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Background Computed tomography (CT)-guided biopsy is emerging as a preferred method for obtaining tissue samples from retroperitoneal lesions due to clear visualization of needle and vessels. Purpose To assess diagnostic yield and safety of CT-guided biopsy of retroperitoneal lesions and compare CT findings in different disease categories. Material and Methods This retrospective analytical study included 86 patients with retroperitoneal lesions who underwent CT-guided biopsy from December 2010 to March 2020. All procedures were performed with co-axial technique and multiple cores were obtained and subjected to histopathology. Additional tests like immunohistochemistry or microbiological analysis were done depending on clinical suspicion. Diagnostic yield calculation and comparison of imaging findings was done by one-way ANOVA, chi-square, and Fisher’s exact tests. Results CT-guided biopsy was technically successful in all cases with a diagnostic yield of 91.9%. Minor complications in the form of small hematomas were seen in two patients. Major disease categories on final diagnosis were lymphoma, tuberculosis, and metastases. A variety of malignant and benign soft-tissue neoplasms were also noted less commonly. With help of immunohistochemistry, lymphoma subtype was established in 88.8% of cases. Addition of microbiological tests like the GeneXpert assay helped in the diagnosis of tuberculosis in some cases. A mass-like appearance and vascular encasement was common in metastatic group and lymphoma. Conclusion Percutaneous CT-guided biopsy is a safe method for the sampling of retroperitoneal lesions with high diagnostic yield. Imaging findings are mostly overlapping; however, some features are more common in a particular disease condition.

Diagnosing tuberculous peritonitis can be challenging, with mycobacterial culture potentially taking weeks for a positive result. This report describes 2 cases where a prompt diagnosis of tuberculous peritonitis was made employing the Xpert MTB/RIF assay (Cepheid Inc., Sunnyvale, CA, USA).

Purpose: to assess the accuracy and clinical usefulness of CT-guided core-needle biopsy in the diagnosis of omental pathology Material and Methods: We retrospectively reviewed the results of CT-guided percutaneous core biopsies in 25 patients with focal (n=2) or diffuse (n=23) omental pathology. These results were compared to the final diagnoses as determined by laparotomy (n=15), laparoscopic biopsy (n=3), endoscopic biopsy (n=1), or by the results of percutaneous biopsy and clinical-radiological and bacteriological modalities (n=6). the final diagnoses showed 4 patients with isolated omental pathology and 21 with widespread peritoneal involvement. the CT-guided biopsies were performed with 1.0–1.8-mm Surecut core-needles Results: in 16 patients, the final diagnosis was metastatic adenocarcinoma - with the primary tumor sites in the ovary (n=3), stomach (n=1), appendix (n=2), and unknown (n=10). in the remaining 9 patients, the final diagnosis was hepatocellular carcinoma, lymphoma, and mesothelioma in 1 patient each; tuberculosis in 5; and actinomycosis in 1. Sufficient histological (n=16) or cytological (n=8) material was obtained by CT biopsy in 24/25 (96%) cases; the specimen was insufficient for diagnosis in 1 case. in differentiating benign from malignant disease, CT-guided biopsy showed a sensitivity, specificity and accuracy of respectively 89.5%, 100% and 92%. It gave a specific diagnosis in 78.9% (15/19) of patients with malignant conditions and in 50% (3/6) of patients with benign disorders. There were no biopsy-related complications Conclusion: CT-guided percutaneous core-needle biopsy of the omentum is a safe, useful and highly accurate procedure for diagnosing malignant omental pathology

Among 155 patients who were initiated on continuous ambulatory peritoneal dialysis (CAPD), 4 patients (2 men, 2 women) developed tuberculous peritonitis. They had been on PD for between 2 months and 84 months when they developed the peritonitis. The Mantoux test was negative in all of them. The diagnosis was made by a variety of means in the various cases: demonstration of Mycobacterium tuberculosis in the peritoneal cavity; presence of caseating granuloma in a peritoneal biopsy; Mycobacterium tuberculosis in a cold abscess adjacent to the peritoneal cavity; and demonstration of IS6110 and MPB64 genes of Mycobacterium tuberculosis by polymerase chain reaction (PCR) technique. Two of the patients developed ultrafiltration failure. Among 3 patients who were switched to hemodialysis, 2 died and 1 continues on maintenance dialysis. The last patient, whose catheter was removed, was reimplanted with a new catheter and continues on PD without ultrafiltration failure. Any patient with peritonitis unresponsive to conventional therapy should be investigated for tuberculous peritonitis. Institution of chemotherapy without delay will preserve peritoneal membrane integrity.

Intra-abdominal tuberculosis remains a significant health hazard in the developing countries. In countries where sophisticated medical facilities are not easily available, laparoscopic examination of intra-abdominal organs is helpful. In this study, 22 patients were found to have peritoneal tuberculosis out of 82 laparoscopic examinations. The major clinical presentation in these patients were abdominal pain, weight loss, fever and ascites. Tuberculin test was not always positive. Direct visualization of the peritoneum and obtaining peritoneal biopsies provide the definitive tissue diagnosis to confirm the clinical diagnosis.

Thirty cases of abdominal tuberculosis were diagnosed over an 18-year period, 26 being in immigrants; the mean age at presentation was 33 years. There were 25 cases of tuberculous peritonitis, two of tuberculous mesenteric lymphadenitis, and one each of gastric tuberculosis, colonic tuberculosis and tuberculous ischiorectal abscess. The presenting symptoms were of vague ill-health and not diagnostic, and the most common findings were of pyrexia, abdominal tenderness and ascites. The most common haematological abnormalities were raised ESR (22 patients) and mild anaemia (15 patients). Most commonly, diagnosis was made by formal laparotomy (19 cases) with biopsy (18 cases); histological examination gave a positive diagnosis in all 18 cases, but bacteriological examination yielded the tubercle bacillus in only 10 (56%). There were 2 deaths in the series, not directly related to the abdominal tuberculosis. In view of its infrequent and vague presentation, care is required to avoid overlooking the diagnosis of abdominal tuberculosis, particularly in the immigrant population.

We report the case of a 72-year-old woman with tuberculous peritonitis, complicated by the unusual association of pancytopenia and pseudo-obstruction of the colon.