R. Jain et al., DIAGNOSIS OF ABDOMINAL TUBERCULOSIS - SONOGRAPHIC FINDINGS IN PATIENTS WITH EARLY DISEASE, American journal of roentgenology, 165(6), 1995, pp. 1391-1395
OBJECTIVE. The diagnosis of abdominal tuberculosis is often difficult,
because clinical manifestations and results of laboratory studies are
nonspecific. If sonographic findings are sufficiently characteristic
for diagnosis, sonography would be useful, especially in India, where
abdominal tuberculosis is common and more expensive imaging techniques
are not easily available. Accordingly, we performed sonography to est
ablish the sonographic findings in cases of early tuberculosis in 56 p
atients with abdominal tuberculosis who had normal barium studies of t
he small bowel. SUBJECTS AND METHODS. Fifty-six patients with clinical
features suggestive of abdominal tuberculosis (history of fever, abdo
minal pain, and weight loss) with no history of intestinal obstruction
and normal barium studies of the small bowel had abdominal sonography
. All sonograms were independently assessed by three radiologists, and
the findings were tabulated by consensus. Diagnosis of tuberculosis w
as confirmed by sonographically guided biopsy of mesenteric lymph node
s in 19 patients, analysis of aspirated ascitic fluid in 12, and respo
nse to antituberculous chemotherapy in 25. Sonography was repeated 1,
3, 6, and 12 months after antituberculous chemotherapy was begun. Abdo
minal sonograms were also performed in 30 healthy volunteers, and meas
urements of mesenteric thickness were recorded. The mesenteric thickne
ss was statistically compared in two groups of patients: patients at p
resentation with patients at the end of antituberculous chemotherapy a
nd patients at presentation with healthy individuals. RESULTS. The mes
enteric thickness in healthy individuals ranged from 5 to 14 mm. Sonog
raphic findings in all patients with abdominal tuberculosis included a
n echogenic thickened mesentery (greater than or equal to 15 mm) with
mesenteric lymphadenopathy. Other findings were dilated small bowel lo
ops in 38 patients, minimal ascites in 17, matted small bowel loops in
five, and omental thickening with altered echogenicity in three. Regr
ession of these changes was noted on follow-up of all patients undergo
ing treatment. CONCLUSION. The characteristic sonographic features of
early abdominal tuberculosis are mesenteric thickness of 15 mm or more
and an increase in the mesenteric echogenicity (due to fat deposition
), combined with mesenteric lymphadenopathy. Presence of dilated small
bowel loops and ascites further substantiate the diagnosis.