Mediastinal tuberculous lymphadenitis: CT manifestations.

Area of Science:

• Radiology
• Infectious Diseases
• Pulmonology

Background:

• Mediastinal and hilar masses on chest radiographs can represent various pathologies.
• Tuberculous lymphadenitis is a common cause of lymphadenopathy, especially in endemic regions.
• Distinguishing tuberculous lymphadenitis from other causes like malignancy can be challenging based on initial imaging.

Purpose of the Study:

• To analyze computed tomographic (CT) findings in Korean patients diagnosed with tuberculous lymphadenitis.
• To identify characteristic CT features of mediastinal and hilar lymphadenopathy caused by tuberculosis.
• To assess the utility of CT in differentiating tuberculous lymphadenitis from other mediastinal masses.

Main Methods:

• Retrospective analysis of CT scans from 23 Korean patients with mediastinal/hilar masses and confirmed tuberculous lymphadenitis.
• Evaluation of lymph node size, location, and enhancement patterns after contrast administration.
• Correlation of CT findings with plain chest radiograph findings and clinical presentation.

Main Results:

• Predominant involvement of right paratracheal and tracheobronchial lymph nodes was observed on CT.
• Enlarged lymph nodes (>2 cm) typically showed central low density with peripheral rim enhancement.
• Smaller nodes exhibited homogeneous enhancement, while enhanced walls were often irregularly thickened.
• Pulmonary tuberculosis findings were present on plain radiographs in 14 out of 23 patients.

Conclusions:

• CT demonstrates a characteristic pattern of lymphadenopathy in tuberculous lymphadenitis, particularly in young adults.
• The described CT features, including specific enhancement patterns of mediastinal lymph nodes, are highly suggestive of tuberculosis.
• CT imaging plays a crucial role in supporting the diagnosis of tuberculous lymphadenitis, aiding in differential diagnosis from metastatic disease.