CT Findings of Tuberculous Lymphadenitis in the Abdominal Cavit}

ji Bai Choi; Young Tae Ko; Yup Yoon; Jae Hoon Lim; Soon Yong Kim

doi:10.3348/jkrs.1985.21.6.963

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Choi, Ko, Yoon, Lim, and Kim: CT Findings of Tuberculous Lymphadenitis in the Abdominal Cavit}

Original Article

J Korean Radiol Soc 1985;21(6):963-968.

Published online: 23 December 1985

DOI: https://doi.org/10.3348/jkrs.1985.21.6.963

CT Findings of Tuberculous Lymphadenitis in the Abdominal Cavit}

ji Bai Choi, M.D., Young Tae Ko, M.D., Yup Yoon, M.D., Jae Hoon Lim, M.D., Soon Yong Kim, M.D.

Department of Diagnostic Radiology, Kyung Hee University Hospital

Received 20 November 198511 November 1985

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Athors analyzed CT findings of 8 patients with t䴸berc䴸ᅵᄋ䴸s lymphadenitis and one case of tuberc䴸lo䴸s abscess diagnosed surgically or clinically. The results were as follows;

1. Soft tissue density masses were noted in 8 patients in paraaortic, mesenteric, peripancreatic, celiac, porta hepatis, and esophagogastric junction areas in order of frequency, and these correspond to lymph node groups of the same name.

On contrast enhanced CT, rim enhancement with m䴸Itiloc䴸lar low densities indicating casecujs necrosis were noted in 3 patients, ill defined low densities were seen in 3 patients, and no definite changes were noted in 2 patients.

2. Two or more lymph node groups were involved in 6 patients, and one lymph node gro䴸ρ was involved in two patients.

3. A h䴸ge cystic mass with relatively irregular rim enhancement and small ano䴸nt of solid component occupied nearly entire 䴸pper abdomen in 1 patient and this was confirmed as Ujberculous abscess in peritoneum.

4. In 2 cases, bowel wall thickening was suggested in ceojm, ascending colon, and terminal ileum.

REFERENCES

1.We rb el off L., Novis BH., Bank S, et al. Radiology of tuberculosis of the gastronistestinal tract. Br J Radio. 45:329–336. 1973.

2.Amerson JR., Martin JD. Tuberculosis of the alimentary tract. Am J Surg. 107:340–345. 1964.

3.Bhansali SK. Abdominal tuberculsis. Am J Gastroentero. 67:324–337. 7977.

4.Stanley RJ. Fluid characterization with computed tomography. Moss ΑΔ, Goldgberg HI, editors. eds.Computed tomography, ultrasound and X-ray: an integrated approach. New York: Academic Press;p. 65–66. 1980.

5.Epstein BM., Mann JH. CT of abdominal tuberculosis. AJR. 139:861–866. 1982.

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8.Borgia G., Ciampi R., Nappa S, et al. Tuberculous mesenteric lymphadenitis clinically presenting as abdominal mass; CT and sonographic findings. J Clin Ultrasound. 13:491–493. 1985.

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11.Auerbach O. Pleural, peritoneal and pericardial tuberculosis; review of 209 cases uncomplicated by treatment of secondary infection. Am Rev Tuberc. 61:845–861. 1950.

12.Krudy AG., Donnick WR., Magrath IT, et al. CT of American Burkitt lymphoma. AJR. 136:747–754. 1981.

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Fig. 1.

(Case II). A. U.G.I, shows inverted 3 sign suggesting pancreatic head cancer. B. ERCP reveals no gross abnormality except extrinsic compression on CBD. C. Contrast enhancement CT shows soft tissue density mass in the peripancreatic region. Laparotomy revealed child head sized mass below small bowel mesentery, surrounding aorta and JVC

Fig. 2.

(Case IX). A. Contrast enhancement CT shows rim enhancement with multilocular low densities, indicating caseous necrosis of tuberculous nodes. B. On US, posterior reinforcement is noted in the echolucent mesenteric node, indicating necrosis oi the lymph node.

Fig. 3.

(Case VII). A. Huge cystic mass occupies nearly entire upper abdomen and displaces the liver, pancreas, and stomach posteriorly. B. On contrast enhancement CT, wall enhancement with relatively irregular thickness and small amount of solid component are seen. Laparotomy reveled huge pus-containing mass in peritoneum.

Fig. 4.

(Case VIII). A. Soft tissue density masses are seen in the mesenteric and paraaortic regions, with bowel wall thickening in cecum and terminal ileum. B. On contrast enhancement scan, rim enhancement with multilocular low densities are noted in the involved nodes. Operation revealed tuberculous enterocolitis and mesenteric lymhadenitis.

Table 1.

Summary of Cases

Case	Age/Sex	Clinical problems	Positive radiologic finding	CT findings	Operative findings
I	20/M	Epigastric pain & indigestion Weight loss 8kg/8 Mo 111 defined tender mass in epigastrium and RUQ	US: less echogenic mass surrounding SMA	Large conglomerated soft tissue mass in peripan creatic region On CECT, ill-defined low density was noted in the mass.	Child head sized mass was noted below small bowel mesentery and the mass surrounded aorta and IVC Pathology: tuberculous lymphadenitis
II	36/M	Dull pain in RUQ	UGI: inverted 3 sign	Multiple ill defined soft	Floating adult fist sized mass
		Weight loss 2 kg/3 Mo	suggesting pancreatic	tissue density masses in	was in subpyloric and
		Nodular mass in	head cancer	peripancreatic region	peripancreatic areas, and
		epigastrium	ERCP: Extrinsic indent	and paraaortic region	caseous material was
			ation on CBC	On CECT, ill defined low	aspirated.
				density in the	Pathology: Tuberculous
				peripancreatic mass	lymphadenitis.
III	48/M	Intermittent lower	US: enlarged paraaortic	Huge soft tissue mass
		abdominal pain	and mesenteric nodes	surrounds SMA and
		Weight loss for 2 months	Colon study: Nodular	paraaortic and mesenteric
		Hard tender mass in lower	filling defects in terminal	nodes are enlarged
		abdomen	ileum and spastic change
			in cecum
			CHEST: Advanced
			pulmonary tuberculosis
IV	50/F	Epigastric pain & melena	SBS: nodular filling defects	Enlargement of paraaortic
		for 6 months	in teriminal ileum with	nodes
		Palpable mass(-)	soft density mass adjacent
			to terminal ileum
			Colon study: spastic
			change in cecum
V	67/F	Vomiting & dizzines for	US: Less echogenic mass	Irregular soft tissue	Child fist sized fluctuating
		1 month	in hepatoduodenal	masses in peripancreatic	mass was found in retro
		ligament	region	in retropermoneal cavity,	peritoneal cavity.
					superior to pancreas head
					& body and posterior to
					gastric antrum. Caseous
					material was aspirated.
					Pathology: Tuberculous
					lymph adentitis.
VI	23/F	Palpable mass in peri	US: Multiple abdominal	Multiple necrotizing	100 ml of caseous necrotic
		umbilical region for 8	lymph node involvement	masses widespread in	material was removed from
		months	Psoas muscle thickening	abdomen Wall thickening	lower part of left psoas
				of cecum and ascending	muscle.
				colon was suggested	Excisional biopsy of left
					psoas muscle: Tuberculosis.
VII	20/M	Epigastric discomfort for	Chest: Advanced	Huge cystic mass with	Pus containing huge mass
		5 months	pulmonary tuberculosis	irregular wall enhance	was seen in peritoneal cavity.
		Abdominal distention	US: Huge cystic mass in	ment and small amount	Pathology: Tuberculous
			upper abdomen	of solid component	abscess
VIII	62/F	Pain & palpable mass in		Multiple necrotizing	Adult fist sized mass was
		right midabdomen for 4		masses in paraaortic and	found medial to ascending
		months		mesenteric regions	colon, and it is enlarged
				Bowel wall thickening	and liquefied mesenteric
				is suggested in cecum and	lymph node. Ulceration was
				terminal ileum.	suspected in cecum and
					ascending colon, on cut
					surface.
					Pathology: colon; Tuber
					culosis mesenteric node,
					tuberculosis
IX	30/M	Fever & chill	US: Multiple mesenteric	Multiple necrotizing nodes
		Periumbilical mass	node enlargement with	widespread in abdomen
		for 1 month	cystic necrosis

Table 2.

Location of Soft Tissue Masses

Location	I	II	III	IV	V	VI	VIII	IX	Total
Paraaortic region	+	+	+	+		+	+	+	7
Mesenteric region	+	+	+			+	+	+	6
Peripancreatic region	+	+	+		+	+		+	6
Celiac region		+			+				2
Porta hepatis region						+		+	2
Esophagogastric junction								+	1

^∗ Cystic mass occupied nearly entire upper abdomen, and laparotomic biopsy confirmed tuberculous abscess in peritoneum

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