Usefulness of ultrasound in the diagnosis of peritoneal tuberculosis

Abstract

The peritoneum is one of the most common extrapulmonary sites of tuberculous infection. We report a case of peritoneal tuberculosis (TB) in a 25-year-old man. In this case, ultrasound of the abdomen played an important role in the diagnostic process. The diagnosis of this disease, however, remains a challenge because of its insidious nature, the variability of its presentation, and the limitations of available diagnostic tests. A high index of suspicion should be considered, particularly in high-risk patients with unexplained ascites. In our case ultrasound guided the diagnosis by rapidly identifying abnormal signs, which in high-prevalence settings are extremely suggestive of peritoneal tuberculosis.

Ultrasonography of peritoneal tuberculosis

“…The single-layer or uni-lamellar thickening, homogeneous and hyperechoic, found in 21% in our series, reflects an isolated hypertrophy of the fatty layer without affecting the two peritoneal leaflets. Nodular heterogeneous omental thickening, the most described form in the literature (12,22,31,32) , was found in 32.1% of our series. The nodules, most often hypoechoic, correspond to hypertrophic lymphoid formations.…”

“…Peritoneum involvement may occur by haematogenous way from lung miliary tuberculosis , by contamination from swallowed sputum in a patient with pulmonary involvement or by spreading from ruptured abdominal lymphadenopathy (10) . More rarely, it may be caused by unpasteurized cow’s milk contaminated with Mycobacterium bovis (11,12) .…”

“…Its frequency is variable and estimated between 22 and 68% according to studies (30,31) . It results in regular hypoechoic thickening continuing on the visceral peritoneum covering the loops and responsible for small bowel agglutination (12) . Adenomegaly is found in 34.3% of patients, most often with necrotic appearance; frequency comparable to some African studies (23,33) .…”

Role of laparoscopy in the diagnosis of peritoneal tuberculosis in endemic areas

“…Elle est parfois cloisonnée, ce qui est un argument en faveur de son origine tuberculeuse. D'autres signes évocateurs de TP peuvent être mis en évidence, tels que l'épaississement du péritoine, la présence de nodules péritonéaux, l'épaississement du mésentère contenant des adénopathies profondes, souvent décrites comme étant des masses hypoéchogènes multiples et parfois confluentes, et l'épaississement pseudo-tumoral hétérogène de l'épiploom qui comporte des nodules hypoéchogènes [33,34].…”

Ultrasonographic Manifestations of Tuberculous Pleurisy

“…Внелегочным локализациям туберкулеза уделяется недостаточно внимания, хотя эти формы заболевания являются составной частью общей фтизиатрической проблемы, обусловленной единым инфекционным началом, схожестью течения воспалительного процесса и изменения функций гомеостаза [1][2][3]� Своевременная диагностика и выявление внелегочного туберкулеза -сложная задача врачей первичного уровня здравоохранения� Важную роль, наряду с другими методами диагностики плевритов, играет ультразвуковое исследование (УЗИ) [4], которое имеет ряд достоинств: высокая информативность, неинвазивность, безвредность, широкая доступность [5,6]…”