Original articles

Abdominal and pericardial ultrasound in suspected extrapulmonary or disseminated tuberculosis

Maya Nathu Patel, Stephen Beningfield, Vanessa Burch

Abstract


Objective. Tuberculosis (TB) in patients with or without advanced HIV infection may present as smear-negative, extrapulmonary and/or disseminated forms. We studied the role of pericardial and abdominal ultrasound examinations in the determination of extrapulmonary or disseminated TB.

Methods. A prospective descriptive and analytic cross-sectional study design was used to determine the ultrasound findings of value in patients with subsequently proven TB. Ultrasound examinations were performed on 300 patients admitted to G F Jooste Hospital with suspected extrapulmonary or disseminated TB.

Outcome measures. The presence of hepatomegaly, splenomegaly, lymphadenopathy (location, size and appearance), ascites, pleural effusions, pericardial effusions and/or splenic micro-abscesses was noted. Clinical findings, microbiological and serological data were also recorded, correlated and analysed.

Results. Complete data sets were available for 267 patients; 91.0% were HIV positive, and 70.0% had World Health Organization clinical stage 4 disease. Active TB (determined by smear or culture) was present in 170 cases (63.7%). Ultrasonically visible abdominal lymphadenopathy over 1 cm in minimum diameter correlated with active TB in 55.3% of cases (odds ratio (OR) 2.6, 95% confidence interval (CI) 1.5 - 4.6, p=0.0002). Ultrasonographically detected pericardial effusions (OR 2.8, 95% CI 1.6 - 5.0, p<0.0001), ascites (OR 2.2, 95% CI 1.2 - 4.2, p=0.005) and splenic lesions (OR 1.9, 95% CI 1.0 - 3.5, p=0.024) also predicted active TB.

Conclusion. Pericardial and abdominal ultrasound examinations are valuable supplementary investigations in the diagnosis of suspected extrapulmonary or disseminated TB.

Authors' affiliations

Maya Nathu Patel,

Stephen Beningfield,

Vanessa Burch,

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Keywords

Smear-nagative tuberculosis; Ultrasound; Extrapulmonary tuberculosis; Disseminated tuberculosis: Aabdominal lymphadenopathy: Pericardial effusion

Cite this article

South African Medical Journal 2011;101(1):39-42.

Article History

Date submitted: 2010-04-18
Date published: 2011-01-06

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