Distribution and characteristics of hematogenous disseminated tuberculosis within the abdomen on contrast-enhanced CT.
BACKGROUND
The incidence of abdominal tuberculous lymphadenopathy never appears low. In addition to infecting the abdominal lymph nodes through the digestive tract, the tuberculosis bacteria can also infect the abdominal lymph nodes and extra-nodal organs through hematogenous dissemination. This study investigated contrast-enhanced CT features and anatomic locations of hematogenous disseminated tuberculosis involving abdominal organs.


METHODS
Thirteen patients with documented hematogenous disseminated tuberculosis involving abdominal organs were recruited. Contrast-enhanced CT scanning was carried out in the abdomen of all patients. CT images were retrospectively analyzed for the size, attenuation, enhancement patterns, and anatomic distribution of the foci in infected lymph node, liver, spleen, and kidney.


RESULTS
Hematogenous disseminated tuberculosis dominantly affected lymph nodes in the hepatoduodenal ligament (84.6%), the portacaval space (84.6%), the root of the mesentery (84.6%), the peripancreatic region (84.6%), the periceliac region (76.9%), the hepatogastric ligament (69.2%), and the upper and lower paraaortic region (both were 69.2%). Out of the 13 cases studied, 12 (92.3%) had lymphadenopathy with peripheral enhancement accompanied by multilocular appearance; 10 (76.9%) had homogeneous hepatomegaly; 13 (100%) had inhomogeneous splenomegaly accompanied by scattered low-density lesions with peripheral enhancement; and 8 (61.5%) had low-density lesions in the kidney with peripheral enhancement.


CONCLUSIONS
Anatomically, peritoneal and retroperitoneal lymph nodes are most susceptible to hematogenous disseminated tuberculosis. The hepatomegaly manifested to be homogeneous in most cases while the splenomegaly is of frequently inhomogeneous attenuation. All these characteristics are closely related to the infection routes and pathologic features of abdominal hematogenous disseminated tuberculosis.
Li
Yuan
Y
Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China.
Yang
Zhi-Gang
ZG
Guo
Ying-Kun
YK
Min
Peng-Qiu
PQ
Yu
Jian-Qun
JQ
Ma
En-Sen
ES
Hu
Jian
J
D000005:Abdomen; D000328:Adult; D003287:Contrast Media; D003973:Diatrizoate; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D014057:Tomography, X-Ray Computed; D014388:Tuberculosis, Lymph Node / Q000000981:diagnostic imaging* / Q000473:pathology
D003287:Contrast Media; D003973:Diatrizoate