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2015 ; 6
(6
): 647-58
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Hepatic tuberculosis: a multimodality imaging review
#MMPMID26499189
Kakkar C
; Polnaya AM
; Koteshwara P
; Smiti S
; Rajagopal KV
; Arora A
Insights Imaging
2015[Dec]; 6
(6
): 647-58
PMID26499189
show ga
OBJECTIVES: We aim to illustrate the multimodal imaging spectrum of hepatic
involvement in tuberculosis (TB). Whilst disseminated tuberculosis on imaging
typically manifests as multiple small nodular lesions scattered in the liver
parenchyma, isolated hepatic tuberculosis remains a rare and intriguing entity.
METHODS: Indubitably, imaging is the mainstay for detection of tubercular hepatic
lesions which display a broad spectrum of imaging manifestations on different
modalities. While sonography and computed tomography (CT) findings have been
described in some detail, there is a paucity of literature on magnetic resonance
imaging (MRI) features. Due to a significant overlap with other commoner and
similar appearing hepatic lesions, hepatic tuberculosis is often either
misdiagnosed or labelled as indeterminate lesions. This article is a compendium
of cases highlighting the spectrum of imaging patterns that can be encountered in
patients with isolated primary hepatic tuberculosis as well as disseminated
(secondary) disease. Rare patterns of primary disease such as tubercular
cholangitis, hypervascular liver masses, and those with vascular complications
are also illustrated and discussed. CONCLUSIONS: Imaging plays a valuable role in
the detection of tubercular hepatic lesions. Also, imaging can be helpful in
their characterisation and for assessing associated complications. TEACHING
POINTS: ? Hepatic TB has myriad imaging manifestations and is often confounded
with neoplastic lesions. ? Imaging patterns include miliary TB, macronodular TB,
serohepatic TB and tubercular cholangitis. ? Concurrent splenic, nodal or
pulmonary involvements are helpful pointers towards the diagnosis. ? Miliary
calcifications along the bile ducts are characteristic of tubercular cholangitis.
? Histological/microbiological confirmation is often necessary to confirm the
diagnosis.
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