Lethargic with a distended abdomen. No respiratory symptoms.
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Diffusely enhancing peritoneal reflections.
Loculated ascites. Inflammatory change in the omentum.
Thickened small bowel in the pelvis, but the terminal ileum is normal.
Minor right middle and left lower lobe consolidation. Small left sided pleural effusion.
Tuberculosis is a multi-system disorder. Patients may present without any respiratory symptoms.
In the abdominal cavity it can involve other systems: genitourinary, gastrointestinal and omental/peritoneum.
Thickened enhancing peritoneum, ascites and omental stranding through to omental cake are imaging features of peritoneal tuberculosis.
This case was biopsy proven with caseating granulomas and mycobaterium identified.
Key Learning Point:
The clinicians requested a CA-125 (the patient is 18 years old) and when it was very elevated assumed she has ovarian cancer. CA-125 may be elevated in many forms of peritoneal irritation.
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