How to differentiate abdominal tuberculosis from lymphomas?

The incidence of tuberculosis is increasing. Lymphadenopathy is the most common manifestation of abdominal tuberculosis and may, in up to 55% of cases without other evidence of abdominal involvement, be easily confused with lymphomas involving abdominal lymph nodes. Clinical and radiologic differentiation between the two can be challenging. A comparison of CT findings in tuberculosis and lymphoma of the mesenteric lymph nodes has not been reported.

A research article to be published on 28 June 2008, in the World Journal of Gastroenterology addresses this question. The research team led by Dr. Dong P from Weifang Medical University of China has determined that tuberculosis and non-Hodgkin's lymphomas (NHL) mainly affected the lymph nodes in the body and root of the SBM on CT images. Homogeneous enhanced lymph nodes in the body and root of SBM were more often in the NHL (P < 0.05). Homogeneous mixed with peripheral enhanced lymph nodes in the body of SBM were more often in mesenteric TL and TLM (P < 0.05). Peripheral enhanced lymph nodes in the root of SBM were more often in mesenteric TL and TLM (P < 0.01). "Sandwich sign" in the root of SBM was more often in NHL (P < 0.05). The result is helpful in differentiating between tuberculosis and untreated NHL involving the small bowel mesentery (SBM).

Tuberculosis demonstrates a variety of clinical and radiologic features depending on the organ site involved and has a known propensity for dissemination from its primary site. Lymphadenopathy is the most common manifestation of abdominal tuberculosis and may, in up to 55% of cases without other evidence of abdominal involvement, be easily confused with lymphomas involving abdominal lymph nodes. It is important to be familiar with the various radiologic features of tuberculosis and NHL involving the SBM to ensure accurate diagnosis.

The incidence of tuberculosis is increasing. Lymphadenopathy is the most common manifestation of abdominal tuberculosis. Currently, the comparison of CT findings in tuberculosis and lymphomas involving the SBM has not been published in english radiologic literature.

CT manifestations of tuberculosis and NHL mainly affected the lymph nodes in the body and root of the SBM. Homogeneous enhanced lymph nodes in the body and root of SBM were more often in the NHL (P < 0.05). Homogeneous mixed with peripheral enhanced lymph nodes in the body of SBM were more often in mesenteric TL and TLM (P < 0.05). Peripheral enhanced lymph nodes in the root of SBM were more often in mesenteric TL and TLM (P < 0.01). "Sandwich sign" in the root of SBM was more often in NHL (P < 0.05).

In the view of the authors, the CT can show the specific enhancement patterns of lymphadenopathy, sandwich sign and anatomic lymph nodes distribution in tuberculosis and untreated NHL involving the SBM.

This article describes the difference between tuberculosis and NHL involved the SBM, and CT is helpful to the diagnosis and differential diagnosis of the tuberculosis and NHL involving the SBM.

Further research should compare the CT findings of mesenteric tuberculosis with metastatic malignancy and other entities which involved the SBM.

Reference: Dong P, Wang B, Sun QY, Cui H. Tuberculosis versus non-Hodgkin's lymphomas involvement of small bowel mesentery: Evaluation with contrast-enhanced CT. World J Gastroenterol 2008; 14(24): 3914-3918
http://www.wjgnet.com/1007-9327/14/3914.asp

Correspondence to: Dong Peng, Department of Medical Imaging, Weifang Medical University, Weifang 261042, Shandong Province, China. dongpeng98021@sina.com
Telephone: +86-536-8068959 Fax: +86-536-8238243

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

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