Ultrasound diagnosis of "dry type" ileocecal tuberculosis: a case report

Abdominal tuberculosis is a common curable disease in third world countries. CT is the most sensitive imaging technique. The purpose of this paper is to report the ultrasound diagnosis of a missed dry type ileocecal tuberculosis. A 40 year old patient was admitted to hospital for loin pain and was discharged following negative ultrasound and IVU tests. Symptoms recurred and a barium enema, follow through and abdominal CT were conducted. Barium studies were non specific and CT was normal. Sigmoidoscopy was negative for inflammatory bowel disease. A second ultrasound indicated a "coned" cecum with edematous and dilated terminal ileum. A diagnosis of tuberculosis was suggested. Colonoscopy showed typical lesions in the cecum with nodular terminal ileum. Biopsies were supportive of a tuberculosis diagnosis. In conclusion, an ultrasound with a high index of clinical suspicion is a useful test for the diagnosis of ileocecal tuberculosis. The coned contracted cecum with a dilated edematous terminal ileum are important diagnostic signs.