Antituberculosis treatment for a patient with massive ascites: the role of f-18-fluorodeoxyglucose positron emission tomography.

Abstract

The diagnosis of peritoneal tuberculosis (TB) is difficult, and the condition is often misdiagnosed as advanced ovarian cancer. The clinical discrimination is important to avoid both unnecessary surgery and a delay in anti-TB treatment. A 66-year-old woman presented with abdominal distension. Positron emission tomography (PET) with F18-fluorodeoxyglucose showed a diffuse F18-fluorodeoxyglucose accumulation on the entire peritoneum. The presumptive diagnosis was peritoneal TB, and anti-TB treatment was thus started. Follow-up F18-fluorodeoxyglucose-PET revealed the disappearance of the pathologic foci and a decreased peak standardized uptake value. F18-fluorodeoxyglucose-PET may be a helpful tool in the diagnosis of peritoneal TB and serial F18-fluorodeoxyglucose-PET plays a potentially important role in monitoring the treatment response. The peak standardized uptake value may also be helpful for making a quantitative assessment of the therapeutic response.