RESUMO
Hepatic involvement by tuberculosis is a rare type of manifestation of the disease. There are several forms of clinical presentations. One of them is the hepatic tuberculoma in which we base our presentation. Given that hepatic tuberculoma is a rare entity and generally shows inespecific symptoms, it is rarely suspected by the clinical picture. The diagnosis of hepatic tuberculosis is generally done in the intraoperative or postoperative period by analyzing a specimen taken by laparoscopy or laparotomy during the study of a hepatic mass. Laboratory tests or image studies do not give pathognomonic information to conform the diagnosis. The cornerstone in the treatment of this pathology is the antituberculous therapy. Surgical or endoscopic interventions are occasionally required. The role of surgery in the treatment of this pathology is reserved for a few solitary lesions. Once the correct treatment is performed the outcome is favorable. We present 4 cases of hepatic tuberculoma with different imaging and clinical presentations.
Assuntos
Tuberculoma/diagnóstico , Tuberculose Hepática/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tuberculoma/cirurgia , Tuberculose Hepática/cirurgiaRESUMO
El compromiso hepático por tuberculosis es una manifestación poco frecuente de dicha enfermedad, pudiéndose manifestar clínicamente de diferentes formas. Una de ellas es el tuberculoma hepático, el cual motiva nuestra presentación. Dado a que el tuberculoma hepático es poco común y los enfermos se presentan generalmente con síntomas inespecíficos, la sospecha diagnóstica sólo con la clínica del enfermo es infrecuente. El diagnostico de tuberculosis hepática generalmente es intra o postquirúrgico mediante el análisis de la muestra realizada por medio de una laparotomía o laparoscopía en el estudio de una masa hepática. Asimismo, tanto en los análisis de laboratorio como en los estudios por imágenes no hay hallazgos patognomónicos de dicha patología. El pilar principal del tratamiento es la terapia antituberculosa. Ocasionalmente se requieren intervenciones quirúrgicas o endoscópicas. El papel de la cirurgía en el tratamiento se reserva para algunas lesiones solitarias. Una vez instaurando el tratamiento adecuado su prognóstico es favorable. Se comunican 4 casos de tuberculoma hepático con diversidad en cuanto a su presentación clínica e imagenológica.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Tuberculoma/diagnóstico , Tuberculose Hepática/diagnóstico , Tuberculoma/cirurgia , Tuberculose Hepática/cirurgiaRESUMO
El compromiso hepático por tuberculosis es una manifestación poco frecuente de dicha enfermedad, pudiéndose manifestar clínicamente de diferentes formas. Una de ellas es el tuberculoma hepático, el cual motiva nuestra presentación. Dado a que el tuberculoma hepático es poco común y los enfermos se presentan generalmente con síntomas inespecíficos, la sospecha diagnóstica sólo con la clínica del enfermo es infrecuente. El diagnostico de tuberculosis hepática generalmente es intra o postquirúrgico mediante el análisis de la muestra realizada por medio de una laparotomía o laparoscopía en el estudio de una masa hepática. Asimismo, tanto en los análisis de laboratorio como en los estudios por imágenes no hay hallazgos patognomónicos de dicha patología. El pilar principal del tratamiento es la terapia antituberculosa. Ocasionalmente se requieren intervenciones quirúrgicas o endoscópicas. El papel de la cirurgía en el tratamiento se reserva para algunas lesiones solitarias. Una vez instaurando el tratamiento adecuado su prognóstico es favorable. Se comunican 4 casos de tuberculoma hepático con diversidad en cuanto a su presentación clínica e imagenológica.(AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Tuberculoma/diagnóstico , Tuberculose Hepática/diagnóstico , Tuberculoma/cirurgia , Tuberculose Hepática/cirurgiaRESUMO
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
Assuntos
Humanos , Feminino , Adulto , Tuberculose Hepática/diagnóstico , Granuloma , Tuberculose Hepática/cirurgiaRESUMO
A presença de massa hepática de origem tuberculose émanifestaçao rara da tuberculose abdominal. No caso em telas, o diagnóstico pré-operatório foi de lesao abscedada de fígado. Como apresentava colecistite calculosa concomitante, foi submetido a videolaparoscopia diagnóstica e terapêutica de ambas as afecçoes. O fígado foi puncionado, drenado e biopsiado. No intra-operatório a suspeita foi de neoplasia infectada. O diagnóstico definitivo mostrou tratar-se de tuberculose hepática. Os sintomas desapareceram com o tratamento específico.
Assuntos
Humanos , Masculino , Adulto , Tuberculose Hepática/diagnóstico , Tuberculose Hepática/cirurgiaRESUMO
The nodular form of hepatic tuberculosis (TB) is a very uncommon disease characterized by coalescing tubercles to form tumour-like tuberculomas or abscesses without evidence of extrahepatic tuberculosis. Since 1950, 23 cases of isolated nodular TB in the liver have been reported in the world literature. In 19 of these cases laparotomy was performed and the correct diagnosis was obtained only on histologic examination. We report one additional case of multiple tuberculous abscesses which were initially diagnosed as hepatic abscesses and at intraoperative evaluation were thought to be a liver tumour. The diagnosis was made by histological examination with identification of acid-fast bacili.