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病例分享:淋巴结结核(CT、MRI表现)+鉴别诊断

History: A 46-year-old man presents to the emergency department (ED) with neck fullness and abdominal pain. The patient moved to the U.S. from Liberia 10 years ago.

病史:46岁男性,因颈部肿胀、腹部疼痛就诊于急诊科,患者十年前曾从美国去过利比里亚。

A contrast-enhanced CT scan of the neck was performed. Axial and coronal images are shown below.

行颈部CT增强,轴位及冠状位如下所示。





Additional images:

Further imaging was obtained due to the patient's nonspecific abdominal discomfort.

Contrast-enhanced CT scans of the chest and abdomen/pelvis were performed. Coronal, axial, and sagittal images are shown below.

由于患者腹部不适,进一步行胸腹盆CT增强,冠状、轴位及矢状图像如下所示。







Findings:

Necrotic lymphadenopathy is seen through the cervical region, mediastinum, hila, abdomen, and retroperitoneum.

影像表现:

颈部、纵隔、肺门、腹腔及腹膜后见多发坏死性肿大淋巴结。

(补充:增强扫描呈环形强化)

Differential diagnosis:

1.Tuberculous lymphadenopathy

2.Lymphoma

3.Metastatic carcinoma

4.Mycobacterium tuberculosis infection

5.Nontuberculous mycobacterial infection

6.Disseminated histoplasmosis infection

7.Whipple disease

8.Autoimmune disease (i.e., systemic lupus erythematosus)

鉴别诊断:

1.淋巴结结核

2.淋巴瘤

3.转移癌

4.结核分枝杆菌感染

5.非结核分枝杆菌感染

6.播散型组织胞浆菌病感染

7.惠普尔病

8.自身免疫性疾病(如:系统性红斑狼疮)

Diagnosis: Tuberculous lymphadenopathy, biopsy-proven

诊断:淋巴结结核(活检证实)

Background

1.Tuberculosis (TB) is typically confined to the respiratory system.

2.However, it can affect any organ system, and immunocompromised patients have an increased risk of extrapulmonary TB.

3.Radiographic evidence of lymphadenopathy is seen in more than 95% of children and over 40% of adults with TB.

4.Lymphadenopathy as the only evidence of TB radiographically is more common in infants and decreases in frequency with age.

背景:

1.结核(TB)通常局限于呼吸系统;

2.然而,也可以累及其它器官,免疫缺陷人群更易患肺外结核;

3.超过95%的儿童及超过40%的成人结核患者影像学可发现淋巴结肿大;

4.婴儿常常仅表现为淋巴结肿大,这种情况随年龄增加而减少。

Imaging:

CT:

1.Lymph nodes larger than 2 cm often have a low attenuation center from necrosis and are suggestive of active disease.

2.Cervical TB lymphadenopathy is often the first site of extrathoracic lymph node involvement; known as scrofula or cervical TB lymphadenitis.

影像表现(CT):

1.淋巴结大于2cm时常由于坏死而表现为中心低密度,提示疾病处于活动期;

2.颈部结核性淋巴结肿大常是胸外淋巴结受累的第一站,被称作淋巴结结核或颈部结核性淋巴结炎。

Diagnosis

Outside of the U.S., up to 50% of patients with chronic lymphadenopathy have TB as the causative etiology. However, malignancy is a significant alternative diagnosis.
Thus, a biopsy is thus recommended to confirm TB and exclude other diagnoses.

诊断:

在美国以外的地方,多达50%的慢性淋巴结肿大患者的病因为结核;然而,恶性肿瘤是一个重要的替代诊断。因此,需活检证实为TB,除外其他诊断。

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