The increasing resurgence of tuberculosis as an opportunistic infection in HIV infected individuals is a cause of major concern. Abdominal tuberculosis can have various manifestations and can involve the GI tract, the peritoneum, the solid viscera or the lymph nodes. Tuberculosis superinfection in HIV- infected individuals can result in significant mortality.
According to many studies of patients with visceral tuberculosis, intra-abdominal adenopathy and visceral lesions were more common in HIV infected patients while non-HIV infected patients more frequently had omental thickening and ascites. The lymph nodes can significantly enlarge and encase the adjacent mesenteric vessels. The enlarged tuberculous nodes have a predilection for the mesenteric, peripancreatic and periportal locations as compared to retro-peritoneal location.
The closest differential for enlarged nodes in a HIV infected individual would be lymphoma [Non-Hodgkin’s]. The other common secondary disease processes seen in AIDS are Kaposi’s sarcoma and cytomegalovirus infection.
1. Enlarged conglomerate nodal mass which is heterogeneous and predominantly hypoechoic.
2. Increased through transmission of sound by the abdominal nodal mass suggests caseating necrosis and is highly suggestive though not specific of tubercular lymphadenitis.
3. Calcifications may also be noted in the lymph nodes.
4. The other features associated with abdominal tuberculosis include bowel wall thickening [especially in the ileo-cecal junction], peritoneal nodules, mesenteric thickening and clear or complex ascites. Visceral involvement may be seen as organomegaly or as multiple small abscesses in the organs.
5. Ultrasound guided fine needle aspirate is useful in arriving at a diagnosis by obtaining tubercular organisms that can be cultured.
|| Caption : Sagittal image of the right mid abdomen.
Description : The right kidney is diffusely echogenic, an appearance classically associated with AIDS nephropathy. Increased echogenicity of the kidneys is also seen with other forms of renal parenchymal disease.
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|| Caption : Transverse scan of the abdomen.
Description : A large heterogeneous, predominantly hypoechoic mass is seen in the abdomen.
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