Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

LETTER TO EDITOR
Year
: 1999  |  Volume : 9  |  Issue : 3  |  Page : 157--158

Isolated abdominal parietal cold abscess diagnosed on ultrasound


Anananda Moyee Dhar, Satish Bhargava, Sudhanshu Bankata 
 Department of Radiology & Imaging, University College of Medical Sciences and GTB Hospital, New Delhi, India

Correspondence Address:
Anananda Moyee Dhar
Department of Radiology & Imaging, University College of Medical Sciences and GTB Hospital, New Delhi
India




How to cite this article:
Dhar AM, Bhargava S, Bankata S. Isolated abdominal parietal cold abscess diagnosed on ultrasound.Indian J Radiol Imaging 1999;9:157-158


How to cite this URL:
Dhar AM, Bhargava S, Bankata S. Isolated abdominal parietal cold abscess diagnosed on ultrasound. Indian J Radiol Imaging [serial online] 1999 [cited 2019 Nov 16 ];9:157-158
Available from: http://www.ijri.org/text.asp?1999/9/3/157/28330


Full Text

Sir,

Tuberculosis is a rampant disease in developing countries and with the rapid spread of AIDS it has made inroads into the developed nations as well. The common organs of involvement are the lungs, kidneys, bones and gastrointestinal tract. The difference in the number and virulence of bacilli, the routes of infection and the host's immune status determine the varied manifestations seen in tuberculosis. There are only limited case reports of isolated tuberculous involvement of the parietes [1]

Reports do mention tuberculous abscesses at a site distant from the lung primary without communication [2]. Parietal tuberculous abscesses usually develop secondary to an embolus of tuberculous organisms from the pulmonary focus, by direct inoculation or extension from an underlying lymphadenitis/synovitis/osteomyeliti [3]. The following case illustrates the US appearances of a tuberculous abdominal wall abscess without pulmonary, skeletal or gastrointestinal tuberculosis.

An eight-years old boy presented with a slowly progressive, palpable swelling in the abdomen in the umbilical region on the right side. No history of preceding trauma or any associated fever could be elicited. The US study revealed a 3.7 x 5.2 cms abdominal parietal wall mass (predominantly cystic) of mixed echogenicity, with irregular walls and a liquefied, necrotic center [Figure 1]. There was evidence of posterior acoustic enhancement with focal areas of calcification within the lesion. US-guided aspiration followed by cytological examination was performed and revealed tuberculous granulomas with areas of caseous necrosis.

The patient was evaluated for concomitant tuberculosis of the lungs, spine and bowel with the help of relevant radiographs, bone scan and barium studies. All tests performed to establish a primary tuberculous focus were negative. Tests carried out for HIV infection were also negative. The patient was started on anti-tuberculous drugs and resolution of the swelling was observed both clinically and on ultrasound.

This case cautions the ultrasonologist that the possibility of tuberculosis cannot be ruled out when considering the differential diagnosis of any lesion even in unlikely anatomical regions.

References

1Taylor RH, McNicol MW. Ultrasound in the diagnosis of two unusual tuberculous abscesses. Br J Surg 1980; 67: 556.
2Kleid JJ, Rosenberg RF. Pulmonary tuberculosis with noncommunicating chest wall abscess. NY State J Medical 1970; 70: 2993-2995.
3Chen CH, Shih JF, Wang LS, Perng RP. Tuberculous subcutaneous abscess: an analysis of seven cases. Tuber Lung Dis 1996; 77: 184-187.