Favored diagnosis of tuberculous peritonitis with evidence of active infection in the right lung. 

The enhancing peritoneum and stranding is suggestive of TB peritonitis, wet type. Intra-abdominal TB is the most common site of extra-pulmonary TB. 

Differentials for the abdominal findings include peritoneal carcinomatosis. This is most commonly due to ovarian and GI adenocarcinoma (including gastric, CRC, pancreas, appendix and gallbladder). 

Patient went on have an ascitic tap. The fluid results were negative for acid fast bacilli and malignancy. 

Sputum acid fast bacilli, blood cultures and serology were all negative. 

Patient then went on to have a bronchoscopy with bronchoalveolar lavage. This was positive (Genexpert testing) PCR for mycobacterium tuberculosis. 

He was commenced on appropriate antibiotic therapy.