Hepatic tuberculosis: a multimodality imaging review.
OBJECTIVE
We aim to illustrate the multimodal imaging spectrum of hepatic involvement in tuberculosis (TB). Whilst disseminated tuberculosis on imaging typically manifests as multiple small nodular lesions scattered in the liver parenchyma, isolated hepatic tuberculosis remains a rare and intriguing entity.


METHODS
Indubitably, imaging is the mainstay for detection of tubercular hepatic lesions which display a broad spectrum of imaging manifestations on different modalities. While sonography and computed tomography (CT) findings have been described in some detail, there is a paucity of literature on magnetic resonance imaging (MRI) features. Due to a significant overlap with other commoner and similar appearing hepatic lesions, hepatic tuberculosis is often either misdiagnosed or labelled as indeterminate lesions. This article is a compendium of cases highlighting the spectrum of imaging patterns that can be encountered in patients with isolated primary hepatic tuberculosis as well as disseminated (secondary) disease. Rare patterns of primary disease such as tubercular cholangitis, hypervascular liver masses, and those with vascular complications are also illustrated and discussed.


CONCLUSIONS
Imaging plays a valuable role in the detection of tubercular hepatic lesions. Also, imaging can be helpful in their characterisation and for assessing associated complications.


CONCLUSIONS
• Hepatic TB has myriad imaging manifestations and is often confounded with neoplastic lesions. • Imaging patterns include miliary TB, macronodular TB, serohepatic TB and tubercular cholangitis. • Concurrent splenic, nodal or pulmonary involvements are helpful pointers towards the diagnosis. • Miliary calcifications along the bile ducts are characteristic of tubercular cholangitis. • Histological/microbiological confirmation is often necessary to confirm the diagnosis.
Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, India. chandankakkar@yahoo.co.in.
Chandan
http://orcid.org/0000-0002-1051-3876
C
Kakkar
Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Parel, Mumbai, India. ashwin_m_polnaya@yahoo.co.in.
Ashwin M
AM
Polnaya
Department of Radiodiagnosis and Imaging, Kasturba Medical College and Hospital, Manipal, India. docprakashinik@yahoo.co.in.
Prakashini
P
Koteshwara
Department of Radiodiagnosis and Imaging, Kasturba Medical College and Hospital, Manipal, India. smitis11@hotmail.com.
S
S
Smiti
Department of Radiodiagnosis and Imaging, Kasturba Medical College and Hospital, Manipal, India. rajagopalkv@yahoo.com.
K V
KV
Rajagopal
Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India. aroradrankur@yahoo.com.
Ankur
A
Arora
CT; Hepatic tuberculosis; Miliary; Nodular; Tubercular cholangitis, MRI