ORIGINAL RESEARCH
Transabdominal ultrasound as a screening stage for the diagnosis of tuberculous peritonitis
1 Moscow Research and Clinical Center for TB Control, Moscow, Russia
2 Pirogov Russian National Research Medical University, Moscow, Russia
3 The Loginov Moscow Clinical Scientific Center, Moscow, Russia
Correspondence should be addressed: Dmitry Vladimirovich Plotkin
Ostrovitianova, 1, Moscow, 117997; ur.tsil@31nk
Compliance with ethical standards: the study was approved by the Ethics Committee of the Moscow Research and Clinical Center for TB Control (protocol №.12 dated December 9, 2019). The informed consent was submitted by all study participants.
Author contribution: Plotkin DV, Reshetnikov MN, Nikanorov AV, Sinitsyn MV — study concept and design, overall management; Kirillova OV, Shtykhno АО, Loshkareva EO — sample collection; Korotkova ES, Plotkin DV — statistical analysis; Plotkin DV, Reshetnikov MN, Kirillova OV, Nikanorov AV — data analysis; Plotkin DV, Reshetnikov MN — manuscript writing; Kirillova OV, Shtykhno АО, Nikanorov AV — editing. Compliance with ethical standards: the study was approved by the Ethics Committee of the Moscow Research and Clinical Center for TB Control (protocol №.12 dated December 9, 2019). The informed consent was submitted by all study participants.
In recent years, the incidence of tuberculous peritonitis increased. Peritoneal tuberculosis is difficult to diagnose, and often the diagnosis is verified with significant delay. In clinical practice, a quick and affordable diagnostic radiology method, ultrasonography (USG), is proposed for patients with suspected tuberculous peritonitis. The study was aimed to describe the sonographic semiology of tuberculous peritonitis, to create the integrated scale for the individual peritoneal tuberculosis sonographic symptoms significance assessment, and to determine the role of ultrasound imaging in the diagnosis verification. Retrospective study of the invasive and ultrasound investigation results of 37 patients with confirmed tuberculous peritonitis was carried out in 2009–2019. Similar data obtained by investigation of 28 patients with the disorders which often mimic the tuberculous peritonitis (peritoneal carcinomatosis and sarcoidosis, non-specific ascites) were used as a comparison group. Direct and indirect signs of peritoneal lesion in patients with tuberculosis were identified. On the basis of that, an integral scale for the individual sonographic symptoms significance assessment was created. Each sonographic symptom received a 0–3 score. Assessment of those sonographic signs visualization allowed us to evaluate the probability of the disorder’s tuberculous etiology. The following data were obtained: score under 4 corresponded to low probability, score 5–8 corresponded to medium probability, and score over 9 corresponded to high probability of tuberculous peritonitis based on the visualization of all described songraphic symptoms. The proposed integrated scale for the sonographic signs assessment allows the clinician to verify the tuberculous peritonitis diagnosis based on the ultrasound imaging data or to select the further tactics of diagnosis.
Keywords: peritonitis, ultrasonography, peritoneal tuberculosis, carcinomatosis, sarcoidosis