Look in four places — the peritoneum (ascites, omental and mesenteric thickening), the nodes (necrotic, matted), the ileocaecal region (thickening, a contracted caecum) and solid organs — and remember Crohn disease and peritoneal carcinomatosis are the mimics.
Orient first
- Abdominal tuberculosis is common in India and presents with pain, fever, weight loss, ascites or subacute obstruction.
- Ileocaecal disease is the classic site: symmetric or asymmetric wall thickening of the terminal ileum and caecum, a contracted, pulled-up caecum and an open, gaping ileocaecal valve.
- Peritoneal tuberculosis may be wet (free or loculated high-attenuation ascites), fibrotic (omental caking, matted loops) or dry (nodules, adhesions); mesenteric nodes often show central necrosis with rim enhancement.
Acquire the study
- Portal venous phase CT with neutral or positive oral contrast; coronal reformats.
The manoeuvre
- Ileocaecal region on coronal reformats: wall thickening in mm, caecal contraction, the ileocaecal valve.
- Nodes: mesenteric and peripancreatic, central low attenuation with rim enhancement, calcification.
- Peritoneum: ascites attenuation in HU, smooth peritoneal thickening, omental caking, mesenteric stranding.
- Strictures and obstruction: the transition point and the number of strictures.
- Solid organs and the chest bases: splenic or hepatic microabscesses, basal lung or pleural disease.
What confirms it
- A combination of ileocaecal thickening, necrotic nodes and peritoneal disease supporting tuberculosis — tissue or fluid confirms.
What licenses you to exclude it
- A normal CT makes significant abdominal tuberculosis unlikely but does not exclude early peritoneal disease.
The classic misread
- Calling tuberculosis Crohn disease (skip lesions, fibrofatty proliferation, the comb sign) or carcinomatosis (nodular irregular peritoneum) without weighing the pattern.