Sharma Vishal, Bhatia Anmol, Malik Sarthak, Singh Navjeet, Rana Surinder S
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Ther Adv Infect Dis. 2017 Jan;4(1):3-9. doi: 10.1177/2049936116685262. Epub 2017 Feb 13.
Scalloping of visceral organs is described in pseudomyxoma peritonei, malignant ascites, among other conditions, but not tuberculosis.
We report findings from a retrospective study of patients with abdominal tuberculosis who had visceral scalloping on abdominal computed tomography (CT). Diagnosis of abdominal tuberculosis was made on the basis of combination of clinical, biochemical, radiological and microbiological criteria. The clinical data, hematological and biochemical parameters, and findings of chest X-ray, CT, Mantoux test, and HIV serology were recorded.
Of 72 patients with abdominal tuberculosis whose CT scans were included, seven patients had visceral scalloping. The mean age of these patients was 32.14 ± 8.43 years and four were men. While six patients had scalloping of liver, one had splenic scalloping. The patients presented with abdominal pain (all), abdominal distension (five patients), loss of weight or appetite (all), and fever (four patients). Mantoux test was positive in five, while none had HIV infection. The diagnosis was based on fluid (ascitic or collections) evaluation in four patients, ileo-cecal biopsy in one patient, fine needle aspiration from omental thickening in one patient, and sputum positivity for acid fast bacilli (AFB) in one patient. On CT examination, four patients had ascites, five had collections, one had lymphadenopathy, four had peritoneal involvement, three had pleural effusion, and two had ileo-cecal thickening. All except one patient received standard ATT for 6 months or 9 months (one patient). Pigtail drainage for collections was needed for two patients.
This report is the first description of visceral scalloping of liver and spleen in patients with abdominal tuberculosis. Previously, this finding has been reported primarily with pseudomyxoma peritonei and peritoneal carcinomatosis.
Visceral scalloping may not conclusively distinguish peritoneal tuberculosis from peritoneal carcinomatosis or pseudomyxoma peritonei.
腹膜假黏液瘤、恶性腹水等疾病可出现内脏扇贝样改变，但结核病未见相关报道。
我们报告了一项对腹部计算机断层扫描（CT）显示内脏扇贝样改变的腹部结核患者的回顾性研究结果。腹部结核的诊断基于临床、生化、放射学和微生物学标准的综合判断。记录临床数据、血液学和生化参数，以及胸部X线、CT、结核菌素试验和HIV血清学检查结果。
纳入的72例腹部结核患者的CT扫描中，7例出现内脏扇贝样改变。这些患者的平均年龄为32.14±8.43岁，4例为男性。6例患者肝脏出现扇贝样改变，1例脾脏出现扇贝样改变。患者均有腹痛，5例有腹胀，均有体重减轻或食欲减退，4例有发热。结核菌素试验5例呈阳性，均无HIV感染。4例患者通过液体（腹水或积液）评估确诊，1例通过回盲部活检确诊，1例通过大网膜增厚处细针穿刺确诊，1例通过痰涂片抗酸杆菌（AFB）阳性确诊。CT检查显示，4例有腹水，5例有积液，1例有淋巴结肿大，4例有腹膜受累，3例有胸腔积液，2例有回盲部增厚。除1例患者外，所有患者均接受了6个月或9个月（1例患者）的标准抗结核治疗。2例患者需要对积液进行猪尾导管引流。
本报告首次描述了腹部结核患者肝脏和脾脏的内脏扇贝样改变。此前，这一发现主要见于腹膜假黏液瘤和腹膜癌病。
内脏扇贝样改变可能无法明确区分腹膜结核与腹膜癌病或腹膜假黏液瘤。
