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

Background: 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.

Case: 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.

Conclusion: 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.