This case demonstrates findings suggestive of tuberculosis: abnormal terminal ileum and multiple necrotic mesenteric lymph nodes. The patient went on to have laparoscopic mesenteric lymph node biopsy, with histopathology demonstrating tuberculosis.

The appendiceal findings are suspicious for acute appendicitis. The necrotic lymph nodes plus the abnormal terminal ileum raise a strong possibility of tuberculosis. 

Learning points:

• The gastrointestinal system is one of the many potential organ systems affected by tuberculosis.
• The abdominal structures commonly implicated in gastrointestinal tuberculosis include: terminal ileum, ileocecal junction and abdominal lymph nodes.
• The CT findings in this case which are suggestive of gastrointestinal tuberculosis include:
  • Terminal ileum and cecal wall thickening and dilatation
  • Mesenteric lymphadenopathy with low central attenuation

Case with thanks to Prof Oliver Hennessy.