Tuberculous lymphadenitis

Case contributed by Dr Michael P Hartung

Presentation

Worsening leg swelling.

Patient Data

Age: 30 years
Gender: Female
CT

Abnormal left cardiophrenic lymph node. Right pleural effusion. 

Extensive retroperitoneal, mesenteric, and pelvic low-attenuation adenopathy. Notice the nodes extending along the mesentery to the bowel loops. Thickening of the jejunum. 

Ascites. 

Right iliac vein severely narrowed by enlarged sidewall lymph nodes. Asymmetric edema right thigh subcutaneous fat. 

Small subligamentous abscess in the right lower thoracic spine at the level of the kidneys. 

Case Discussion

Advanced case of abdominal tuberculous infection predominantly characterized by the typical low-attenuation adenopathy, with numerous bulky retroperitoneal and pelvic sidewall lymph nodes and numerous smaller mesenteric lymph nodes. 

The reason for leg swelling is due to mass effect on the iliac veins (right worse than left). 

Ascites and small bowel inflammation indicate an element of peritonitis/wet TB. 

Small subligamentous abscess along the right lower thoracic spine is typical for early Pott disease. 

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