Ultrasonography for diagnosis of abdominal tuberculosis in HIV infected people

Abstract

Background & objectives: There is an increasing incidence of abdominal tuberculosis with the advent of HIV infection. This study was aimed at determining the pattern of presentation of abdominal tuberculosis on ultrasonography (USG) in HIV positive patients. Methods: This retrospective study was carried at the ART Centre, Sir Sunderlal Hospital, Banaras Hindu University, Varanasi, between March 2005 to July 2007. HIV positive patients (n=2453) with prolonged fever, abdominal pain/distension, altered bowel habits and diarrhoea underwent ultrasonography for tuberculosis of abdomen. The different ultrasonological findings in abdominal tuberculosis were noted. CD4 counts of these patients were also recorded. Results: Of the total 2453 patients, 244 showed findings suggestive of abdominal tuberculosis. Lymphadenopathy with predominantly hypoechoic/necrotic echotexture was seen in 158/244 (64.8%) patients. Splenomegaly was seen in 68 patients with 61 of them (89.7%) showing multiple hypoechoic lesions in the parenchyma. 53 of 244 (21.7%) showed extensive abdominal involvement. Liver enlargement was seen as a part of extensive abdominal involvement. A total of 203 patients completed antitubercular treatment, of which 198 (97.5%) showed resolution of lesions in USG. CD4 counts in patients with extensive abdominal involvement were lowest compared to CD4 count in patients with others USG findings. Interpretation & conclusion: Ultrasonological findings like lymphadenopathy (≥1.5 cm) with hypoechoeic/necrotic echotexture, hypoechoic splenic lesions and extensive abdominal involvement in HIV infected patients may be suggestive of abdominal tuberculosis.