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Macronodular hepatic tuberculosis in a child: computed tomographic appearances.

Hepatic tuberculosis (TB) is usually miliary, associated with pulmonary miliary disease. Large tuberculous hepatic abscesses are not frequently seen, and are extremely rare in children, in whom the overall incidence of hepatic TB is lower than in adults. The largest reported series of hepatic TB to date described 200 cases in all, of which only one case, an adult, demonstrated macronodular caseating abscesses (Hersch, 1964). This form of TB is usually seen in extremely debilitated patients with poor immunological resistance, which often serves to complicate the clinical picture and make the diagnosis difficult. In the case described, computed tomography (CT) proved invaluable in making the diagnosis and on follow-up. A 4-year-old black male child presented to the Red Cross Childrens' Hospital in June 1985 with a 2-month history of weight loss, fever, vague abdominal pain and malaise. On examination he was clearly emaciated, pale, with a distended abdomen, ascites, nodular hepatomegaly, and pyrexial with a...