Hepatic tuberculosis

a multimodality imaging review

Chandan Kakkar, Ashwin M. Polnaya, Prakashini Koteshwara, S. Smiti, K. V. Rajagopal, Ankur Arora

Research output: Contribution to journalReview article

13 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)647-658
Number of pages12
JournalInsights into Imaging
Volume6
Issue number6
DOIs
Publication statusPublished - 01-12-2015

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Hepatic Tuberculosis
Cholangitis
Liver
Tuberculosis
Multimodal Imaging
Miliary Tuberculosis
Bile Ducts
Diagnostic Errors
Blood Vessels
Ultrasonography
Teaching
Tomography
Magnetic Resonance Imaging
Lung

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Kakkar, Chandan ; Polnaya, Ashwin M. ; Koteshwara, Prakashini ; Smiti, S. ; Rajagopal, K. V. ; Arora, Ankur. / Hepatic tuberculosis : a multimodality imaging review. In: Insights into Imaging. 2015 ; Vol. 6, No. 6. pp. 647-658.
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Hepatic tuberculosis : a multimodality imaging review. / Kakkar, Chandan; Polnaya, Ashwin M.; Koteshwara, Prakashini; Smiti, S.; Rajagopal, K. V.; Arora, Ankur.

In: Insights into Imaging, Vol. 6, No. 6, 01.12.2015, p. 647-658.

Research output: Contribution to journalReview article

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T2 - a multimodality imaging review

AU - Kakkar, Chandan

AU - Polnaya, Ashwin M.

AU - Koteshwara, Prakashini

AU - Smiti, S.

AU - Rajagopal, K. V.

AU - Arora, Ankur

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N2 - 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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