Multiloculated thoracoabdominal tuberculosis: A radiological presentation of disseminated tuberculosis

Abstract

Tuberculosis is more frequently found among high-risk populations in the United States. It has a challenging diagnosis since it can present with diverse organ involvement that may delay the diagnosis. This is especially true regarding hepatic tuberculosis, with prevalence varying in each study but highly suggestive of underdiagnosis. An 18-year-old male with high-risk exposure to multidrug-resistant tuberculosis presented with fever, night sweats, weight loss, and cough. Imaging revealed a right lung cavitary mass with bilateral pulmonary nodules, right pleural nodular thickening traversing diaphragm extending to the liver with subcapsular hepatic lobulated hypodensities. MRI showed spinal involvement consistent with Pott's disease. It is important to consider hepatic tuberculosis in differential diagnoses for a hepatic lesion, allowing early detection and treatment to optimize patient outcomes.

Keywords: Contiguous spread; Disseminated Tuberculosis; Hepatic Tuberculosis; Hepatic abscess; Mycobacterium tuberculosis; Subligamentous spread.

Fig. 1

Chest CT scan, in coronal (A) and sagittal (B) sections. Imaging revealing large right upper lung cavitary mass with bilateral pulmonary nodules and masses. Nodularity of the right pleura is also seen, representing possible metastatic disease or complex pleural collection in the setting of TB. Adjacent subcapsular lobulated lesions were noted in the right hepatic lobe.

Fig. 2

CT scan of the abdomen. Imaging revealing right pleural thickening with loculated low-attenuation areas and rim enhancement, extending to the diaphragm and the liver capsule, suggestive of multiloculated abscess/empyema from tuberculosis.

Fig. 3

MRI of the cervical spine. Enhancing soft tissue noted epicentered along the anterior margin of C4 vertebral body with loss of anterior cortex and mild marrow enhancement, extending both superiorly and inferiorly along the C3 and C5 vertebra. Findings suggest subligamentous spread of TB, characterised by relative sparing of the disc spaces.