Background: Peritoneal tuberculosis (PT) and peritoneal malignancy (PM) are the most frequent causes of exsudate ascitic fluid but the different diagnosis between the former and the latter is also difficult and elusive. Objective: To study the difference of clinical and laparoscopic features between PT and PM. Subjects and method: 76 patients with PT and 50 with PM were diagnosed by laparoscopy and peritoneal biopsy. Ascitic mycobacterium tuberculosis was detected by PCR analysis. Exsudate ascites was confirmed according to criteria of Light. Results and Conclusions: Average age of PT was younger than of PM (p < 0.001). The frequency of fever, pleural effusion in the patients with PT was higher than those in PM (p < 0.001 and 0.05). The anemia and abdominal tumefaction in those of PM was more frequent than in those of PT (p < 0.05 and 0.001). High protein ascitic fluid and numerous lymphocytes in the patients with PT was frequent than in those with PM (p < 0.05). Laparoscopic features: In those patients with PT the white "miliary nodules" or adhesions between abdominal wall was more frequent than in those with PM (p < 0,05) and in patients with PM omental thickening, tumor formation was more than in those with PT.
Peritonitis ; Tuberculous/pathology ; diagnosis ; Laparoscopy

OBJECTIVETo improve the recognition and diagnosis of abdominal tuberculosis (TB) in children.

METHODThe data from 30 cases with abdominal TB hospitalized in Beijing Children's Hospital were analyzed retrospectively. The clinical significance of various tests was discussed respectively.

RESULTTwenty of the 30 cases were misdiagnosed as having upper respiratory tract infection, gastroenteritis, indigestion, and only 6 cases were diagnosed as pulmonary tuberculosis while the diagnosis of abdominal TB was made in just 4 cases at initial consultation. Twenty-one cases (70%) experienced the symptoms of abdominal pain or distension, diarrhoea, or constipation. The positive abdominal signs existed in all children including doughy sensation (9 cases), tenderness (8 cases), mass (4 cases), and hepatosplenomegaly (3 cases). Extraabdominal TB was found in 24 children, the positive PPD and abnormal ultrasonic image were seen in 93% and 100% of the cases, respectively. The exploratory laparotomy and colonoscopic biopsy confirmed the diagnosis in 3 and 2 cases, respectively. Twenty-four children received systematic treatment with good results.

CONCLUSIONThe abdominal TB in children which is easily misdiagnosed in it's early stage usually consisted of gastrointestinal symptoms and signs. The TB beyond the abdomen can be a clue for making correct diagnosis. PPD and ventral ultrasonic examination are important for ultimate clinical diagnosis while colonoscopy, and laparotomy can provide pathological evidence.

Abdominal Cavity ; pathology ; Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Male ; Peritonitis, Tuberculous ; diagnosis ; Retrospective Studies

OBJECTIVETo evaluate the computed tomography (CT) findings of peritoneal tuberculosis mimicking advanced ovarian carcinoma for better understanding of the CT manifestations and accurate preoperative diagnosis.

METHODSCT findings of 18 cases with tuberculous peritonitis clinically simulating advanced ovarian cancer but pathologically proved otherwise were retrospectively reviewed.

RESULTS1. Masses with solid and cystic structures were found in 6 cases and tumor-like flakes were found in 7 cases in the adnexal regions. The solid components and tumor-like flakes were moderately to markedly enhanced with dynamic CT scanning. 2. The peritoneum was smooth and slightly thickened in 10 cases; irregular thickening was seen in 4 cases, and patches of calcification in 3 cases. Thickened peritoneum with pronounced enhancement was noted in 7 cases. 3. Omentum with flake-like thickening was noted in 11 cases, coarse reticulate thickening in 2 cases and omental cakes in 2 cases. The margin of the thickened omentum with enhancement was ill-defined. 4. Nodular and stripe-like thickening of the mesentery was noted in 16 cases. 5. Ascites was present in all of the 18 cases, being encapsulated in 14 of them. 6. Lymphadenopathy was seen in 9 cases, all at located in the diaphragmatic levels. Enhancement of the lymph nodes was marked in 8 of the 8 patients examined. They appeared as ring-like (> 1 cm in diameter) or uniform (

CONCLUSIONCT examination combined with clinical manifestations helps differentiate tuberculous peritonitis from advanced ovarian cancer.

Adolescent ; Adult ; Aged ; Diagnosis, Differential ; Female ; Humans ; Hyperplasia ; Lymph Nodes ; pathology ; Middle Aged ; Ovarian Neoplasms ; diagnostic imaging ; pathology ; Peritonitis, Tuberculous ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed

Tuberculous pericarditis is a rare form of tuberculosis usually presenting as pericardial effusion or constrictive pericarditis. But rarely it may present as pericardial mass. We experienced a case of tuberculous pericarditis presenting as pericardial mass which was confirmed by open thoracotomy. The patient was 34-year-old female, who was previously treated for tuberculous pleurisy. She admitted for dyspnea on exertion and imaging study including chest CT and echocardiography showed pericardial mass. Open thoracotomy showed hard adhesive mass lesion around pulmonary artery and pathology showed chronic granulomatous inflammation with caseation necrosis. We report a rare case of tuberculous pericarditis presenting as pericardial mass.
Adhesives ; Adult ; Dyspnea ; Echocardiography ; Female ; Humans ; Inflammation ; Necrosis ; Pathology ; Pericardial Effusion ; Pericarditis, Constrictive ; Pericarditis, Tuberculous* ; Pulmonary Artery* ; Thoracotomy ; Tomography, X-Ray Computed ; Tuberculosis ; Tuberculosis, Pleural

Tuberculous pericarditis is a rare form of tuberculosis usually presenting as pericardial effusion or constrictive pericarditis. But rarely it may present as pericardial mass. We experienced a case of tuberculous pericarditis presenting as pericardial mass which was confirmed by open thoracotomy. The patient was 34-year-old female, who was previously treated for tuberculous pleurisy. She admitted for dyspnea on exertion and imaging study including chest CT and echocardiography showed pericardial mass. Open thoracotomy showed hard adhesive mass lesion around pulmonary artery and pathology showed chronic granulomatous inflammation with caseation necrosis. We report a rare case of tuberculous pericarditis presenting as pericardial mass.
Adhesives ; Adult ; Dyspnea ; Echocardiography ; Female ; Humans ; Inflammation ; Necrosis ; Pathology ; Pericardial Effusion ; Pericarditis, Constrictive ; Pericarditis, Tuberculous* ; Pulmonary Artery* ; Thoracotomy ; Tomography, X-Ray Computed ; Tuberculosis ; Tuberculosis, Pleural

OBJECTIVETo summarize the clinical and pathological characteristics of constrictive pericarditis in China.

METHODData from 150 patients with constrictive pericarditis who admitted to our hospital from 2000 to 2007 were retrospectively analyzed.

RESULTSConstriction pericarditis was detected by echocardiography in 149 out of 150 patients. Pericardial effusion was evidenced in 59.3% patients (89/150). The diagnostic accuracy rate for identifying constrictive pericarditis by echocardiography (98.7%, 107/109) was comparable to that of surgical diagnosis (100%, 109/109). Tuberculosis was the main cause of constrictive pericarditis in this cohort (78.7%, 118/150) including 25 (16.7%) cases with pathological or etiological evidences of tubercular pericarditis, 8 (5.3%) cases with pathologically active tuberculous focus elsewhere in the body, 66 (44.0%) cases with typical clinical tuberculosis manifestation and responded to anti-tubercular therapy and 19 (12.7%) cases with a diagnosis of suspicious tuberculosis. Pericardiectomy was performed in 108 cases and pericardial biopsy and surgical drainage was performed in 1 patient. In hospital death rate was 8.7% (13/150, 4 tubercular patients and 9 non-tubercular).

CONCLUSIONTuberculosis is the leading cause of constrictive pericarditis in this cohort and the best diagnosis tool is echocardiography other than pathological and etiological findings in pericardium.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Mycobacterium tuberculosis ; Pericarditis, Constrictive ; diagnosis ; etiology ; microbiology ; pathology ; Pericarditis, Tuberculous ; complications ; diagnosis ; pathology ; Retrospective Studies ; Young Adult

BACKGROUND/AIMS: Liver cirrhosis and malignant tumors are two major causes of ascites according to the reports from Western countries, 80% and 10% respectively. Assuming that there might be regional differences in etiologies and changes in their frequency over time, we investigated causes of ascites and the diagnostic usefulness of various laboratory tests. METHODS: Medical records of 366 patients, who underwent diagnostic paracentesis in the mid-1990s (1996 and 1997) and early 2000s (2001 and 2002), were retrospectively reviewed. The etiology was confirmed by histology, imaging studies, and ascites analyses. RESULTS: The frequency of cirrhotic ascites was 59.6%, cancer-related 25.7%, tuberculous peritonitis 6.6%, and others 8.1%. Among cirrhotics, the frequency of cases related to hepatitis B decreased significantly from 72% to 55% over time, and alcoholic cirrhosis increased from 18% to 34%. Among cancer-related ascites, peritoneal carcinomatosis type was 75.5% (primary sites: stomach 24.5%, pancreas 15.9%, colon 15.9%, lung 7.4%, etc), metastatic liver cancers 8.5%, hepatocellular carcinoma without cirrhosis 6.4%, etc. The sensitivity of serum-ascites albumin gradient for the diagnosis of cirrhotic ascites was 91.4%, and total protein in ascites also revealed a comparable diagnostic sensitivity, 90%. The diagnostic sensitivity of adenosine deaminase for tuberculous peritonitis was 94.2%, and its positive predictive value was 75%. CONCLUSIONS: Liver cirrhosis is the leading cause of ascites, especially alcoholic cirrhosis has significantly increased. The next common etiology is cancer-related, and its frequency in Korea is higher than in western countries. Tuberculous peritonitis is still prevalent, and adenosine deaminase could precisely differentiate it from other causes.
Adenosine Deaminase/analysis ; Adult ; Aged ; Ascitic Fluid/chemistry/pathology ; Female ; Humans ; Liver Cirrhosis/*diagnosis/epidemiology/etiology ; Liver Cirrhosis, Alcoholic/*diagnosis/epidemiology ; Male ; Middle Aged ; Neoplasms/*diagnosis/epidemiology/etiology ; *Paracentesis ; Peritonitis, Tuberculous/*diagnosis/epidemiology ; Predictive Value of Tests ; Prevalence ; Retrospective Studies

Tuberculous liver abscesses are rare. Paradoxical response in tuberculosis is common and occurred between 2 weeks and 12 weeks after anti-tuberculous medication. We report here a case of tuberculous liver abscess that developed in a paradoxical response during chemotherapy for tuberculous peritonitis in a 23-year-old male. He was hospitalized, complaining of ascites, epigastric pain. He was diagnosed tuberculous peritonitis by expiratory laparoscopic biopsy and took medication for tuberculosis. After 2 months, a hepatic lesion was detected with CT scan incidentally. Chronic granulomatous inflammation was seen in ultrasound-guided liver biopsy, and tuberculous liver abscess was diasnosed. It was considered as paradoxical response, rather than treatment failure or other else because clinical symptoms of peritoneal tuberculosis and CT scan improved. After continuing initial anti-tuberculous medication, he was successfully treated. Herein, we report a case of tuberculous liver abscess as paradoxical response while treating peritoneal tuberculosis without changing anti-tuberculous treatment regimen.
Antitubercular Agents/*adverse effects/*therapeutic use ; DNA, Bacterial/analysis ; Humans ; Laparoscopy ; Liver/pathology/ultrasonography ; Liver Abscess/*chemically induced/*diagnosis/microbiology ; Male ; Mycobacterium tuberculosis/genetics/isolation & purification ; Necrosis/pathology ; Peritoneum/pathology ; Peritonitis, Tuberculous/*drug therapy ; Tomography, X-Ray Computed ; Tuberculosis/*diagnosis/microbiology ; Young Adult