[Radiological aspects of hepatic tuberculoma. 3 cases]

Localized macronodular tuberculosis of the liver is rare. Tuberculous involvement of the liver is usually a diffuse process. We report 3 cases in which clinical and imaging features suggested the diagnosis of macronodular hepatic tuberculoma which was pathologically confirmed by percutaneous biopsy. In the first case, abdominal CT-scan showed a noncalcified hypodense nodular lesion in segment IV of the liver with an enhancing peripheral rim. In the second case, ultrasound showed 4 homogenous hypoechoic hepatic nodules. In the third case, a nodule was incidentally identified in segment VII of the liver. The lesion was hypoechoic with ultrasound, hypodense without enhancement on CT-scan, and hyperintense on both T1- and T2-weighted MR imaging. After percutaneous biopsy, pathologic examination showed peripheral granulomous lesions in all patients with central caseous necrosis consistent with tuberculosis in two patients despite a negative for Zielh stain. Specific M. tuberculosis culture was positive in the first patient, negative in the second patient, and was not performed in the third patient. Appropriate treatment resulted in disappearance of hepatic lesions on follow-up imaging examinations. These 3 cases show that clinical and imaging features of hepatic tuberculoma are not specific and that percutaneous biopsy of lesions provides a definite diagnosis.