血行播散型结核累及腹部器官的CT强化特征及其优势解剖分布

CT Enhanced Features and Anatomic Distribution of Affected Abdominal Organs in Hematogenous Dissemination Tuberculosis

目的 明确血行播散型结核累及腹部器官的CT强化特征及其优势解剖分布。资料与方法 经临床病理证实的累及腹部器官的血行播散型结核 11例 ,行腹部CT增强扫描 ,在CT图像上 ,观察受累淋巴结的大小、形态、强化特征和分布 ,以及受累肝、脾和肾脏内病灶的大小、形态、密度以及结核灶周边强化特点。结果 血行播散型结核优势地累及小网膜、肠系膜、胰周以及腹主动脉周围上、下部淋巴结。 10例 (90 .9% )受累淋巴结增大呈环状强化 ,周边强化的淋巴结易形成多房样征象。 10例 (90 .9% )肝脏呈均匀密度增大 ,11例 (10 0 % )脾脏呈不均匀密度增大 ,内有散在低密度灶 ,直径 0 .3～ 2 .5cm ,病灶周边有强化。 6例 (5 4 .5 % )肾脏受累 (双侧 2例 ,单侧 4例 ) ,肾实质内有低密度灶 ,灶周强化。结论 血行播散型结核累及腹腔、腹膜后淋巴结存在优势解剖分布 ,同时肝脏多呈均匀密度增大 ,脾呈不均匀密度增大 。

Objective To clarify CT enhanced features and the anatomic distribution of the affected abdominal organs in hematogenous dissemination tuberculosis.Materials and Methods Eleven cases with pathologically-proved diseased abdominal organs affected by hematogenous dissemination tuberculosis were collected. Enhanced CT scanning was carried out in all patients. Imaging observation was focused on the size, shape, enhanced pattern, density and distribution of the affected lymph nodes, liver, spleen and kidney. The enhanced feature of the circumference of the tuberculous lesion was analyzed.Results Hematogenous dissemination tuberculosis dominantly affected lesser omentum, mesentery and the lymph nodes around the pancreas and abdominal aorta. Rim enhancement and multilocular sign of affected lymph nodes were seen in 10 cases (90.9%). Enlarged liver with homogeneous density was seen in 10 cases (90.9%), while splenomegaly of inhomogeneous density with scattered low-density, rim-enhanced foci (0.3～2.5 cm) was seen in all 11 patients. Renal involvement, bilateral (n=2) or unilateral (n=4) was found in 6 cases (54.5%), presenting as low-density, rim-enhanced lesions within renal parenchyma.Conclusion Hematogenous dissemination tuberculosis is apt to affect abdominal organs and retroperitoneal lymph nodes. The liver may be enlarged with homogeneous density and the spleen may be enlarged with inhomogeneous density, these features are well correlated with the infection route and pathologic findings.