Pancreatic Tuberculosis: A Computed Tomography Imaging Review of Thirteen Cases

Abstract Background Pancreatic tuberculosis (PT) is an enigma for doctors, as it mimics other disorders of the pancreas. The purpose of this article is to review the spectrum of CT images of PT so that radiologists can, in an appropriate setting, ensure timely diagnosis to facilitate optimal treatment. Methods We retrospectively analyzed patients who had been diagnosed with PT in our unit over the previous 14 years. Their clinical and imaging findings, with an emphasis on CT, were retrieved. CT findings were evaluated with reference to 10 features, including size, location, components, etc. Results The pancreatic head was most frequently involved. PT can appear as one or more heterogeneous hypoattenuating masses of variable size that show multiple enhancing walls or septa. In most cases, the main pancreatic duct (MPD) was normal in size. Biliary system dilatation and parenchymal calcifications were not present. Centrally necrotic peripancreatic nodes and vascular invasion were not uncommon. On dynamic CECT, the dynamically enhanced process of the lesions could be displayed as mild to moderate that gradually developed into intense cystic wall or solid area enhancement upon time delay after contrast injection. Conclusion Diagnosis of PT is challenging, due to typically vague clinical symptoms and misleading imaging results. The use of dynamic enhanced CT scanning demonstrates its diagnostic value to differentiate PT and other neoplastic processes. Recognition of the wide spectrum of CT findings of PT (such as the absence of biliary system dilatation and parenchymal calcification), especially when a combination of findings is present, is highly suggestive of the diagnosis in the appropriate clinical setting.