Visceral scalloping on abdominal computed tomography due to abdominal tuberculosis

Abstract

Objective: Scalloping of visceral organs is described in pseudomyxoma peritonei, malignant ascites, among other conditions, but not tuberculosis.

Methods: 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.

Results: 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.

Discussion: 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.

Conclusion: Visceral scalloping may not conclusively distinguish peritoneal tuberculosis from peritoneal carcinomatosis or pseudomyxoma peritonei.

Keywords: ascites; computed tomography; liver; scalloping; spleen; tuberculosis.

Figure 1.

Case 1. Axial CECT image showing perihepatic collections causing scalloping of the liver margins. CECT, contrast enhanced computed tomography.

Figure 2.

Case 2. Axial CECT images showing scalloping of the liver margins (arrow in a) with loculated ascites (both A and B), peritoneal fat stranding with thickening, and enhancement of the peritoneal lining (arrows in B). CECT, contrast enhanced computed tomography.

Figure 3.

Case 5. Axial CECT image showing scalloping of the splenic surface by perisplenic soft tissue (arrow in A), with ascites (seen in both A and B) and omental fat stranding (arrow in B). CECT, contrast enhanced computed tomography.

Figure 4.

Case 7. Axial CECT images showing loculated ascites with scalloping of liver margins (arrow in A), peritoneal soft tissue thickening and enhancement (arrow in B). CECT, contrast enhanced computed tomography.