Liver tuberculosis

Hepatic

tuberculosis: a multimodality imaging review. A 27-year-old man with fever, anorexia and isolated hepatic involvement. a Ultrasound shows an ill-defined heterogeneous area in the right lobe with a few well-defined hypoechoic areas (arrows) suggestive of liquefaction. b, c Arterial and portal venous phase reveals a well-circumscribed enhancing mass composed of multiple tiny abscesses. Vessels can be seen coursing through the lesion without being attenuated or infiltrated. d Magnified view shows tiny abscesses in a large complex mass giving a ‘cluster’ appearance

Hepatic

tuberculosis: a multimodality imaging review. Axial T2-weighted MRI displaying an ill-defined heterogeneous area (short arrows) in the right lobe of liver corresponding to granulomatous infiltration, which extends into the periportal location, resulting in central biliary radical dilatation (dotted arrows) with concurrent multiple hypointense splenic nodules (arrows) in a patient with hepatobiliary tuberculosis

Hepatic

tuberculosis: a multimodality imaging review. a, b Contrast-enhanced CT shows an ill-defined mass in the periportal location (short, thin arrows) with associated rather marked thickening of the extrahepatic common duct (short, thick arrow). Extensive calcifications can be seen along the biliary radicals (black arrows). c Concurrent hypodense liver lesions either granulomas or cholangitic abscesses (dotted arrows). d Associated large retroperitoneal nodal mass (asterisk) is visualised

Hepatic

tuberculosis: a multimodality imaging review. A 28-year-old man a known case of disseminated tuberculosis presenting with jaundice. a, b Ultrasound shows multiple areas of linear and miliary calcifications (arrow) in both lobes of liver. c Colour Doppler image shows dilated biliary radical with peripheral wall calcification. d Additionally, there is a well-defined small hypoechoic parenchymal lesion likely of a granuloma (short arrow)

Hepatic

tuberculosis: a multimodality imaging review. Coronal-oblique and coronal CT images in a patient with tubercular cholangitis displaying thickening and stricture of the extrahepatic common duct (arrows) with upstream intrahepatic biliary dilatation. The presence of hepatic calcifications (dotted arrows) help exclude cholangiocarcinoma and instead consider tuberculosis in appropriate clinical settings

Hepatic

tuberculosis: a multimodality imaging review. A 53-year-old man with fever and weight loss. a, b Axial contrast-enhanced CT showing peripherally located conglomerated hypodense lesions (white arrows) contiguously extending along the subcapsular plane of the right lobe, caudate lobe and on either side of the falciform ligament. The overlying thickened enhancing capsule simulates ‘sugar coating’. There is associated bulky necrotic gastrohepatic and retroperitoneal adenopathy (black arrows). c, d Low- and high-power miscroscopy reveal focally preserved liver tissue (arrowhead) intermixed with areas of caseous necrosis (asterisk)

Hepatic

tuberculosis: a multimodality imaging review. A 35-year-old man previously treated for pulmonary tuberculosis now presenting with elevated alkaline phosphatase. a, b Axial contrast-enhanced CT reveals chunky calcified nodular lesion in the segment VII of right lobe (arrow) with adjacent biliary radical dilatation (dotted arrow). b, c Axial T1- and T2-weighted MRI shows the corresponding lesion to be hypointense on T1 (thick arrow) and isointense to liver parenchyma on T2-weighted sequence. e, f Axial T2-weighted MRI reveals focal biliary radical dilatation (paired arrows), which is very well depicted on the MRCP image (short arrow)

Hepatic

tuberculosis: a multimodality imaging review. A 22-year-old man with features of hepatic failure. a Ultrasound shows a heterogeneously hypoechoic mass (arrows) in the right liver lobe. b Plain CT image shows dense calcification along the interlobar fissure with non-visualisation of the left lobe. c, d On arterial images, the lesion depicts arterial enhancement and central necrosis whilst it appears hypodense in the portal venous phase thus simulating a hepatocellular carcinoma. e Caudal sections reveal attenuated and thrombosed left portal branch (arrow) and normal appearing right and main portal branch. f Core biopsy specimen shows few hepatocytes and extensive caseous necrosis (asterisk)

Hepatic

tuberculosis: a multimodality imaging review. A 45-year-old man with right upper quadrant pain and fever. a, b Axial portal venous phase CT shows a hypodense lesion in the right lobe causing focal contour bulge and capsular thickening (arrow) with an associated organised collection in the perihepatic space (arrowhead). This was a patient with isolated hepatic tuberculosis with contained rupture of the tubercular liver abscess