Abstract:
Tuberculosis (TB) infection is still common today and remains an important cause
of morbidity and mortality. Abdominal TB is one of the most prevalent forms of
extrapulmonary manifestations, and collectively refers to gastrointestinal,
splenic, pancreatic, hepatobiliary and abdominal lymphadenopathy involvement.
The manifestation can be nonspecific, and mimics many conditions, including
malignancies. Biliary involvement is extremely rare. It can directly involve or
be a result of external compressions or extension from adjacent organs.
Strictures can be simple or multiple and isolated or complex. Radiologically, it
is difficult to exclude cholangiocarcinoma. Hepatic involvement is more common
and is categorised as the miliary or isolated local type. Both can be further
sub-divided into nodular or diffuse forms. The manifestations range from
abscesses and tuberculomas to hepatic calcifications. Calcifications range from
small isolated specks to gross calcification with or without hepatic atrophy.
The diagnosis of hepatobiliary TB (HBTB) can be difficult. Ultrasonography and
computed tomography are the main radiological investigations. Endoscopic
retrograde cholangiography is important in the management of biliary TB. It is
often important to look for the involvement of other organs and consider the
coexistence of other pathologies such as malignancies. This pictorial essay
reviews some of the HBTB infections that have been encountered in our tertiary
referral centre.
Correspondence:
VH Chong. Department of Medicine, Raja Isteri Pengiran Anak Saleha Hospital,
Bandar Seri Begawan, BA 1710, Brunei Darussalam.
chongvuih@yahoo.co.uk
Article is
freely available from
http://smj.sma.org.sg/5109/5109pe1.pdf (Journal website)