IMAGING FEATURES OF HEPATIC TUBERCULOMA - 3 CASES

Localized macronodular tuberculosis of the liver is rare. Tuberculous involvement of the liver is usually a diffuse process. We report 3 cas es in which clinical and imaging features suggested the diagnosis of m acronodular hepatic tuberculoma which was pathologically confirmed by percutaneous biopsy. In the first case, abdominal CT-scan showed a non calcified hypodense nodular lesion in segment IV of the liver with an enhancing peripheral rim. In the second case, ultrasound showed 4 homo genous hypoechoic hepatic nodules. In the third case, a nodule was inc identally identified in segment VII of the liver. The lesion was hypoe choic with ultrasound hypodense without enhancement on CT-scan, and hy perintense on both T1- and T2-weighted MR imaging. After percutaneous biopsy, pathologic examination showed peripheral granulomous lesions i n all patients with central caseous necrosis consistent with tuberculo sis ill two patients despite a negative for Zielh stain. Specific M. t uberculosis culture was positive in the first patient, negative in the second patient, and was not performed in the third patient, Appropria te treatment resulted in disappearance of hepatic lesions on follow-up imaging examinations. These 3 cases show that clinical and imaging fe atures of hepatic tuberculoma are not specific and that percutaneous b iopsy of lesions provides a definite diagnosis.