Clinical Images

Peritoneal Tuberculosis (Wet-Ascites)

Explanation: Peritoneal tuberculosis is often described as having a wet-ascitic form dominated by formation of ascites (See above image). or fibrotic/fixed/dry patterns where ascites is less dominant and caseous nodules, adhesions and omental and mesentric involvement dominate the picture. Ascites could be free or loculated.

Peritoneal Tuberculosis (Dry)



Explanation: Omental nodules and multiple lymph nodes, note the absence of ascites. The terms fibrotic-fixed and dry-plastic are often used in an overlapping manner. To avoid a confusion, only the term dry type is used. This classification has recently been called into question by Ahamed et al from PGIMER, Chandigarh who have suggested a new classification for peritoneal tuberculosis (See here https://www.tandfonline.com/doi/full/10.1080/14787210.2019.1642746)

Note the presence of adhesions and clumped bowel loops in dry peritoneal tuberculosis

Tubercular abdominal lymphadenopathy

Explanation: Tubercular lymph nodes are usually > 1 cm, and have a hypodense center  consistent with necrosis. In the above image such lymph nodes are  noticeable in gastrohepatic region

Hepatic Tuberculosis

Hepatic cacifications

Explanation: Note the presence of hepatic calcification in a patient who had intestinal tuberculosis. Hepatic tuberculosis can be nodular, miliary or abscess like. Past involvement may be suggested by presence of calcifications

Luminal Tuberculosis

Colonic Ulcer (Tuberculosis)


Explanation: Intestinal ulceration signifies presence of active disease. Typically the tubercular intestinal ulcers are transverse or circumferential. Presence of linear or longitudinal ulcers or aphthous suggests presence of Crohn’s disease. Healing of tubercular ulcers on antitubercular therapy (ATT) may be noted as early as 2 months after the ATT (Early mucosal response). For details see here https://doi.org/10.1111/apt.14495

Ileo-cecal tuberculosis

Explanation: Mural thickening of right colon / ascending colon can be seen

Ileo-cecal ulceration

STILL IMAGE

Explanation: Ileocecal ulceration and involvement in form of narrowing and stricture formation is a feature which favors the diagnosis of tuberculosis over Crohn’s disease. However, occasionaly as in the above case, this could occur in Crohn’s also. Also note presence of few aphthous like ulcer above

Ileal ulcer

Explanation: Ileal ulcers could occur in a number of conditions including ITB and CD. Many infectious causes like enteric fever can also cause ileal ulcers.

Ileal Stricture

Explanation: This patient had ongoing abdominal pain even after 2 months of ATT. Ileocolonoscopy showed narrowing with healed ulcer. Endoscopic balloon dilatation helped in resolution of symptoms

Apthous ulcers

Explanation : Apthous ulcer, although more frequent in Crohn’s disease, may also be seen in ITB

Serpiginous ulcers (Ileum)

Explanation: Linear or serpiginous ulcers are more frequent in Crohn’s disease