Increased through-transmission in abdominal tuberculous lymphadenitis.
OBJECTIVE
To describe 2 cases of abdominal tuberculosis in which sonographic evaluation of mesenteric lymphadenopathy showed increased through-transmission suggestive of caseating necrosis.


METHODS
Two patients with abdominal pain and other symptoms (including fever, diarrhea, and weight loss) underwent abdominal sonography with a 6-MHz curved array transducer. One patient also underwent sonographically guided fine-needle aspiration of multiple lymph nodes, and the other underwent computed tomography, colonoscopy, and colon biopsy.


RESULTS
In both patients, sonography showed multiple rounded hypoechoic lesions with increased ultrasound through-transmission suggestive of necrotic lymphadenopathy. No color flow was shown. In 1 case, the posterior acoustic enhancement was accentuated in the harmonic imaging mode. In the other case, the lesions shown on sonography corresponded to computed tomographic findings of low-density lymph nodes. Results of fine-needle aspiration and colon biopsy were positive for tuberculosis.


CONCLUSIONS
Posterior acoustic enhancement in abdominal lymphadenopathy can suggest the diagnosis of tuberculous lymphadenitis. Detection of this finding is facilitated by scanning in the harmonic mode. Necrotic nodes will lack color flow and can be distinguished from lymphadenopathy of other causes. Sonography can also be used for fine-needle aspiration of necrotic nodes to yield a definitive diagnosis.
Ghazinoor
Shaya
S
Stanford Hospital and Clinics, 300 Pasteur Dr, Stanford, CA 94305-5621, USA.
Desser
Terry
T
Jeffrey
R Brooke
RB
D000005:Abdomen / Q000000981:diagnostic imaging; D000328:Adult; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008297:Male; D008640:Mesenteric Lymphadenitis / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000000981:diagnostic imaging; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed; D014388:Tuberculosis, Lymph Node / Q000000981:diagnostic imaging*; D014463:Ultrasonography