Value of multi-series computed tomography in diagnosing peritoneal tuberculosis in patients with exudative ascites

Abstract

Aim: Value of multi-series computed tomography in diagnosing peritoneal tuberculosis in patients with exudative ascites at Bach Mai Hospital. Materials and methods: A cross-sectional descriptive study on 102 patients, including 39 patients with a confirmed diagnosis of peritoneal tuberculosis and 63 patients with ascites secretions caused by non-peritoneal tuberculosis at Bach Mai hospital from January 1, 2022 to September 1, 2023. CT findings were evaluated for the presence of ascites, peritoneal thickening and nodular, omental thickening and enhancement, mesenteric thickening and nodules, and presence of lumph nodes.

Results: Among these 48 PTB patients, there were 16 females and 23 males giving a male- female ratio of 1.44:1. The most common clinical symptom was ascites with 74,7%. 100% of patients were exudative ascites, high lymphocytes with average ratio of lymphocyte was 61,9±11,4%, ADA of peritoneal fluid increased, average 39,6 ± 9,2 UI/L. In the group of patients with non-tuberculous exudative ascites, there were 40 patients with peritoneal metastases, accounting for 63,5%, the remaining causes were pancreatitis, ascites infection, and malignant peritoneal mesothelioma. Smooth peritoneal thickening, peritoneal micro nodules, lymph node necrosis and omental enhancement smudged pattern were seen more common in PTB (p<0,05). The sensitivity and specificity of omental enhancement smudged pattern were 92,3% and 58,7%, accuracy was 71,6%. Smooth peritoneal thickening, peritoneal micro nodules, lymph node necrosis had highly specificity ranging from 69,8% to 100%, accuracy ranging from 63,7% to 67,6% but low sensitivity (15,4% - 54,6%). Focal peritoneal thickening (or peritoneal thickening irregular) and omental enhancement cake like, nodular were seen more commonly in the group of patients with non-tuberculous exudative ascites.

Conclusion: Although the characteristics of peritoneal lesions were mostly found in the two groups of patients with exudative ascites, smooth peritoneal thickening, peritoneal micro nodules, lymph node necrosis and omental enhancement smudged pattern suggest PTB.