To Identify the Features Differentiating Peritoneal Tuberculosis from Carcinomatosis on Ct Scan Abdomen Taking Omental Biopsy as a Gold Standard. | [Journal of Pakistan Medical Association • 2018]

Author(s):

1. Farah Naz: Aga Khan University Hospital Karachi, Pakistan

2. Waseem Akhter Mirza: Aga Khan University Hospital Karachi, Pakistan

3. Nauman Hashmani: Dow University of Health Sciences (DUHS), Karachi, Pakistan

4. Raza Sayani: Aga Khan University Hospital Karachi, Pakistan

Abstract:

Objective: To differentiate peritoneal tuberculosis from carcinomatosis on computed tomography scan of abdomen, taking omental biopsy as the gold standard. Method: This retrospective diagnostic accuracy review of cases was conducted at Aga Khan University Hospital, Karachi, and comprised patient's medical record files from February 2007 to February 2016. Computed tomography scan findings were compared with diagnosis made on the basis of histopathology. Multiple logistics regression analysis was done and sensitivity and specificity were tested through Pearson chi square test. Results: Of the 98 patients identified, 62(63.2%)were found to be cases of disseminated tuberculosis and 36(36.7%) were diagnosed as malignant on histopathology. Computed tomography features were significantly specific to differentiate abdominal tuberculosis from carcinomatosis (p=0.004). On computed tomography,4 findings showed statistical significance: Smooth thickening of the peritoneum (p<0.001), abdominal mass (p=0.03), lymph node necrosis (p=0.024) and high-density ascitic fluid (p<0.001). Out of these, smooth thickening of the peritoneum (sensitivity=77%; specificity=86.1%) and high-density ascitic fluid (sensitivity=68.9%; specificity=72.2%) were more specific findings. Overall, the sensitivity and specificity of computed tomography was found to be 88.5% and 83.3%, respectively. Conclusion: Although no single finding on a computed tomography scan was diagnostic proof of peritoneal tuberculosis, a combination of findings could reliably distinguish between peritoneal tuberculosis and carcinomatosis.

Page(s): 1461-1464

DOI: DOI not available

Published: Journal: Journal of Pakistan Medical Association, Volume: 68, Issue: 10, Year: 2018

Keywords:

Computed tomography , CT scan , Carcinomatosis , Omental biopsy

References:

[1] 1992.Tuberculosis control and research strategies for the 1990s: memorandum from a WHO meeting,Bull World Health Organ 70 17 -21

[2] RaviglioneMC,SniderDE, 1995.Global epidemiology of tuberculosis; morbidity and mortality of a world wide epidemic,JAMA 273 220 -6

[3] SmithI., 2003.Mycobacterium tuberculosis Pathogenesis and Molecular Determinants of Virulence,Clin Microbiol Rev 16 463 -96

[4] BolukbazC,BoukbasFF,KendirT, 2005.Clinical presentation of abdominal tuberculosis in HIV seronegative adults,BMC Gastroenterol -

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