Tuberculosis of the liver

Aktuelle epidemiologische Daten zeigen in den letzten Jahren einen Anstieg der Tuberkulose im Kindes- und Jugendalter. Es findet sich zudem auch in Deutschland ein Anstieg von Infektionen mit gegenuber Tuberkulosemedikamenten resistenten Erregern. In diesem Zusammenhang stellt die Diagnose, Pravention und Therapie der Tuberkulose vor allem im Kindesalter eine Herausforderung dar. Leitlinien fur die Diagnostik und Therapie der Tuberkulose im Erwachsenenalter konnen nicht generell auf das Kindesalter ubertragen werden, da hier relevante altersabhangige Unterschiede bzgl. der Krankheitsprogression, Krankheitsmanifestation, Unterschiede in der Anwendung von diagnostischen Masnahmen und der Therapie bestehen. Unter Federfuhrung der Deutschen Gesellschaft fur Padiatrische Infektiologie (DGPI) e. V. wurde die S2k-Leitlinie fur die Diagnostik, Pravention und Therapie der Tuberkulose im Kindes- und Jugendalter verfasst, um die adaquate Versorgung von Kindern und Jugendlichen mit Tuberkulose-Exposition, Infektion oder Erkrankung nach neuesten wissenschaftlichen Erkenntnissen zu sichern. Aktualisierte Dosierungsempfehlungen berucksichtigen die altersabhangige Pharmakokinetik in der Therapie der medikamentensensiblen, aber auch resistenten Tuberkulose. Daruber hinaus werden die Themen perinatale Exposition und Erkrankung sowie die im Kindesalter haufigeren extrapulmonalen Manifestationsformen gesondert behandelt.

https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0043-116545.pdf

S2k-Leitlinie zur Diagnostik, Prävention und Therapie der Tuberkulose im Kindes- und Jugendalter : Eine Leitlinie unter Federführung der Deutschen Gesellschaft für Pädiatrische Infektiologie (DGPI) e. V.

Clinical and radiological features of Marchiafava-Bignami disease.

OBJECTIVE. Tuberculosis (TB) may present with highly variable imaging findings. The findings may vary from nonspecific hepatomegaly to abscesses or solid focal lesions, mimicking liver tumors. Biliary tract involvement may also be detected, which may manifest with ductal dilatations from underlying strictures. CONCLUSION. All cross-sectional imaging modalities, including sonography, CT, and MRI, may be used in the evaluation of patients with TB. Imaging findings may be perplexing to radiologists, particularly ones who practice in areas where TB is not endemic; thus, histopathologic diagnosis may be required.

Hepatobiliary Tuberculosis: Imaging Findings

Tuberculosis in childhood is clinically challenging, but it is a preventable and treatable disease. Risk factors depend on age and immunity status. The most common form of pediatric tuberculosis is pulmonary disease, which comprises more than half of the cases. Other forms make up the extrapulmonary tuberculosis that involves infection of the lymph nodes, central nervous system, gastrointestinal system, hepatobiliary tree, and renal and musculoskeletal systems. Knowledge of the imaging characteristics of pediatric tuberculosis provides clues to diagnosis. This article aims to review the imaging characteristics of common sites for extrapulmonary tuberculous involvement in children.

Extrapulmonary involvement in pediatric tuberculosis

We aim to illustrate the multimodal imaging spectrum of hepatic involvement in tuberculosis (TB). Whilst disseminated tuberculosis on imaging typically manifests as multiple small nodular lesions scattered in the liver parenchyma, isolated hepatic tuberculosis remains a rare and intriguing entity. Indubitably, imaging is the mainstay for detection of tubercular hepatic lesions which display a broad spectrum of imaging manifestations on different modalities. While sonography and computed tomography (CT) findings have been described in some detail, there is a paucity of literature on magnetic resonance imaging (MRI) features. Due to a significant overlap with other commoner and similar appearing hepatic lesions, hepatic tuberculosis is often either misdiagnosed or labelled as indeterminate lesions. This article is a compendium of cases highlighting the spectrum of imaging patterns that can be encountered in patients with isolated primary hepatic tuberculosis as well as disseminated (secondary) disease. Rare patterns of primary disease such as tubercular cholangitis, hypervascular liver masses, and those with vascular complications are also illustrated and discussed. Imaging plays a valuable role in the detection of tubercular hepatic lesions. Also, imaging can be helpful in their characterisation and for assessing associated complications. • Hepatic TB has myriad imaging manifestations and is often confounded with neoplastic lesions.
 • Imaging patterns include miliary TB, macronodular TB, serohepatic TB and tubercular cholangitis.
 • Concurrent splenic, nodal or pulmonary involvements are helpful pointers towards the diagnosis.
 • Miliary calcifications along the bile ducts are characteristic of tubercular cholangitis.
 • Histological/microbiological confirmation is often necessary to confirm the diagnosis.

/pdf/hepatic-tuberculosis-a-multimodality-imaging-review-950l78d72o.pdf

Hepatic tuberculosis: a multimodality imaging review

Peripheral nerve sheath tumors are categorized into benign and malignant forms, comprising of neurofibroma and schwannoma in the benign category and malignant peripheral nerve sheath tumors in the malignant category. Magnetic resonance imaging plays an important role in the diagnosis of these lesions. The various imaging features and signs that help to identify and characterize a nerve sheath tumor are, distribution of the tumor along a major nerve, an entering or exiting nerve sign, target sign, a fascicular sign and a split-fat sign.

Telltale signs of peripheral neurogenic tumors on magnetic resonance imaging

The presence of a ureter within an inguinal hernia is an extremely rare entity, usually discovered incidentally during herniorrhaphy and may pose a surgical risk. Early preoperative diagnosis is crucial to guide proper surgical approach and to preserve renal function.

Case Report-Inguinoscrotal ureteral hernia diagnosed on micturating cystourethrography.

Objective: To assess the performance of mannitol as a luminal contrast as compared to water and positive contrast in evaluation of bowel on multidetector computed tomography (MDCT). Materials and Methods: Three hundred patients were randomly selected for this study and were divided equally into three groups. Each subject received 1500 ml of oral contrast. Group 1 received 3% mannitol in water, group 2 received diluted iodinated positive contrast, and group 3 received plain water without additives. Qualitative and quantitative analysis for distension, fold visibility, and overall image quality were analyzed by actual diameter measurement and point scale system at different bowel levels. One-way analysis of variance (ANOVA) followed by Tukey's HSD Post-hoc test and Pearson's Chi-square (exact test) test were applied. Results: Group 1 showed better results for small bowel distension, intraluminal homogeneity, and visibility of mucosal folds on quantitative and qualitative analysis with statistically significant P value (P<0.001). The ileo-caecal junction distension and mural feature visibility was better with mannitol (P < 0.001). No significant difference in distension of stomach and duodenum was found between the three groups. Conclusion: Mannitol as endoluminal contrast increases the diagnostic accuracy of the investigative studies in comparison to water and iodine-based contrast by producing significantly better bowel distension and visibility of mural features with improved image quality without additional adverse effects.

Quantitative and qualitative bowel analysis using mannitol, water and iodine-based endoluminal contrast agent on 64-row detector CT.

Marchiafava-Bignami disease (MBD) is a form of toxic demyelinating disease more often seen in chronic alcoholics. The disease process typically involves the corpus callosum and clinically often presents with altered sensorium, neurocognitive defects or seizures with acute cases often deteriorating to comatose state. The death rate is high. We report a rare case of MBD with complete clinical recovery. A 50-year-old male patient presented in an unconscious state and underwent MRI of the brain which showed significant lesions involving the corpus callosum. Following treatment with thiamine and supportive therapy, he improved clinically and a follow-up MRI revealed significant resolution of the earlier lesions. Diffusion-weighted MRI showed the changes more conspicuously as compared with conventional imaging. The clinical resolution corresponded well with the MRI pattern. The case highlights that diffusion-weighted MRI is an extremely useful tool in evaluation and prognostication of MBD.

https://casereports.bmj.com/content/casereports/2014/bcr-2013-203442.full.pdf

Chandan Kakkar

Papers

Hepatic tuberculosis: a multimodality imaging review

Telltale signs of peripheral neurogenic tumors on magnetic resonance imaging

Case Report-Inguinoscrotal ureteral hernia diagnosed on micturating cystourethrography.

Quantitative and qualitative bowel analysis using mannitol, water and iodine-based endoluminal contrast agent on 64-row detector CT.

Acute Marchiafava-Bignami disease: clinical and serial MRI correlation