Tuberculous peritonitis

Case contributed by Dr Ian Bickle

Presentation

Young expatriate female worker. Two weeks of increasing abdominal distension. No fever. Highly elevated CA-125.

Patient Data

Age: 25 years
Gender: Female
CT

Thickened enhancing peritoneum.

Ascites.

Omental cake.

Bilateral pleural effusions.

An 18G ultrasound guided biopsy of the omentum was performed.

Photo

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 biopsy proven with caseating granulomas and mycobaterium identified.

The CA-125 was very elevated in this patient and the patient had neither a fever or any clinical or radiological evidence of pulmonary TB.

Learning point:  Despite it being increasingly untrendy to provide succinct clinical information and correlation with all other tests, it as in this case,it is vital in establishing a definitive diagnosis.

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