Abdominal tuberculosis (TB) is rare in childhood and usually a diagnostic challenge, particularly in the absence of active pulmonary infection, and because clinical manifestations and results of laboratory studies are nonspecific. Intestinal TB can involve any segment of the gastrointestinal tract, but has a predilection for the ileocecal valve and the adjacent ileum and cecum (ParkEr 2003; EngiN and Balk 2005).
Clinical features suggestive of TB are a history of fever, abdominal pain and weight loss.
Abdominal plain films may show no abnormalities or show a few or multiple air-fluid levels in the small bowel loops due to the enteritis component.
Upper GI examination reveals thickened folds, spasticity, irregular contours, and ulcers involving the cecum and terminal ileum. In the case of fibrosis, single or multiple short strictures that can be localized in a single segment or be present throughout the bowel will be found. Incidentally fistulae formation can be recognized radiographically.
Sonographic evaluation may show thickening of the wall of the cecum and terminal ileum, an inflammatory mass, dilated small bowel loops, an increase of mesenteric thickness and echogenicity (due to fat deposition), mesenteric lymphadenopathy and ascites. The lymph nodes are heterogeneous and can contain calcifications. Calcifications are virtually pathognomonic for TB (Jain et al. 1995).
Imaging with CT will show the same findings as with US, but is the preferred examination for obese
children, children in which US is difficult because of heavy pain when touching the abdomen, or if biopsy is needed (Fig. 5.28).
MRI of abdominal TB lymphadenopathy shows a variety of signal intensities and patterns of contrast enhancement and is described by De Backer et al. (2005). Mostly the signal intensities, in relation to abdominal wall muscle, are hyperintense on T2-WI with, in some cases, a hypointense peripheral rim and internal heterogeneity and hypo-/iso-intensity on T1-WI, also occasionally with a peripheral rim, but then hyperintense or internal heterogeneity. Contrast-enhanced fat-suppressed T1-WI demonstrate predominantly peripheral enhancement.
Crohn disease and peri-appendiceal abscesses should be considered as differential diagnoses, as well as, although less frequently in the case of children, carcinoma and lymphoma.
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