超声检查和计算机断层扫描在结核性颈淋巴结炎复杂病例中的作用

Role of ultrasonography and computed tomography in complicated cases of tuberculous cervical lymphadenitis.

作者信息

Gupta K B, Kumar Ashok, Sen Rajiv, Sen Jyotsna, Vermas Manish

机构信息

Department of Tuberculosis and Chest Diseases, Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana.

出版信息

Indian J Tuberc. 2007 Apr;54(2):71-8.

PMID:17575678

Abstract

AIM

To evaluate complicated cases of tuberculous cervical lymphadenitis by ultrasonography and computed tomography in order to detect more lymph nodes, and to study their lesions.

MATERIAL AND METHODS

Total 27 patients of tuberculous cervical lymphadenitis previously proved bacteriologically or histopathologically on anti-tuberculosis treatment (ATT) presenting with complications were taken for study. Each case was subjected to ultrasound (USG) and computed tomography (CT) of involved area. Based on USG and CT findings, patients were subjected to repeat fine needle aspiration cytology (FNAC) of involved lymph node or drainage of pus.

RESULTS

On USG, all lesions were hypoechoic and showed necrosis. Other findings were: sharp margins in 70.4 %, hilum in 22.2 %, abnormal surrounding tissue in 85.2 %, matting in 37 %, calcification in 29.6 % and posterior enhancement in 22.2 % patients. On CT, majority of lesions were with central low density (CLD) in 16 (59.3 %), followed by large confluent low density (LCLD) in 7 (25.9 %), multilocular central low density (MCLD) in 4 (14.8 %) and homogeneous soft tissue density (HSTD) in 2 (7.4 %) patients. Necrotising granulomatous lymphadenitis was the most common diagnosis in 17 (63%), followed by necrotising in 6 (22.2 %) and granulomatous in 4 (14.8 %) patients. Fifteen (55.5 %) patients were positive for AFB on ZN smear examination. In 17 patients, culture and sensitivity test for Mycobacterium Tuberculosis from lymph node aspirate was done and 12 (70.6 %) patients were found culture positive. Out of these, 2 (16.7 %) were found to be multi-drug resistant (MDR) cases.

CONCLUSION

USG and CT modalities are complementary in diagnosis and management of tuberculous lymphadenitis presenting with complications. USG helps in better localization of site for biopsy/FNAC procedure and drainage of pus with high diagnostic yield. While CT helps in better anatomical localization of lymph nodes not usually detected on clinical examination.

摘要

目的

通过超声检查和计算机断层扫描评估结核性颈淋巴结炎的复杂病例，以便发现更多淋巴结并研究其病变情况。

材料与方法

选取27例先前经细菌学或组织病理学证实为结核性颈淋巴结炎且正在接受抗结核治疗（ATT）并出现并发症的患者进行研究。对每例患者受累区域进行超声（USG）和计算机断层扫描（CT）检查。根据USG和CT检查结果，对患者受累淋巴结进行重复细针穿刺细胞学检查（FNAC）或脓液引流。

结果

在USG检查中，所有病变均为低回声且显示坏死。其他表现为：70.4%边界清晰，22.2%有淋巴结门，85.2%周围组织异常，37%有粘连，29.6%有钙化，22.2%有后方增强。在CT检查中，大多数病变表现为中央低密度（CLD），16例（59.3%），其次是大片融合低密度（LCLD），7例（25.9%），多房中央低密度（MCLD），4例（14.8%），均匀软组织密度（HSTD），2例（7.4%）。坏死性肉芽肿性淋巴结炎是最常见的诊断，17例（63%），其次是坏死性，6例（22.2%），肉芽肿性，4例（14.8%）。15例（55.5%）患者齐-尼氏涂片检查抗酸杆菌阳性。对17例患者的淋巴结抽吸物进行结核分枝杆菌培养和药敏试验，12例（70.6%）患者培养阳性。其中，2例（16.7%）为耐多药（MDR）病例。