• Contiguous spread
• Disseminated Tuberculosis
• Hepatic Tuberculosis
• Hepatic abscess
• Mycobacterium tuberculosis
• Subligamentous spread

• extrapulmonary tuberculosis
• genexpert in hepatic abscess
• hepatic tuberculosis
• isolated tubercular liver abscess
• mixed infection pyogenic and tubercular liver abscess

• hepatic tuberculosis
• target ring sign
• tuberculoma
• tuberculosis
• weight loss

• Carcinoma, hepatocellular
• Tuberculosis
• Tuberculosis, hepatic

• extrapulmonary tuberculosis (eptb)
• hepatic abscess
• isoniazid resistance
• liver abscess aspiration
• tubercular abscess

• Cholangiocarcinoma
• Hepatic tuberculosis
• Intestinal tuberculosis

• Diffusion-weighted MRI
• Gastrointestinal
• Lymph node
• Tuberculosis

• Abdomen/diagnostic imaging
• Diffusion Magnetic Resonance Imaging/methods
• Humans
• Lymphadenopathy
• Magnetic Resonance Imaging/methods
• Sensitivity and Specificity
• Tuberculosis

• Capsular retraction
• Caseation necrosis
• Cholangiocarcinoma
• Hepatic metastasis
• Hepatic tuberculosis
• Langhan’s giant cells
• Masquerader
• Tumor markers

• infection (gastroenterology)
• infections
• paediatrics
• public health

• Child
• Child, Preschool
• Female
• Granuloma
• Humans
• Splenic Diseases/diagnostic imaging
• Splenic Diseases/drug therapy
• Tuberculin Test
• Tuberculosis/diagnosis
• Tuberculosis/drug therapy
• Ultrasonography

We report a case of an adult female with pulmonary tuberculosis who had biochemical evidence of liver injury during the presentation manifested as raised transaminases, but without clinically obvious pre-existing liver disease nor a history of hepatotoxic drug use. This is a fairly common scenario seen in tuberculosis endemic areas; however, this is an under reported condition in the literature and guidelines for its management has not been established. Many clinicians including the authors have treated such cases with modified liver friendly regimens in fear of increasing the hepatotoxicity with standard antitubercular drugs. However, the modified regimens may not be optimal in treating the underlying tuberculosis. In this report, we gave full dose standard drugs, and the liver injury resolved as evidenced by normalization of transaminases. Further research is required in this regard, but the presence of transaminitis with no obvious common underlying etiology may not warrant a modification of standard antitubercular regimen.

• liver friendly regimen
• standard ATT
• transaminitis
• tuberculosis

• contrast-enhanced ultrasonography
• hepatic
• hepatocellular carcinoma
• magnetic resonance imaging
• tuberculosis

• Carcinoma, Hepatocellular/diagnostic imaging
• Contrast Media
• Diagnosis, Differential
• Hepatectomy
• Humans
• Liver Neoplasms/diagnostic imaging
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Tuberculosis, Hepatic/diagnostic imaging
• Tuberculosis, Hepatic/surgery
• Ultrasonography

A 54-year-old woman presented with an incidentally identified asymptomatic liver lesion with imaging characteristics suspicious for malignancy. She underwent a left hemihepatectomy for presumed cholangiocarcinoma. Histopathology revealed granulomas with microbiological investigations later revealing a diagnosis of isolated hepatic tuberculosis. There were no pulmonary or other disease sites identified. The patient has been medically managed for primary hepatic tuberculosis and remains well postoperatively. This case identifies a rare differential for a liver mass that needs to be considered in the clinicians’ workup.

• cholangiocarcinoma
• hemihepatectomy
• primary hepatic tuberculosis

• alcoholic liver disease
• liver disease
• nonalcoholic steatosis

• Adult
• Antitubercular Agents/therapeutic use
• Biopsy
• Diabetes Mellitus, Type 2
• Diagnosis, Differential
• Humans
• Immunocompromised Host
• Male
• Metabolic Syndrome
• Tuberculosis, Hepatic/diagnosis
• Tuberculosis, Hepatic/drug therapy

Primary hepatic tuberculosis is a rare entity and can closely mimic malignancy with respect to clinical presentation and imaging features. We identified five patients at a high volume tertiary care cancer center, whose clinical features and imaging closely mimicked primary liver malignancy or metastases but final histopathology was suggestive of hepatic tuberculosis. Three patients underwent a surgical resection whereas two were diagnosed on a biopsy. Anti-tuberculosis therapy was started for all the patients which was well tolerated. All patients are doing well at the time of the last follow up. This case series stresses the importance of having a high index of suspicion and preoperative biopsy in cases where imaging features are equivocal.

• Malignancy
• Mimic
• Primary hepatic tuberculosis

• hepatitis and other GI infections
• infectious diseases

• Langhans type giant cells
• Miliary tuberculosis

• Children
• Extrapulmonary tuberculosis
• Imaging
• Tuberculosis

• Child
• Diagnostic Imaging
• Humans
• Tuberculosis/diagnostic imaging
• Tuberculosis, Central Nervous System/diagnostic imaging
• Tuberculosis, Gastrointestinal/diagnostic imaging
• Tuberculosis, Hepatic/diagnostic imaging
• Tuberculosis, Lymph Node/diagnostic imaging
• Tuberculosis, Osteoarticular/diagnostic imaging
• Tuberculosis, Renal/diagnostic imaging

Tuberculosis is a major re-emerging global health concern. The disease may involve any body system and is a great mimicker of various pathologies owing to its non-specific imaging findings. Herein we report an extremely rare case of atypical tuberculosis of the liver in a young female with complaints of abdominal pain and haematemesis for 10 weeks. Isolated hepatic tuberculosis is a rare entity with < 100 cases reported in the literature. It is therefore important to have a high index of suspicion and be familiar with the atypical imaging findings of abdominal tuberculosis. This discussion highlights the clinical presentation, imaging findings and types of hepatic involvement in tuberculosis.

• Abdominal wall abscess
• Acid fast bacilli
• BACTEC MGIT 960
• Tubercular liver abscess

• Aged
• Contrast Media/metabolism
• Disease Progression
• Gadolinium DTPA/metabolism
• Hepatectomy/methods
• Humans
• Magnetic Resonance Imaging
• Male
• Treatment Outcome
• Tuberculosis, Hepatic/pathology
• Tuberculosis, Hepatic/physiopathology
• Tuberculosis, Hepatic/surgery

While hepatic tuberculosis is rare, primary tubercular liver abscess (TLA) is a rarer condition even in endemic countries such as India. Liver abscess in portal cavernoma cholangiopathy (PCC) is predominantly pyogenic. A 14-year-old girl was found to have PCC with multiple liver abscesses. Persistent fever and development of neurological symptoms prompted further evaluation, and she was found to have primary TLA complicated by tubercular meningitis. We report a rare case of primary TLA complicated by tubercular meningitis in asymptomatic PCC.

• CT
• Hepatic tuberculosis
• Miliary
• Nodular
• Tubercular cholangitis, MRI

Primary involvement of liver in tuberculosis is a rare entity. It is difficult to diagnose in absence of previous history of tuberculosis or concurrent pulmonary involvement. It is usually misdiagnosed as neoplastic liver lesion, which misdirects the treatment protocol and delays proper treatment. Here we are presenting a case of 36-year-old male patient with vague right upper quadrant abdominal pain. All the laboratory values were within normal limits. Radiological investigations were in favor of biliary cystadenoma but final diagnosis was primary focal involvement of liver in tuberculosis which was histopathologically proven to be tuberculous granulomas on biopsy of the resected mass.

Hepatic tuberculosis (TB) is usually associated with pulmonary or miliary TB, but primary hepatic TB is very uncommon even in countries with high prevalence of TB. The clinical manifestation of primary hepatic TB is atypical and imaging modalities are unhelpful for differential diagnosis of the liver mass. Image-guided needle biopsy is the best diagnostic method for primary hepatic TB. In the cases presented here, we did not perform liver biopsy because we believed the liver masses were cholangiocarcinoma, but primary hepatic TB was ultimately confirmed by postoperative pathology. Here we report two cases of patients who were diagnosed with primary hepatic TB mimicking mass-forming intrahepatic cholangiocarcinoma.

• Cholangiocarcinoma
• Hepatectomy
• Tuberculosis

Mycobacterium tuberculosis (TB) infection of the liver, known as hepatic TB, is an extrapulmonary manifestation of TB. Hepatic TB has become more prevalent, likely as a result of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. We sought to review case series to characterize the epidemiology, pathophysiology, clinical features, diagnosis, and treatment of hepatic TB and to comment on the impact of HIV co-infection on these characteristics.

We conducted a systematic literature search in PubMed and ScienceDirect for articles pertaining to hepatic TB with human subjects from 1960 to July 2013.

We obtained data on 618 hepatic TB patients from 14 case series. The most common reported signs and symptoms were hepatomegaly (median: 80%, range: 10-100%), fever (median: 67%, range: 30–100), respiratory symptoms (median: 66%, range: 32-78%), abdominal pain (median: 59.5%, range: 40-83%), and weight loss (median: 57.5%, range: 20-100%). Common laboratory abnormalities were elevated alkaline phosphatase and gamma-glutamyl transferase. Ultrasound and computerized tomography (CT) were sensitive but non-specific. On liver biopsy, smear microscopy for acid-fast bacilli had a median sensitivity of 25% (range: 0-59%), histology of caseating granulomas had a median sensitivity of 68% (range: 14-100%), and polymerase chain reaction for TB had a median sensitivity of 86% (range: 30-100%). Standard anti-tuberculous chemotherapy for 6 to 12 months achieved positive outcomes for nearly all patients with drug-susceptible TB.

Clinicians in TB-endemic regions should maintain a high index of suspicion for hepatic TB in patients presenting with hepatomegaly, fever, respiratory symptoms, and elevated liver enzymes. The most sensitive imaging modality is a CT scan, while the most specific diagnostic modality is a liver biopsy with nucleic acid testing of liver tissue samples. Upon diagnosis, 4-drug anti-TB therapy should promptly be initiated. HIV co-infected patients may have more complex cases and should be closely monitored for complications.

Finding of focal 18F-fluoro-deoxyglucose (FDG) uptake in liver on FDG positron emission tomography/computed tomography (FDG PET/CT) in a known case of malignancy is often considered to be metastases. We report a similar finding on FDG PET/CT in a case of Ewing's sarcoma of thigh, which turned out to be of tuberculous etiology, an unusual cause of false positive FDG uptake in the liver.

• 18F-fluoro-deoxyglucose
• focal uptake
• liver
• metastases
• tuberculosis

Abdominal tuberculosis is a common clinical entity in Indian subcontinent; however, hepatic tuberculosis in the absence of miliary abdominal tuberculosis is restricted to the case reports and small case series in English literature. It mimics common liver diseases like liver abscess and tumors. We report a case of 25-year-old immunocompetent female who presented with features of acute liver failure. Ultrasonography (USG) abdomen revealed multiple hypoechoic lesions. However, patient expired within 48 h of presentation but her liver autopsy revealed multiple epithelioid cell caseating granulomas with positive staining for acid fast bacilli (AFB). Polymerase chain reaction (PCR) was also positive for Mycobacterium tuberculosis.

• Focal liver tuberculosis
• Granulomatous inflammation

• Uremia
• hemodialysis
• hepatic tuberculosis

There is an increasing incidence of both intra- and extra-thoracic manifestations of tuberculosis, in part due to the AIDS epidemic. Isolated tubercular involvement of the solid abdominal viscera is relatively unusual. Cross-sectional imaging with ultrasound, multidetector computed tomography (CT), and magnetic resonance imaging (MRI) plays an important role in the diagnosis and post treatment follow-up of tuberculosis. Specific imaging features of tuberculosis are frequently related to caseous necrosis, which is the hallmark of this disease. However, depending on the type of solid organ involvement, tubercular lesions can mimic a variety of neoplastic and nonneoplastic conditions. Often, cross-sectional imaging alone is insufficient in reaching a conclusive diagnosis, and image-guided tissue sampling is needed. In this article, we review the pathology and cross-sectional imaging features of tubercular involvement of solid abdominopelvic organs with a special emphasis on appropriate differential diagnoses.

• Abdomen
• computed tomography
• magnetic resonance imaging
• tuberculosis

• Adult
• Diagnosis, Differential
• Humans
• Male
• Mycobacterium tuberculosis/genetics
• Polymerase Chain Reaction
• Tomography, X-Ray Computed
• Tuberculosis, Hepatic/diagnostic imaging
• Ultrasonography