Resumo
Tuberculous involvement of the liver is usually a diffuse process, associated with miliary tuberculosis. However localized tuberculosis of the liver producing a macronodular tuberculoma or an abscess is rare. The authors present a case of pseudotumoral hepatic tuberculosis in a 34-year old woman. This patient presented a 2 month history of fever weight loss of 4Kg and right upper quadrant abdominal pain. She denied jaundice, choluria, or acholia. Laboratory investigation, including renal and liver function tests. revealed normal levels. Chest X-ray was normal. Abdominal ultrasonography demonstrated a hypoechoic nodule in the right hepatic lobe. CT scan showed hypodense areas in the same place and no retroperitoneal lymphadenopathy. Due to the inespecificity of the signs, symptoms and image findings, a diagnostic laparoscopy was performed, it was however inconclusive. Then, the patient was submitted to a laparotomy with ressection of the lesion. Histological examination revealed a tuberculoid granulomatous lesion with caseous necrosis. Postoperatively, the patient was placed on antituberculous chemotherapy with rifampin, isoniazid and pyrazinamide. Eight months later the patient is asymptomatic.
Hepatic tuberculosis; Pseudotumoral hepatic tuberculosis; Tuberculoid granuloma
Hepatic tuberculosis; Pseudotumoral hepatic tuberculosis; Tuberculoid granuloma
RELATOS DE CASOS
Tuberculose hepática pseudotumoral
Pseudotumoral hepatic tuberculosis
Antonio Nocchi Kalil, TCBC-RSI; Fernanda Alvarez CoelhoII; Gislaine Silveira OlmII
IProfessor Adjunto, Doutor do Departamento de Cirurgia Geral da FFFCMPA e do Complexo Hospitalar Santa Casa de Porto Alegre
IIAcadêmica da FFFCMPA
Endereço para correspondência Endereço para correspondência: Dr. Antônio Nocchi Kalil Rua Marcelo Gama, 924/201 90540-041- Porto Alegre-RS
ABSTRACT
Tuberculous involvement of the liver is usually a diffuse process, associated with miliary tuberculosis. However localized tuberculosis of the liver producing a macronodular tuberculoma or an abscess is rare. The authors present a case of pseudotumoral hepatic tuberculosis in a 34-year old woman. This patient presented a 2 month history of fever weight loss of 4Kg and right upper quadrant abdominal pain. She denied jaundice, choluria, or acholia. Laboratory investigation, including renal and liver function tests. revealed normal levels. Chest X-ray was normal. Abdominal ultrasonography demonstrated a hypoechoic nodule in the right hepatic lobe. CT scan showed hypodense areas in the same place and no retroperitoneal lymphadenopathy. Due to the inespecificity of the signs, symptoms and image findings, a diagnostic laparoscopy was performed, it was however inconclusive. Then, the patient was submitted to a laparotomy with ressection of the lesion. Histological examination revealed a tuberculoid granulomatous lesion with caseous necrosis. Postoperatively, the patient was placed on antituberculous chemotherapy with rifampin, isoniazid and pyrazinamide. Eight months later the patient is asymptomatic.
Key words: Hepatic tuberculosis; Pseudotumoral hepatic tuberculosis; Tuberculoid granuloma.
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Recebido em 3/12/98
Aceito para publicação em 19/4/99
Trabalho realizado no Departamento de Cirurgia da Fundação Faculdade Federal de Ciências Médicas de Porto Alegre (FFFCMPA) e Complexo Hospitalar Santa Casa de Porto Alegre-RS.
- 1. Tan TCF, Cheung AYC. Wan WYL, Chen TC. Tuberculoma of the liver presenting as a hyperechoic mass on ultrasound. Br J Radiol 1997;70:1.293-5.
- 2. Oliva A, Duarte B, Jonasson O, Nadimpalli V. The nodular form of local hepatic tuberculosis. J Clin Gastroenterol 1990; 12: 166-73.
- 3. Levine C. Primary macronodular hepatic tuberculosis: US and CT appearances. Gastroint Radiol 1990;15:307-9.
- 4. Achem SR, Kolts BE, Grisnik J, et al. Pseudotumoral hepatic tuberculosis: atypical presentation and comprehensive review of the literature. Clin Gastroenterol 1992; 14:72-7.
- 5. Herman P, Pugliese V, Neto RL, et al. Nodular form of local hepatic tuberculosis: case reporto J Trop Med Hyg 1995;98:141-2.
Datas de Publicação
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Publicação nesta coleção
27 Jan 2010 -
Data do Fascículo
Jun 1999
Histórico
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Aceito
19 Abr 1999 -
Recebido
03 Dez 1998
