendicolith noted, nor periappendiceal collection.

Conclusion:

Features are of acute appendicitis.
The low-density lymph nodes raise the possibility of intra-abdominal and pelvic tuberculous disease.

Case Discussion

This case demonstrates findings suggestive of tuberculosis: abnormal terminal ileum and multiple necrotic mesenteric lymph nodes. The patient went on to have laparoscopic mesenteric lymph node biopsy, with histopathology demonstrating tuberculosis.

The appendiceal findings are suspicious for acute appendicitis. The necrotic lymph nodes plus the abnormal terminal ileum raise a strong possibility of tuberculosis. 

 

Learning points:

  • The gastrointestinal system is one of the many potential organ systems affected by tuberculosis.
  • The abdominal structures commonly implicated in gastrointestinal tuberculosis include: terminal ileum, ileocecal junction and abdominal lymph nodes.
  • The CT findings in this case which are suggestive of gastrointestinal tuberculosis include:
    • Terminal ileum and cecal wall thickening and dilatation
    • Mesenteric lymphadenopathy with low central attenuation

 

Case with thanks to Prof Oliver Hennessy.

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Case information

rID: 65631
Published: 24th Feb 2019
Last edited: 1st Feb 2020
Inclusion in quiz mode: Included

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