Uncategorized
  • 24 y/o woman with a question of remote history of a stricture at or near the TI which was thought represnt Crohn’s disease,
  • She now presents with
    • abdominal pain,  fevers, night sweats, diarrhea,
    • 25 lbs weight loss
  • Subsequently diagnosed
    • Tuberculous Enteritis
    • s/p Treatment with RIPE therapy (6 months) 
CT

b1511-01L-Tuberculosis-TB-of-terminal-ileum-cecum-ascites-CT.jpg

 Tuberculosis (TB) of the Terminal Ileum and Cecum with Ascites
A 24-year-old female presents with abdominal pain, night sweats, and a 25-pound weight loss. CT scan coronal (a, b, and c), axial (b and e), and sagittal views show a thickened and enhancing terminal ileum (pink arrowhead a, magnified in d, and b), a focal stricture (red arrowhead a and d), thickened and enhancing contracted cecum and ascending colon (brown arrowhead b, e, and f) with thickened and indurated pericolic soft tissue and peritoneum (white arrowhead b, c, and e). Loculated ascites is noted alongside the ascending colon (orange asterisk a and d).
Comment:
Findings are consistent with ileo-colitis, and in the appropriate clinical setting, tuberculosis. The differential diagnosis of ileo-colitis includes Crohn?s disease. However, simultaneous continuous involvement of both the ileum and colon without skip areas, as seen in this case, is more characteristic of tuberculosis, while Crohn?s disease typically presents with segmental skip lesions and non-contiguous bowel involvement.
Ashley Davidoff MD TheCommonVein.net b1511-01L (02Co)

b1511-01b01-Tuberculosis-TB-of-terminal-ileum-cecum-ascites-CT-1.jpg

 Title: Tuberculosis (TB) of the Terminal Ileum and Cecum with Ascites
A 24-year-old female presents with abdominal pain, night sweats, and a 25-pound weight loss.
CT of the abdomen and pelvis (coronal view) and magnified in the lower image demonstrates thickening and enhancement of the ileocecal wall, loculated ascites in the right lower quadrant (RLQ), and free ascites in the pelvis. Findings in the appropriate clinical setting are consistent with gastrointestinal tuberculosis.
Comment: Gastrointestinal tuberculosis frequently involves the ileocecal region, often presenting with wall thickening, lymphadenopathy, and ascites, which may be loculated or free.
Ashley Davidoff MD TheCommonVein.net b1511-01b01 (02Co)

1511-02L-ileum-cecum-ileocolitis-TB-peritonitis-omental-cake-24F-CT.jpg
Title: Tuberculosis (TB) of the Terminal Ileum and Cecum with Ascites
A 24-year-old female presents with abdominal pain, night sweats, and a 25-pound weight loss.
1511-02L CT axial of the RLQ a,b,c,e,anf f and coronal (d) show evidence of ileo colitis thickening and enhancing ileum (pink arrowhead a, d ) and thickening and enhancing colon (brown arrowhead a, b, c, d) with transmural inflammatory changes ahd peritoneal thickening (white arrowheads a,b, c) . Small enhancing nodes are noted inthe ileocolic region (light green arrowhead b,c) Loculated ascites (orange asteriskd) and free ascites (e,f) Omental induration (omental cake) (white cirle f)
Ashley Davidoff MD TheCommonVein.net b1511-01L (02Co)

Key Features of Tuberculous Peritonitis:

  • Caused by hematogenous or lymphatic spread of Mycobacterium tuberculosis or direct spread from an adjacent infected structure (like ileocecal TB).
  • Radiologic findings often include:
    • Peritoneal thickening and enhancement
    • Loculated ascites
    • Omental caking due to granulomatous inflammation
    • Lymphadenopathy, often with rim enhancement
  • Pathophysiology: The infection stimulates a granulomatous reaction with exudative ascites and peritoneal fibrosis.

b1511-03c-Tuberculosis-TB-of-terminal-ileum-cecum-ascites-omental-thickening-CT.jpg

 Tuberculosis (TB) of the Terminal Ileum and Cecum with Ascites and Omental Thickening
A 24-year-old female presents with abdominal pain, night sweats, and a 25-pound weight loss.
CT axial (a, c) and coronal (b, d) views reveal ileocolic thickening with transmural involvement, induration of the surrounding fat, and thickening of the peritoneum (a). Image (b) shows free ascites and omental caking anteriorly, which is better visualized in the coronal projections (b and d).
Comment: The findings are consistent with tuberculous peritonitis, most likely due to Mycobacterium bovis, which commonly involves the bowel, particularly the ileocecal region, following ingestion of unpasteurized dairy products. The combination of ileocolic thickening, peritoneal enhancement, omental caking, and ascites supports this diagnosis.
Ashley Davidoff MD TheCommonVein.net b1511-03c (02Co)

b1511-03cL-Tuberculosis-TB-of-terminal-ileum-cecum-ascites-omental-thickening-CT.jpg

 b1511-03c Tuberculosis TB of terminal ileum, cecum, ascites omental thickening CT
Title: Tuberculosis (TB) of the Terminal Ileum and Cecum with Ascites
A 24-year-old female presents with abdominal pain, night sweats, and a 25-pound weight loss.
CT axial (a,c) coronal (b,d) reveal thickening, enhancement and transmural involvement of theTuberculosis (TB) of the Terminal Ileum and Cecum with Ascites and Omental Thickening, Likely Mycobacterium bovis
A 24-year-old female presents with abdominal pain, night sweats, and a 25-pound weight loss.
CT axial (a, c) and coronal (b, d) reveal thickening, enhancement, and transmural involvement of the ileum (a, pink arrowhead) and colon (a, brown arrowhead) with induration of the surrounding fat and thickening of the peritoneum (a, white arrowhead). Image (b) shows free ascites (orange asterisk) and omental caking anteriorly (b, white ring). The omental cake is better visualized in the coronal projections (b and d, encircled in white).
Comment: The findings are consistent with tuberculous peritonitis, most likely due to Mycobacterium bovis, which commonly involves the bowel, particularly the ileocecal region, following ingestion of unpasteurized dairy products. The combination of ileocolic thickening, peritoneal enhancement, omental caking, and ascites supports this diagnosis.
Ashley Davidoff MD TheCommonVein.net b1511-03c (02Co) ileum (a pink arrowhead) and colon (a, brown arrowhead) (with induration surrounding fat and thickening of peritoneum (a white arrowhead)
Image b shows free ascites (orange asterisk) and omental cake anteriorly (b, white ring)
The omental cake is better seen in coronal projection (b and d encircled in white)
CW TB peritonitis etc as stated before and then comment about ttB peritonits
Ashley Davidoff MD TheCommonVein.net b1511-02cL (02Co)

 

MRE – 8/17/2018
1. Short segment of wall thickening and enhancement of the terminal
ileum and cecal base.
Colonoscopy: Circumferential Ulcers at the cecum with gross deformation of the IC valve. Concern for TB vs. CMV
Mycobacterum tuberculosis complex as well as positive Quantiferon Gamma Testing.
Pathology: TI: Ulceration with severe chronic and acute inflammation, necrosis and caseating granuloma
Cecal Biopsy: Fragments of necrotic tissue with chronic and actue inflammatory cell infiltrate and few poorly developed necrotizing granulomas
Tuberculous Enteritis s/p Treatment with RIPE therapy (6 months)
Follow up
Underwent a colonoscopy with evidence of a structural deformity of the cecum and IC valve stricture but no evidence of active inflammatory bowel disease. Her ileum was biopsied which showed eivdence of ileal mucosa with crypt distortion and branching. The findings were “consistent with quiescent CD. AFB stains were negative.”

 

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