DIAGNOSIS OF ABDOMINAL TUBERCULOSIS - SONOGRAPHIC FINDINGS IN PATIENTS WITH EARLY DISEASE

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.