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Purpose: To analyze the computed tomography (CT) findings and the reasons for misdiagnosis of female pelvic tuberculosis.
Methods: The clinical and CT features of 32 cases of female pelvic tuberculosis identified over a five-year period (2010-2015) were retrospectively analyzed. The CT features were analyzed for nature, range and extent of the various pathological patterns.
Results: Because of the non-specific clinical and CT features, 20 of 32 cases were misdiagnosed either as ovarian tumor, or chocolate cyst, or PID preoperatively and received surgery. The mean age of the patients was 29.97 years (age range 15-67 years). Elevated levels of serum CA125 were found in 29 patients (90.62％, 29/32). The CT findings were as follows:1. Pelvic mass (87.5%, 28/32):unilateral adnexal mass was in 15 cases, bilateral in 13 cases, 8 masses were cystic, 10 were solid, 23 were mixed, 24 masses showed multilocular caseous necrotic enhancement;2. Ascites (40.62%, 13/32):8 of 13 cases showed high density ascites (CT value ＞18 HU); 3. Thickening and enhancement of peritoneum (37.5%, 12/32):nodulously thickened in 7 cases, smoothly in 5 cases; 4. Adhesion in the abdominopelvic cavity (28.12%, 9/32); 5. Lymphadenopathy (21.87%, 7/32):calcified in 4 cases, low attenuation necrotic lymph nodes with ring enhancement in 2 cases;6. Thickening and enhancement of bowel wall (15.62%, 5/32).
Conclusions: Integrated with clinical history and laboratory tests, pelvic tuberculosis should be considered in young female patients with elevated CA125 and CT findings of adnexal mixed (solid and cystic) mass with multilocular caseous necrotic enhancement, high density ascites, thickened and enhanced peritoneum. Early diagnosis of the disease is a key consideration for early institution of anti-TB therapy to avoid misdiagnosis and surgical explorations.
CT Features and Analysis for Misdiagnosis of Parotid Tuberculosis
Purpose: To analyze the CT features and the reasons for misdiagnosis of parotid tuberculosis (TB).
Methods:CT features of 13 cases of parotid TB identified over a ten-year period (2005-2015) were retrospectively analyzed. The CT features were analyzed for nature, range and extent of the various pathological patterns.
Results:Because of the non-specific CT features, 10 of 13 cases were misdiagnosed as benign and malignant tumors of parotid gland and received surgery. Ten cases of lymph nodal TB, one case of parenchymal TB and two cases of mixed (concurrence of lymph nodal and parenchymal types) TB were found in the parotid gland. On contrast-enhanced CT scan, 2 cases showed homogeneous enhancement and 8 cases showed ring enhancement (including 5 cases with thin-walled ring enhancement, two cases with flower-ring enhancement, and one case with thick-walled and eccentric ring enhancement);diffuse enhancement was seen in the one case of parenchymal type;the two cases of mixed type showed diffuse enhancement of parotid gland and ring enhancement of lymph node. Thickened skin around the parotid gland was seen in 8 cases, including sinus tract between the lesion and skin in two cases. Ipsilateral cervical lymphadenopathy was found in 10 and bilateral in 3 patients.
Conclusions:Non-specific CT features of parotid TB closely relates with pathological changes. Recognition and understanding the spectrum of CT features of parotid TB is helpful for differential diagnosis, but the definitive diagnosis still depends on laboratory and pathological examination.
CT Characterization of Hepatic Tuberculosis
Purpose: The purpose of this study was to evaluate the CT features of hepatic tuberculosis (TB).
Methods: CT features of 15 cases of clinically and pathologically proved hepatic tuberculosis identified over a five-year period (2010-2015) were retrospectively analyzed. The CT features were analyzed for nature, range and extent of the various pathological patterns. The CT images of chest were also evaluated for any lung abnormality.
Results:There were 4 types of hepatic TB:1. Serohepatic type (n=2), which showed coalesced multiple nodular hypodense lesions in the subcapsule of the liver with nodular and fusiform uneven calcifications. 2. Parenchymal type (n = 9): included miliary subtype (n = 2), showing diffuse low-density miliary nodules in the liver with no enhancement after contrast administration;cystic subtype (n=2), demonstrating cystic low-density lesions with no enhancement;nodular subtype (n=5), showing hypodense lesion with curved edge irregular calcification in three cases, and ill-defined low density lesion with minimal enhancement in two cases. 3. Mixed type (n =3), which showed the CT features of both parenchymal and serohepatic types. 4. Tuberculous cholangitis (n = 1), dilatation of biliary ducts and calcification along the wall of bile ducts were revealed. Abnormal chest CT scan was found in 9 cases (60%, 9/15).
Conclusions:Different types of hepatic TB have various imaging features that closely relates with pathological changes. Recognition and understanding the spectrum of CT features of hepatic TB is helpful for the diagnosis; however, definitive diagnosis still depends on pathological examination. Chest CT scan is also helpful to aid in the diagnosis.
Methods: The clinical and CT features of 32 cases of female pelvic tuberculosis identified over a five-year period (2010-2015) were retrospectively analyzed. The CT features were analyzed for nature, range and extent of the various pathological patterns.
Results: Because of the non-specific clinical and CT features, 20 of 32 cases were misdiagnosed either as ovarian tumor, or chocolate cyst, or PID preoperatively and received surgery. The mean age of the patients was 29.97 years (age range 15-67 years). Elevated levels of serum CA125 were found in 29 patients (90.62％, 29/32). The CT findings were as follows:1. Pelvic mass (87.5%, 28/32):unilateral adnexal mass was in 15 cases, bilateral in 13 cases, 8 masses were cystic, 10 were solid, 23 were mixed, 24 masses showed multilocular caseous necrotic enhancement;2. Ascites (40.62%, 13/32):8 of 13 cases showed high density ascites (CT value ＞18 HU); 3. Thickening and enhancement of peritoneum (37.5%, 12/32):nodulously thickened in 7 cases, smoothly in 5 cases; 4. Adhesion in the abdominopelvic cavity (28.12%, 9/32); 5. Lymphadenopathy (21.87%, 7/32):calcified in 4 cases, low attenuation necrotic lymph nodes with ring enhancement in 2 cases;6. Thickening and enhancement of bowel wall (15.62%, 5/32).
Conclusions: Integrated with clinical history and laboratory tests, pelvic tuberculosis should be considered in young female patients with elevated CA125 and CT findings of adnexal mixed (solid and cystic) mass with multilocular caseous necrotic enhancement, high density ascites, thickened and enhanced peritoneum. Early diagnosis of the disease is a key consideration for early institution of anti-TB therapy to avoid misdiagnosis and surgical explorations.
CT Features and Analysis for Misdiagnosis of Parotid Tuberculosis
Purpose: To analyze the CT features and the reasons for misdiagnosis of parotid tuberculosis (TB).
Methods:CT features of 13 cases of parotid TB identified over a ten-year period (2005-2015) were retrospectively analyzed. The CT features were analyzed for nature, range and extent of the various pathological patterns.
Results:Because of the non-specific CT features, 10 of 13 cases were misdiagnosed as benign and malignant tumors of parotid gland and received surgery. Ten cases of lymph nodal TB, one case of parenchymal TB and two cases of mixed (concurrence of lymph nodal and parenchymal types) TB were found in the parotid gland. On contrast-enhanced CT scan, 2 cases showed homogeneous enhancement and 8 cases showed ring enhancement (including 5 cases with thin-walled ring enhancement, two cases with flower-ring enhancement, and one case with thick-walled and eccentric ring enhancement);diffuse enhancement was seen in the one case of parenchymal type;the two cases of mixed type showed diffuse enhancement of parotid gland and ring enhancement of lymph node. Thickened skin around the parotid gland was seen in 8 cases, including sinus tract between the lesion and skin in two cases. Ipsilateral cervical lymphadenopathy was found in 10 and bilateral in 3 patients.
Conclusions:Non-specific CT features of parotid TB closely relates with pathological changes. Recognition and understanding the spectrum of CT features of parotid TB is helpful for differential diagnosis, but the definitive diagnosis still depends on laboratory and pathological examination.
CT Characterization of Hepatic Tuberculosis
Purpose: The purpose of this study was to evaluate the CT features of hepatic tuberculosis (TB).
Methods: CT features of 15 cases of clinically and pathologically proved hepatic tuberculosis identified over a five-year period (2010-2015) were retrospectively analyzed. The CT features were analyzed for nature, range and extent of the various pathological patterns. The CT images of chest were also evaluated for any lung abnormality.
Results:There were 4 types of hepatic TB:1. Serohepatic type (n=2), which showed coalesced multiple nodular hypodense lesions in the subcapsule of the liver with nodular and fusiform uneven calcifications. 2. Parenchymal type (n = 9): included miliary subtype (n = 2), showing diffuse low-density miliary nodules in the liver with no enhancement after contrast administration;cystic subtype (n=2), demonstrating cystic low-density lesions with no enhancement;nodular subtype (n=5), showing hypodense lesion with curved edge irregular calcification in three cases, and ill-defined low density lesion with minimal enhancement in two cases. 3. Mixed type (n =3), which showed the CT features of both parenchymal and serohepatic types. 4. Tuberculous cholangitis (n = 1), dilatation of biliary ducts and calcification along the wall of bile ducts were revealed. Abnormal chest CT scan was found in 9 cases (60%, 9/15).
Conclusions:Different types of hepatic TB have various imaging features that closely relates with pathological changes. Recognition and understanding the spectrum of CT features of hepatic TB is helpful for the diagnosis; however, definitive diagnosis still depends on pathological examination. Chest CT scan is also helpful to aid in the diagnosis.