Gallbladder Tuberculosis: CT Findings with Histopathologic Correlation

Abstract

ObjectiveWe wanted to describe the computed tomography (CT) findings of gallbladder tuberculosis (TB) and to correlate them with pathologic findings.Materials and MethodsThere were seven patients (M:F = 3:4; mean age, 46.3 years; age range, 32 to 78 years) in whom gallbladder TB was eventually diagnosed. All of them underwent cross-sectional imaging with CT, a pathologic examination and a retrospective review. CT imaging evaluation was done in each case, including the findings of a mass versus nodule, wall thickening (uniform or irregular) and the enhancement patterns (homogeneous or heterogeneous).ResultsAll the cases of gallbladder TB revealed the following three different CT findings: micronodular lesion of the gallbladder wall (n = 1), a thickened wall (n = 4) and a gallbladder mass (n = 2). There were three cases of homogeneous enhancement of the lesions, including homogeneous enhancement with nodular lesion, homogeneous uniform thickness enhancement and homogeneous thickness enhancement in one case each, and these cases pathology showed tuberculous granuloma with a little caseating necrosis in one case and tuberculous granuloma with rich fibrous tissue, but little or no evident caseating necrosis in two cases. Four cases of heterogeneous enhancement of the lesions, including heterogeneous uniform-thickness enhancement in two cases, heterogeneous enhancement with a local mass lesion in one case and heterogeneous enhancement with a mass that replaced the gallbladder in one case; in these cases, pathology showed tuberculous granuloma with marked caseation or liquefaction necrosis in three cases and tuberculous granuloma by fibrous and calcifications accompanied by caseating necrosis in one case. Among the seven cases of gallbladder TB, six cases were accompanied by abdominal extra-gallbladder TB, including abdominal lymph node TB in five cases and hepatic TB in four cases.ConclusionGallbladder TB has various CT manifestations, and the enhanced CT findings are well matched with pathological features. An irregularly thickened gallbladder wall or a gallbladder wall mass with multiple-focus necrosis or calcifications accompanied by the typical CT findings of abdominal extra-gallbladder TB should suggest the diagnosis of gallbladder TB.

Common and uncommon imaging features of abdominal tuberculosis

“…The gallbladder is very rarely involved in abdominal TB . There is no typical clinical presentation or imaging finding.…”

“…Xu et al . reviewed the CT features of gallbladder TB in seven patients and classified the pattern of involvement into three types: micronodular type ( n = 1), mural thickening ( n = 4) and mass ( n = 2).…”

Mycobacterial Infection of the Gallbladder Masquerading as Gallbladder Cancer with a False Positive Pet Scan

“…Most previous papers describe gallbladder involvement as a part of generalised abdominal or extra-abdominal disease [2, 3, 5]. Isolated gallbladder affliction was a distinct feature in this case.…”

“…Ultrasound and CT scan may show an enlarged gallbladder, irregularly thickened gallbladder wall, or a soft tissue mass with necrosis or calcification, or nodular lesions, although neither ultrasound nor CT lesions are highly specific [5]. …”

Biliary tract tuberculosis: An enigma

“…A literature survey till date shows less than 120 cases of gall bladder tuberculosis (GBTB) 1 and nearly about 18 cases of tuberculous biliary stricture (TBS) 2 having been reported. Majority of the reported cases have been diagnosed only postoperatively due to lack of specific clinical or radiological pathognomonic features for biliary tract TB (BTB).…”