Lymphatic tuberculosis of the hepatic hilum, a rare form of extra-pulmonary tuberculosis, represents less than 0.1% of tuberculosis cases in adults [
1]. To the best of our knowledge, few cases [
2,
3] have been reported in children or adolescents.The pathogenesis of hepatic hilar tuberculosis includes direct biliary contamination from swallowed mycobacteria and extension from adjacent affected structures; hematogenous spread is rare [
4]. Patients normally present with non-specific signs and symptoms such as mild fever, right upper quadrant abdominal pain, hepatomegaly, weakness, night sweats, and jaundice, which is caused by the enlarged lymph nodes compressing the common bile duct [
5]. Since radiological findings are often non-diagnostic, the condition may mimic any of the common hepatic hilar lesions such as tumor, hemangiomata, and abscesses. Diagnosis is thus a challenge for clinicians and can only be confirmed through histological examination of the tissue specimens, which may yields evidence of caseous granuloma [
4,
6]. Standard anti-tuberculosis therapy is an effective medical treatment regimen [
7];the indications for surgery should be carefully evaluated.Based on our experience with this case and a study of the literature and our data, the indications of surgical treatment for hepatic hilar tuberculosis are: (1) isolated large tuberculoma that does not respond well to anti-tuberculosis treatment; (2) suspicion of malignant lesions; (3) patients presenting with biliary tract bleeding or acute abdomen; (4) compression of the biliary tract causing obstructive jaundice [
8]. In addition, surgical excision of lesions provides relief from related symptoms and provides the tissue specimens for histological examination without the need to remove all the enlarged lymph nodes.
In conclusion, lymphatic tuberculosis of the hepatic hilum is an extremely rare condition that not all physicians may be aware of this condition. Tuberculosis should not be excluded from the differential diagnosis of atypical lesions in the hepatic hilum. Medical therapy remains the mainstay of treatment for lymphatic tuberculosis of the hepatic hilum, but if there are indicators for surgery or difficulty in diagnosis, surgery accompanied by anti-tuberculosis drug therapy could be adopted.