Tuberculosis versus lymphomas in the abdominal lymph nodes: evaluation with contrast-enhanced CT.Author information 1Department of Radiology, First University Hospital, West China University of Medical Sciences, Chengdu, Sichuan.
Abstract OBJECTIVE: Tuberculosis in the abdominal lymph nodes may be difficult to distinguish from lymphomas. This study evaluated specific CT imaging criteria for differentiating these entities. MATERIALS AND METHODS: We retrospectively reviewed the anatomic distribution and CT enhancement patterns of disease in 69 patients, 26 （38%） with tuberculosis and 43 （62%） with untreated lymphomas involving abdominal lymph nodes. Of the patients with tuberculosis, five （19%） had disseminated disease and 21 （81%） had nondisseminated disease. Of the patients with lymphomas, 16 （37%） had Hodgkin's disease and 27 （63%） had non-Hodgkin's lymphoma. RESULTS: Disseminated and nondisseminated tuberculosis involved predominantly lesser omental, mesenteric, anterior pararenal, and upper paraaortic lymph nodes. Lower paraaortic lymph nodes were involved more often in Hodgkin's disease （15 patients [94%]）, non-Hodgkin's lymphoma （24 patients [89%]）, and disseminated tuberculosis （five patients [100%]） than in nondisseminated tuberculosis （one patient [5%]）. Mesenteric lymph nodes were involved more often in disseminated tuberculosis （four patients [80%]） and nondisseminated tuberculosis （11 patients [52%]） than in Hodgkin's disease （one patient [6%]） （p < .01）. Anatomic distribution was not different between disseminated tuberculosis and non-Hodgkin's lymphoma. Tuberculous lymphadenopathy commonly showed peripheral enhancement, frequently with a multilocular appearance, whereas lymphomatous adenopathy characteristically showed homogeneous attenuation （14 patients [87.5%] with Hodgkin's disease and 19 patients [70%] with non-Hodgkin's lymphoma [p < .01]）. CONCLUSION: Our findings indicate that the anatomic distribution and specific enhancement patterns of lymphadenopathy seen on contrast-enhanced CT can be useful in differentiating between tuberculosis and untreated lymphomas of the abdominal lymph nodes.
AJR Am J Roentgenol. 1999 Mar;172（3）:619-23. PMID: 10063847 [PubMed - indexed for MEDLINE]
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