An intraperitoneal tuberculous abscess: Computed tomography (CT) findings and clinical course / 대한내과학회지

ABSTRACT

BACKGROUND/AIMS: Intraperitoneal tuberculous abscesses develop infrequently. Because of overlapping features it is difficult to differentiate a tuberculous abscess from carcinomatosis peritonei. The aim of this study was to define the computed tomography (CT) findings and clinical course of the intraperitoneal tuberculous abscess. METHODS: The study included 11 patients (3 males, 8 females, mean age 34.8 years) with a pathologically proven intraperitoneal tuberculous abscess. We analyzed the CT findings and reviewed the medical records retrospectively. RESULTS: Sixteen abscesses were found in 11 patients. The locations of the abscesses were in the right subphrenic space (n=1), right perihepatic space (n=4), left perihepatic space (n=4), left subphrenic space (n=2), perisplenic space (n=3), right lower abdominal space (n=1), and left lower abdominal space (n=1). Five patients were proven to have abdominal tuberculosis while six patients had paradoxical responses to antituberculosis therapy for tuberculous peritonitis. The abscess lesions presented on the CT scan as thin walled cystic enhancing lesions without calcification (n=16), a septated mass (n=12), with enlargement of lymph nodes (n=2), and peritoneal and omental haziness (n=3). The mean duration from commencement of treatment to onset of a paradoxical response was 88 days. All patients had antituberculosis therapy for 6 to 12 months and five patients underwent surgery. The mean follow-up was 15 months. CONCLUSIONS: The intraperitoneal tuberculous abscess appeared as an ovoid cystic lesion with a slightly enhanced thin wall in the upper abdomen, in the perihepatic space on the CT scan; such as lesion can be the primary lesion of abdominal tuberculosis or associated with the paradoxical response of tuberculous peritonitis.