The Clinico-Demographic and Imaging Profile of Pediatric Patients with Abdominal Tuberculosis

Background: Abdominal tuberculosis (ATB) in children presents a diagnostic challenge due to its nonspecific clinical presentation and low microbiological yield. Imaging plays a crucial role in supporting diagnosis, particularly in resource-limited and high-burden settings. Objective: To describe the clinico-demographic profile and imaging spectrum of pediatric abdominal tuberculosis and to evaluate imaging findings stratified by diagnostic categories. Methods: This retrospective study included 50 pediatric patients (aged 1–14 years) diagnosed with abdominal tuberculosis at a tertiary care center over a one-year period. Cases were categorized as microbiologically confirmed, histopathology-confirmed, or probable tuberculosis based on predefined criteria. Clinical, laboratory, and imaging data were analyzed. Ultrasound and contrast-enhanced computed tomography findings were reviewed using standardized definitions. Imaging features were stratified according to diagnostic category, and exploratory statistical analysis was performed. Results: The study included 28 males and 22 females, with a mean age of 8.2 ± 3.5 years. The most common clinical features were ascites (72%), abdominal pain (62%), and weight loss (40%). Diagnostic classification revealed 15 microbiologically confirmed, 25 histopathology-confirmed, and 10 probable cases. Ascites was the most frequent imaging finding on both ultrasound and CT. Other common findings included mesenteric lymphadenopathy, bowel wall thickening, and omental involvement. Stratified analysis demonstrated that ascites was prevalent across all diagnostic categories (80%, 72%, and 60%, respectively). Necrotic lymphadenopathy, bowel wall thickening, and omental thickening showed overlapping distributions among groups, with no statistically significant differences (p > 0.05). GeneXpert positivity was significantly associated with necrotic lymphadenopathy (p < 0.05). Conclusion: Pediatric abdominal tuberculosis demonstrates a spectrum of overlapping imaging findings across diagnostic categories. While features such as ascites and necrotic lymphadenopathy are common, they are not specific to confirmed disease. Imaging plays an important supportive role, particularly in probable cases lacking microbiological confirmation. An integrated approach combining clinical, laboratory, and radiological findings is essential for timely diagnosis and management.