Hepatobiliary tuberculosis

Chong VH, Lim KS
Correspondence: Dr Vui Heng Chong, chongvuih@yahoo.co.uk

ABSTRACT
Tuberculosis (TB) infection is still common today and remains an important cause of morbidity and mortality. Abdominal TB is one of the most prevalent forms of extra-pulmonary manifestations, and collectively refers to gastrointestinal, splenic, pancreatic, hepatobiliary and abdominal lymphadenopathy involvement. The manifestation can be nonspecific, and mimics many conditions, including malignancies. Biliary involvement is extremely rare. It can directly involve or be a result of external compressions or extension from adjacent organs. Strictures can be simple or multiple and isolated or complex. Radiologically, it is difficult to exclude cholangiocarcinoma. Hepatic involvement is more common and is categorised as the miliary or isolated local type. Both can be further sub-divided into nodular or diffuse forms. The manifestations range from abscesses and tuberculomas to hepatic calcifications. Calcifications range from small isolated specks to gross calcification with or without hepatic atrophy.
The diagnosis of hepatobiliary TB (HBTB) can be difficult. Ultrasonography and computed tomography are the main radiological investigations. Endoscopic retrograde cholangiography is important in the management of biliary TB. It is often important to look for the involvement of other organs and consider the coexistence of other pathologies such as malignancies. This pictorial essay reviews some of the HBTB infections that have been encountered in our tertiary referral centre.

Keywords: bile ducts, diagnostic imaging, endoscopy, hepatic tuberculosis, strictures, tuberculoma, tuberculosis
Singapore Med J 2010; 51(9): 744-751