Ultrasonographic Features and Diagnostic Challenges of Hepatic Tuberculosis: Insights from Taiwan and Southeast Asia.

Hepatic tuberculosis (HTB) is a rare manifestation of extrapulmonary tuberculosis (TB) and represents fewer than 1% of all tuberculosis cases. From an imaging perspective, HTB poses a significant diagnostic challenge because its ultrasonographic appearances are highly variable and frequently mimic hepatic malignancy or pyogenic abscess, often resulting in delayed or incorrect diagnosis. This review focuses on the ultrasonographic features of hepatic and hepatobiliary TB, with reference to the epidemiologic data from Southeast Asia and Taiwan. Ultrasonography remains the most commonly used first-line imaging modality and typically demonstrates five morphologic patterns: nodular, abscess-like, infiltrative or diffuse, biliary, and miliary. However, none of these patterns are specific and substantial overlap exists with malignant and inflammatory hepatic conditions. Awareness of these sonographic patterns, in conjunction with clinical context and risk factors, is therefore essential for raising the suspicion of HTB. Given the limitations of imaging alone, definitive diagnosis requires histopathologic confirmation and microbiologic or molecular testing. For ultrasound practitioners, early recognition of atypical or malignancy-like hepatic lesions and timely recommendation for liver biopsy play a pivotal role in reducing diagnostic delay. Improved awareness of HTB among clinicians and radiologists, particularly in regions affected by population mobility from TB-endemic areas, may facilitate earlier diagnosis and more appropriate management.