When Tuberculosis Defies Appearances: The Tale of a Deceptive Abdominal Mass on Imaging

Abstract

Tuberculosis poses a significant public health challenge, especially in highly endemic countries. Rarely, it appears as an abdominal mass resembling a malignant abdominal tumor and can be misleading on imaging, so early diagnosis remains a challenge, and confirmation may require invasive examinations such as laparotomy. The most characteristic radiological appearance is that of a solid, hypervascular, or peripherally enhancing mass with a hypodense center. We present a case of retroperitoneal tuberculosis that simulated a teratoma on imaging. This case highlights the diagnosis difficulties even in endemic countries, despite advances in imaging techniques such as ultrasound and computed tomography.

Keywords: abdomen; computed tomography; mass; pseudotumor; tuberculosis.

Figure 1. Axial (A+B) and sagittal (C+D) CT scans before and after injection of contrast, showing a mesenteric mass with a hyperdense center, the site of intratumoral calcifications and surrounded by a wall that enhances after injection with peritumoral adenomegaly (arrow).

Figure 2. The resected mass (arrow) and the adherent bowel.

Figure 3. Photomicrograph of the lesion shows a granulomatous reaction characterized by multiple epithelioid cells and Langhans-type multinucleated giant cells. Additionally, a large area of caseous necrosis (arrow) is observed (2: HES, ×400).