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. 2024 Dec 18;24(1):1410.
doi: 10.1186/s12879-024-10318-y.

The role of CEUS in diagnosing tuberculous abscess of the right diaphragm

Wenzhi Zhang  1 , Xiulei Yu  2 , Jun Li  2 , Lingling Wang  2 , Jie Chu  2
Affiliations

The role of CEUS in diagnosing tuberculous abscess of the right diaphragm

Wenzhi Zhang et al. BMC Infect Dis. .

Abstract

Purpose: To evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in detecting tuberculous diaphragmatic abscess (TDA) of the right diaphragm and provide a reference for its clinical diagnosis.

Methods: A retrospective analysis was conducted on 33 patients with right TDA confirmed via surgery and biopsy. The diagnostic accuracy of CEUS and routine ultrasound for detecting right TDA was compared.

Results: Among the 33 right TDA cases, the lesions primarily exhibited mixed and low echogenicity, with an orientation parallel to the diaphragmatic surface. Eighteen patients (54.5%) demonstrated the characteristic "crocodile mouth sign." Heterogeneous enhancement was observed in most cases (24 patients) compared to homogeneous or no enhancement. The diagnostic accuracy of routine ultrasound for right TDA was 54.50% (18/33), whereas CEUS demonstrated a significantly higher accuracy of 78.78% (26/33) (χ2 = 4.364, P = 0.037).

Conclusion: CEUS provides valuable insights into the vascular characteristics of right TDA, with most cases showing mixed echogenicity and heterogeneous enhancement. The "crocodile mouth sign" was a distinctive feature, highlighting the utility of CEUS in improving diagnostic accuracy for right TDA.

Keywords: Abscess; Contrast-enhanced ultrasound; Diaphragm; Tuberculous; Ultrasound.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study involving human participants was reviewed and approved by the Ethics Committee of Hangzhou Red Cross Hospital. All patients/participants provided written informed consent to participate in this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A 25-year-old man with a tuberculous diaphragmatic abscess. The lesion was located at the foot of the diaphragm, with the “crocodile mouth sign” (arrow) visible between the lesion and the diaphragm
Fig. 2
Fig. 2
A 27-year-old woman with a tuberculous diaphragmatic abscess. The lesion (arrow) was located within the diaphragm, causing compression and displacement of the liver. The boundary between the lesion and the liver capsule was clear, and the lesion moved relative to the liver capsule during respiration
Fig. 3
Fig. 3
A 28-year-old woman with a tuberculous diaphragmatic abscess. (A) The lesion exhibited heterogeneous enhancement with internal septal enhancement (arrow). (B) The lesion was located in the diaphragm, compressing and displacing the liver (arrowhead). The boundary between the lesion and the liver capsule was clear, and the lesion moved relative to the liver capsule during respiratory movement
Fig. 4
Fig. 4
A 32-year-old woman with a tuberculous diaphragmatic abscess. (A) CEUS revealed heterogeneous enhancement with a necrotic area (arrow). (B) Routine ultrasound showed mixed echogenicity (arrowhead) with a clear boundary with the liver
See this image and copyright information in PMC

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