单侧腹股沟淋巴结肿物的MSCT分析与诊断

CT imaging diagnosis of unilateral inguinal lymphadenopathy

目的探讨腹股沟淋巴结肿物的CT表现及诊断思路。方法回顾性分析20例经手术病理证实的单侧腹股沟淋巴结肿物的病例资料,全部病例术前均行64层螺旋CT平扫及增强扫描。分析并总结腹股沟淋巴结肿物的CT表现。结果20例中包括良性肿瘤6例和恶性肿瘤14例。(1)转移瘤9例,年龄37~66岁,均有原发恶性肿瘤病史;肿物呈进行性增大;CT上7例边界欠清,密度欠均匀,增强呈环形强化或不规则强化。均为腹股沟浅表淋巴结。上内侧组6例,原发恶性肿瘤位于外阴或盆腔;垂直组3例,原发肿瘤位于下肢。(2)淋巴瘤5例,年龄46~76岁,血乳酸脱氢酶(LDH)均升高;4例缓慢增大、触诊质硬。CT上4例密度均匀,1例呈融合改变,1例融合并呈包膜外侵犯,边界欠清;增强轻-中度强化。(3)Castleman病2例,年龄22及30岁;均为高球蛋白血症;CT平扫密度均匀,边界光整,1例点状钙化灶;增强后明显均匀强化。(4)木村病1例,26岁,为缓慢增大无痛性肿块;嗜酸性粒细胞增多、血清IgE升高;CT平扫密度均匀,边界欠清,增强见增生血管影,中度均匀强化。(5)淋巴结IgG4相关性疾病1例,27岁,肿物进行性增大、压痛;血清IgG4阳性浆细胞升高;CT平扫密度均匀,边界清,增强后中度均匀强化。(6)结核2例,年龄22及25岁;低热、压痛;实验室检查PPD阳性;密度不均,边界不清,呈厚壁不规则强化。结论通过MSCT上的定位特点和影像表现,结合年龄、临床资料及血清学检查,能较准确的区分和诊断单侧腹股沟淋巴结源性肿物。

Objective To investigate the CT findings and diagnostic strategies of inguinal lymphadenopathy.Methods Preoperative non-enhanced and enhanced 64-slice helical CT of 20 patients with pathologically confirmed unilateral inguinal lymphadenopathy was analyzed retrospectively.Results The lymph nodes were benign(6)or malignant(14)including metastasis(9)and lymphoma(5).The patients with metastatic lymph nodes(age range:37-66 years)had history of primary malignancy and progressive lymph node enlargement.All were superficial inguinal lymph nodes either in the upper medial group(6)with the primary malignant tumor located in the vulva or pelvic cavity or in the vertical group(3)with the primary tumor located in the lower limb.CT showed ill-defined boundary,heterogeneous attenuation,rim or irregular contrast enhancement in 7/9 patients.The 5 patients with lymphoma(age range:46-76 years)had elevated blood lactate dehydrogenase level,slowly enlarging and firm lymph nodes(4/5).CT showed uniform attenuation(4),conglomeration(1),extracapsular invasion(1),ill-defined boundary,mild to moderate enhancement.Of 6 patients with benign lymphadenopathy,2 had Castleman’s disease(age:22 and 30 years)with hyperglobulinemia.CT showed uniform attenuation and smooth boundary with or without punctate calcification,marked homogeneous enhancement.One 26-year-old patient with Kimura disease had slowly enlarging painless inguinal mass,eosinophilia and elevated serum IgE.CT showed uniform attenuation,ill-defined boundary,and hypervascularity with moderate uniform enhancement.One 27-year-old patient with IgG4 associated progressive tender lymphadenopathy had elevated IgG4 positive plasma cells.CT showed uniform density,clear boundary,moderate and uniform enhancement.Two patients with tuberculosis(age:22 and 25 years)had low-grade fever and positive PPD skin test.The tender lymph nodes were heterogeneous in CT attenuation with ill-defined boundary and irregular thick enhancing walls.Conclusion The distribution and CT appearance combined with patient’s age,clinical features and serological examination can aid in the differential diagnosis of benign and malignant unilateral inguinal lymphadenopathy.