Hafeez Wajid, Rajalakshmi S, Sripriya S, Madhu Bashini M
1 Resident, Department of Emergency Medicine, 470686 Gleneagles Global Health City , Perumbakkam, Chennai, India.
2 Resident, Department of Internal Medicine and Diabetology, 470686 Gleneagles Global Health City , Perumbakkam, Chennai, India.
Trop Doct. 2018 Apr;48(2):116-122. doi: 10.1177/0049475517740311. Epub 2017 Nov 16.
Background and Aim Diagnosis of typhoid is challenging when blood cultures fail to isolate Salmonella species. We report our experience with interpreting computed tomography (CT) abdomen findings in a case series of typhoid fever. Methods The case series consisted of patients who had a CT abdomen done as part of their investigations and a final diagnosis of typhoid fever. The CT films were reviewed and findings evaluated for distinctive features. Results During 2011-2017, 11 patients met the inclusion criteria. Indication for CT was pyrexia of unknown origin in the majority of patients. Review of CT films revealed mesenteric lymphadenopathy (100%), terminal ileum thickening (85%), hepatosplenomegaly (45%), retroperitoneal lymphadenopathy (18%) and ascites (9%). Conclusions Enhancing discrete mesenteric lymphadenopathy and terminal ileum thickening are non-specific findings noted in typhoid fever. Absence of matted necrotic nodes and peritoneal thickening rule out tuberculosis and raise suspicion of typhoid fever in endemic regions.
背景与目的 当血培养未能分离出沙门氏菌属时，伤寒的诊断具有挑战性。我们报告了一系列伤寒热病例中解读腹部计算机断层扫描（CT）结果的经验。方法 该病例系列包括作为调查一部分进行了腹部CT检查且最终诊断为伤寒热的患者。对CT片进行了复查，并评估了结果的独特特征。结果 在2011年至2017年期间，11名患者符合纳入标准。大多数患者进行CT检查的指征是不明原因发热。对CT片的复查显示肠系膜淋巴结肿大（100%）、回肠末端增厚（85%）、肝脾肿大（45%）、腹膜后淋巴结肿大（18%）和腹水（9%）。结论 强化离散的肠系膜淋巴结肿大和回肠末端增厚是伤寒热中观察到的非特异性表现。无融合坏死性淋巴结和腹膜增厚可排除结核病，并在流行地区引发对伤寒热的怀疑。
