ABDOMINAL TUBERCULOSIS IN CHILDREN

Four boys with abdominal tuberculosis, one of whom had acquired immuno deficiency syndrome, are presented. Abdominal imaging findings on plai n radiography, ultrasonography, computed tomography, and gastrointesti nal contrast studies included tuberculous peritonitis and ascites in a ll patients, tuberculous adenopathy in two, gastrointestinal tuberculo sis in two, and omental tuberculosis in two. The radiographic features particularly characteristic of abdominal tuberculosis were: (1) low a ttenuating adenopathy with rim enhancement, (2) omental or ileocecal i nflammatory mass, (3) high density ascites, and (4) gastrointestinal e nteritis involving the ileocecal region. All patients had acid-fast ba cilli identified in cultures of bodily fluids and/or pathologic specim ens and three patients had cultures positive for Mycobacterium tubercu losis. The patient with a negative culture had a positive PPD skin tes t and a surgical specimen showing caseating granulomata and acid-fast bacilli in the omentum. The radiologist must maintain a high degree of suspicion for abdominal tuberculosis particularly in normal or immuno suppressed children with acquired immunodeficiency syndrome. Fine need le aspiration and biopsy of abdominal adenopathy, inflammatory mass or ascites may be necessary for diagnosis.