Tianyu Li, Liang Zhu, Bo Chen, Mengyi Wang, Di Shi, Chen Lin, Weibin Wang, Xuan Wang
{"title":"Gallbladder and liver miliary nodules: a surprising diagnosis of disseminated tuberculosis during emergency laparoscopic cholecystectomy.","authors":"Tianyu Li, Liang Zhu, Bo Chen, Mengyi Wang, Di Shi, Chen Lin, Weibin Wang, Xuan Wang","doi":"10.1186/s12245-025-00855-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Disseminated tuberculosis (TB) presenting as miliary nodules on the gallbladder and liver is extremely rare and poses significant diagnostic challenges. This report describes a case of disseminated TB discovered during emergency laparoscopic cholecystectomy for acute cholecystitis.</p><p><strong>Case presentation: </strong>A 77-year-old male presented with decreased appetite, weight loss, and fever. Preoperative imaging suggested gallstones and cholecystitis. During surgery, multiple miliary nodules were found on the surfaces of the gallbladder and liver, raising suspicion of metastatic cancer. Intraoperative frozen pathology revealed epithelioid granulomas with necrosis, and postoperative molecular testing confirmed Mycobacterium tuberculosis.</p><p><strong>Conclusions: </strong>This case highlights the importance of considering TB in the differential diagnosis of intra-abdominal nodules, especially in TB-endemic regions. Intraoperative frozen pathology and molecular diagnostics are crucial for timely and accurate diagnosis.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"44"},"PeriodicalIF":2.0000,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877782/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Emergency Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s12245-025-00855-x","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
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Abstract
Background: Disseminated tuberculosis (TB) presenting as miliary nodules on the gallbladder and liver is extremely rare and poses significant diagnostic challenges. This report describes a case of disseminated TB discovered during emergency laparoscopic cholecystectomy for acute cholecystitis.
Case presentation: A 77-year-old male presented with decreased appetite, weight loss, and fever. Preoperative imaging suggested gallstones and cholecystitis. During surgery, multiple miliary nodules were found on the surfaces of the gallbladder and liver, raising suspicion of metastatic cancer. Intraoperative frozen pathology revealed epithelioid granulomas with necrosis, and postoperative molecular testing confirmed Mycobacterium tuberculosis.
Conclusions: This case highlights the importance of considering TB in the differential diagnosis of intra-abdominal nodules, especially in TB-endemic regions. Intraoperative frozen pathology and molecular diagnostics are crucial for timely and accurate diagnosis.
期刊介绍：
The aim of the journal is to bring to light the various clinical advancements and research developments attained over the world and thus help the specialty forge ahead. It is directed towards physicians and medical personnel undergoing training or working within the field of Emergency Medicine. Medical students who are interested in pursuing a career in Emergency Medicine will also benefit from the journal. This is particularly useful for trainees in countries where the specialty is still in its infancy. Disciplines covered will include interesting clinical cases, the latest evidence-based practice and research developments in Emergency medicine including emergency pediatrics.
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