Pseudo-tumoral hepatic tuberculosis developing into a multinodular form despite treatment

Localized macronodular tuberculosis of the liver is rare. In this location antituberculosis therapy results in a favorable clinical evolution in 100% of cases. We report a pseudo-tumoral form of this condition with no specific clinical, biological or radiological data. After ultrasound guided needle aspiration cytology suggesting metastasis, the correct diagnosis was obtained on liver biopsy after laparotomy. After what was probably inadequate therapy, the enlargement of several hepatic and splenic macronodules was observed. After two years and eight months, the clinical condition of the patient was good but radiological features remained. The risk of diagnostic errors and the therapeutic difficulties in the zones where the incidence of tuberculosis is low should be noted.     

Isolated liver tuberculosis abscess in a patient without immunodeficiency: A case report

Although hepatic tuberculosis is not a rare disease entity, tubercular liver abscess (TLA) is extremely rare. It is usually associated with foci of infection either in the lung and/or gastrointestinal tract or with an immunocompromised state. An isolated or primary TLA with no evidence of tuberculosis elsewhere is even rarer. We report on a 28 year old man who developed an isolated tuberculous liver abscess not associated with lung involvement. Ultrasonography and computed tomography of the abdomen showed the abscess lesions in the liver but the diagnosis of tuberculosis was confirmed by histological examination of the wall of the abscess after surgical drainage. Although tuberculous liver abscess is very rare, it should be included in the differential diagnosis of abscess and unknown hepatic mass lesions.     

Tubercular biliary hilar stricture: A rare case report

Localized hepatic tuberculosis (TB) with or without bile duct involvement is a rare form of hepatobiliary tuberculosis; accounting for less than 1% of all tuberculous infections. We report an uncommon case of cholestatic jaundice with disseminated TB in an immunocompetent male who presented with simultaneous involvement of liver and biliary system.     

Cholangite tuberculeuse simulant une maladie de Caroli : difficultés diagnostiques

Abstract

The liver and the bile ducts represent an exceptional location of tuberculosis. The clinical symptomatology is not specific.We describe three aspects macronodular, micronodular and canalicular which are the rarest.

Purpose

Precise the diagnostic difficulties of this entity insisting on the clinical, biological and morphological signs.

Case report

We report the case of 70 year old man without medical history, admitted for a clinicobiological cholangitis syndrome evolving in a context of impaired general condition. Acute cholecystitis was documented by ultrasound with a moderate dilatationof the common hepatic duct. The bili-MRI showed a dilation of the left intrahepatic bile ducts suggestive of Caroli’s disease. A bi-segmentectomy were performed. Histological examination finds a hepatic tuberculosis and infirm the diagnosis of Caroli’s disease.

Conclusion

Tuberculous cholangitis is rare and poses a diagnostic problem. It can simulate a Caroli disease leading to an unnecessary liver resection. Percutaneous liver biopsy can help to rectify the diagnosis for TBC.     

Tuberculous pseudotumors of the liver

A 35 year old man presented with fever, weight loss and adenopathy. The clinical presentation, laboratory studies, liver scan and laparotomy all suggested metastatic carcinoma. Bacteriologic and pathologic studies established a diagnosis of macronodular tuberculosis isolated to the liver. Response to antituberculous drug therapy was rapid. Review of the literature revealed this case to be a rare example of tuberculous pseudotumors of the liver.     

Pseudotumoral hepatic tuberculosis. Atypical presentation and comprehensive review of the literature.

We describe a 40-year-old black North American woman with isolated hepatic tuberculosis and an incidentally elevated alkaline phosphatase. Imaging studies of the liver showed a lesion suggesting primary or metastatic disease, which turned out to be the so-called pseudotumoral form of hepatic tuberculosis. We believe this is the first case recorded in the English language literature of isolated hepatic tuberculosis manifesting first as an incidentally elevated alkaline phosphatase. It seems to be the third documented case in the English literature of a patient with this rare form of tuberculous involvement without systemic manifestations. The patient responded to antituberculous therapy and is healthy 4 years after treatment.     

Hepatobiliary tuberculosis

Tuberculous involvement of the liver as part of generalized military tuberculosis is well known. It is said to be found in 50-80% of all cases dying from pulmonary tuberculosis (1). However, localized tuberculosis of the liver as a clinical entity and producing large nodules or abscesses have been considered exceedingly rare, even in areas where tuberculosis is relatively common. Leader (2), in an extensive review of the world literature in 1952, documented only 80 cases of hepatic tuberculosis with large abscesses or nodules. Other publications deal with localized tuberculous involvement of the hepatobiliary tract in isolated case reports (1-8). In order to learn more about the clinical manifestation and course of this disease, we therefore prospectively evaluated our total experience on hepatobiliary tuberculosis during the last two decades of our practice.     

Isolated tuberculous liver abscesses with multiple hyperechoic masses on ultrasound: a case report and review of the literature

Abstract: Cases of isolated tuberculous liver abscess are rare. The diagnosis is often delayed or missed because of nonspecific symptoms and the disease's rare occurrence. Less than 25 cases have been documented in the imaging literature to date. This report demonstrates the difficulty in correctly diagnosing local hepatic tuberculosis. We report the case of a 56‐year‐old male with hepatitis C‐related liver cirrhosis and end‐stage renal disease treated with hemodialysis, who developed intermittent fever and hepatomegaly with unusual multiple hyperechoic hepatic lesions on ultrasound. To our knowledge, this is only the second reported case of hyperechoic mass‐like hepatic lesions on ultrasound and the only case without pulmonary involvement. A greater awareness of this rare clinical entity may prevent needless surgical interventions, because the prognosis of hepatic tuberculous abscess is good for the majority of patients if diagnosed early and prompt, effective treatment is administered.     

Hepatic tuberculosis in absence of disseminated abdominal tuberculosis

Liver involvement in tuberculosis in absence of miliary tuberculosis is rare. This study was performed to analyse the spectrum and response to treatment of hepatic tuberculosis in the absence of miliary abdominal tuberculosis. Retrospective analysis of seven cases of hepatic tuberculosis without miliary abdominal tuberculosis who presented at the single tertiary referral center were analyzed. All patients presented with fever and hepatomegaly. Five of them had pain in upper abdomen and vomiting. HIV serology was positive in one patient. All patients had normocytic normochromic anaemia, raised erythrocyte sedimentation rate (Mean 65). Mild elevation of liver enzymes and low albumin (Mean 2.4 gm%) with reversal of albumin globulin ratio (Mean 0.6) were seen in all. Two had jaundice. Prothrombin time was normal in all and lactate dehydrogenase values were elevated in all (Mean 794 IU/L). On ultrasonography, 2 had multiple hypodense lesion, 1 had coarse echotexture of liver, 1 had hyperechoic pattern and 3 had just hepatomegaly. Complete resolution of liver lesions on treatment with 4-drug anti-tuberculosis drug chemotherapy was seen. In conclusion, liver tuberculosis has protean manifestations with nonspecific alteration of liver function tests and is best diagnosed on liver biopsy. Overall response to therapy is satisfactory.     

Isolated Tuberculosis of Transplanted Liver,A Case Report and Review of the Literature

Introduction

Recipients of liver transplantation are prone to different types of infections such as tuberculosis (TB).

Case Presentation

Herein we report a 59-year-old man with liver transplantation due to HBV cirrhosis who developed isolated hepatic TB, 18 months after OLT (orthotropic liver transplantation). He has been successfully treated with anti-TB regimen and now after 12 months he is completely symptom-free.

Conclusions

Organ transplantation and treatment of transplanted patients with immunosuppressive drugs would prone them to various unusual infections. One of these is unusual primary involvement of liver by tuberculosis which has been extremely rare in the previous reports.     

Imaging diagnosis of 12 patients with hepatic tuberculosis

AIM: To assess CT, MR manifestations and their diagnostic value in hepatic tuberculosis. METHODS: CT findings in 12 cases and MR findings in 4 cases of hepatic tuberculosis proved by surgery or biopsywere retrospectively analyzed. RESULTS: (1) CT findings: One case of serohepatic type of hepatic tuberculosis had multiple-nodular lesions in the subcapsule of liver. Parenchymal type was found in 10 cases, including multiple, miliary, micronodular and low-density lesions with miliary calcifications in 2 cases; singular, low-density mass with multiple flecked calcifications in 3 cases; multiple cystic lesions in i case; multiple micronodular and low-density lesions fusing into multiloculated cystic mass or “cluser“ sign in 3 cases; and singular, macronodular and low-density lesion with multiple miliary calcifications in 1 case. One case of tuberculous cholangitis showed marked dilated intrahepatic ducts with multiple flecked calcifications in the porta hepatis. (2) MR findings in 4 cases were hypointense on both Tl-weighted imagings and T2-weighted imagings in one case, hypointense on Tl-weighted imagings and hyperintense on T2-weighted imagings in 3 cases. Enhanced MR in 3 cases was slightly shown peripheral enhancementor with multilocular enhancement. CONCLUSION: Various types of hepatic tuberculosis have different imaging findings, and typical CT and MR findingscan suggest the diagnosis.     

Hepatic tuberculoma: presentation of cases and review of the literature

Hepatic involvement by tuberculosis is a rare type of manifestation of the disease. There are several forms of clinical presentations. One of them is the hepatic tuberculoma in which we base our presentation. Given that hepatic tuberculoma is a rare entity and generally shows inespecific symptoms, it is rarely suspected by the clinical picture. The diagnosis of hepatic tuberculosis is generally done in the intraoperative or postoperative period by analyzing a specimen taken by laparoscopy or laparotomy during the study of a hepatic mass. Laboratory tests or image studies do not give pathognomonic information to conform the diagnosis. The cornerstone in the treatment of this pathology is the antituberculous therapy. Surgical or endoscopic interventions are occasionally required. The role of surgery in the treatment of this pathology is reserved for a few solitary lesions. Once the correct treatment is performed the outcome is favorable. We present 4 cases of hepatic tuberculoma with different imaging and clinical presentations.     

Hepatic tuberculosis: case report of pseudotumoral form

Inflammatory pseudo-tumors of the liver are rare and difficult to diagnose, mimicking malignant tumors. We report a patient, 42 year old with hepatic pseudo-tumor who was suspected to have pseudotumoral hepatic tuberculosis without immunodepression and treated by major hepatic surgery because no sure diagnosis. Therapeutic approach of hepatic inflammatory pseudotumors is often medical and surgical and may need major hepatic surgery in case of sure etiologic diagnosis.     

Hepatosplenic tuberculosis with hypersplenism: CT evaluation

Hepatosplenic tuberculosis of macronodular form is extremely rare. We present one case of hepatosplenic tuberculosis with its appearance on computed tomography (CT). The CT findings of hepatosplenic tuberculosis were multiple, well-defined, round or ovoid, low-density masses with a range of +35 to +45 HU. Lymphadenopathy in the abdominal and mediastinal area and pleural effusion were also found. Although CT does not confirm a diagnosis of hepatosplenic tuberculosis, it is a valuable examination to support the diagnosis and define the extent of disease.     

Colonic and peritoneal tuberculosis associated with coloduodenal fistula

We report a very rare case of tuberculous colitis that showed relatively long-segment involvement of the colon near the hepatic flexure with coloduodenal fistula that caused severe malnutrition. The formation of fistula in abdominal tuberculosis is very rare. This is the eighth reported case of abdominal tuberculosis with fistula and the first reported case with a coloduodenal fistula.     

Tuberculous liver abscess not associated with lung involvement

Hepatic tuberculosis is one of the uncommon forms of extrapulmonary tuberculosis. We report a 78-year-old woman who developed tuberculous liver abscesses with splenic abscess not associated with pulmonary foci. Ultrasonography and computed tomography of the abdomen showed the low-density lesions in the liver and spleen. Histopathology of specimens obtained by percutaneous needle biopsy revealed coagulation necrosis and epithelioid cells but not tumor cells, suggesting tuberculosis infection in the liver and spleen. Systemic chemotherapy with anti-tuberculous agents led to the improvement of the lesions in the liver as well as spleen. Although tuberculous liver abscess is a very rare case, it should be included in the differential diagnosis of unknown hepatic mass lesions.     

Hereditary hemorrhagic telangiectasia (Osler-Rendu-Weber disease) and its manifestation in the liver

M. Osler (Hereditary Hemorrhagic Telangiectasia, HHT) is an autosomal dominant inherited disease, with various vascular malformations. The genetic cause of this disease lies in different defects of transmembrane proteins (endoglin, activin receptor like-kinase 1) that can be defined as components of the receptor complex for transforming growth factor beta (TGF beta). Vascular malformations include the gastrointestinal tract and especially the liver. The location of mutations encoding hepatic involvement of M. Osler still remains unknown. These vascular malformations may lead to different shunts in the liver and can result to different complications like cardiac-insufficiency, portal hypertension and hepatic encephalopathy in adulthood. Color Doppler sonography is the method of choice for screening patients with M. Osler--suspected of having hepatic involvement. As in rare events conservative treatment of complications of hepatic involvement fail, embolization of the hepatic artery as minimal invasive therapy, surgical ligation of the A. hepatica and liver transplantation are possible treatment options. As there are only limited experiences with these therapeutic procedures patients with liver involvement should be treated at a center, where all therapy options are available.     

Atypical Hepatic Tuberculosis Presenting as Obstructive Jaundice

A 78-yr-old female with a short history of malaise, anorexia, mild pyrexia, and obstructive jaundice is presented. A diagnosis of tuberculosis of the liver and gallbladder was established at laparotomy. In spite of anti-tuberculous therapy, the patient died on the 5th postoperative day. Widespread miliary tuberculosis affecting the lung, kidneys, spleen, and mesenteric lymph nodes was observed in postmortem studies, with strikingly severe involvement of the intrahepatic bile ducts. Saccular dilatation of the bile ducts alternating with areas of stenosis and narrowed intrahepatic bile ducts was seen. A correlation of the radiological and hepatic postmortem findings is discussed. The atypical presentation of tuberculosis in present times and the causes of jaundice in atypical cases of hepatic tuberculosis are discussed. The rarity of gallbladder tuberculosis is pointed out.     

Left pleural effusion in patients with chronic liver disease and ascites prospective study of 22 cases

In a prospective study of 22 cases of left pleural effusion in patients with chronic liver disease and ascites, 16 patients underwent thoracentesis, revealing ten transudates, considered to be hepatic hydrothorax, and six exudates, four of which turned out to be due to tuberculosis. Unilateral left pleural effusion is rare in chronic liver disease with ascites, but if present it is associated with a high incidence of pleuropulmonary tuberculosis (18%).     

A rare reason for liver transplantation: hepatic alveoloar echinococcosis

One of the rare indications for liver transplantation is hepatic alveolar echinococcosis (AE). We present a case of hepatic AE with portal vein involvement.