<p>¹⁸F-FDG PET–CT Diagnosis of Tuberculosis in Celiac Lymph Nodes</p>

Abstract

The special location of abdominal tuberculosis makes it difficult for biopsy, while its clinical and imaging characteristics make it indistinguishable from tumors. Here, we report a female patient that was initially misdiagnosed with pancreatic cancer, but eventually correctly diagnosed with tuberculosis in the celiac lymph nodes using 18 F-FDG PET-CT. She was 38 years old. Her main complaint was "deep abdominal pain and discomfort for nearly a month", accompanied by nausea and vomiting. Diagnosis of pancreatic tumors or enlarged lymph nodes was initially made based on CT scan results. Abdominal MRI revealed enlarged lymph nodes. 18 F-FDG PET-CT imaging revealed a soft-tissue mass about 2.8 cm in diameter in the hepatic hilar area with a maximum standardized uptake value (SUV max) of 9.4, and delayed imaging measured the SUV max at 12. Enhanced CT showed no vascular envelopment in the mass. Based on these results, the patient was diagnosed with tuberculosis in the celiac lymph nodes. Her tuberculin test was strongly positive. After 5 months of antituberculosis treatment, the mass had reduced to about 1.5 cm in diameter and SUV max reduced to 8.1, as demonstrated by 18 F-FDG PET-CT imaging. Abdominal lymphnode tuberculosis is easy to misdiagnose, but timely 18 F-FDG PET-CT imaging combined with tuberculin testing may reduce misdiagnosis and mistreatment.

FDG-PET/CT of COVID-19 and Other Lung Infections

“…While FDG-PET/CT has shown to be effective in assessing metabolic activity of pulmonary lesions, some studies have indicated that FDG-PET/CT is more efficient than CT in assessing extra-pulmonary involvement 86 . As 15% of TB patients present with extra-pulmonary disease, it is imperative to identify the most sensitive diagnostic techniques, as imaging characteristics can often make M. tuberculosis lesions indistinguishable from tumors 87 . For example, Mao et al have noted that the clinical and traditional imaging features of abdominal tuberculosis can mimic pancreatic cancer, and the location is often difficult to biopsy 87 .…”

“…As 15% of TB patients present with extra-pulmonary disease, it is imperative to identify the most sensitive diagnostic techniques, as imaging characteristics can often make M. tuberculosis lesions indistinguishable from tumors 87 . For example, Mao et al have noted that the clinical and traditional imaging features of abdominal tuberculosis can mimic pancreatic cancer, and the location is often difficult to biopsy 87 . In these circumstances, FDG-PET/CT imaging combined with tuberculin testing or latent TB serology can help elucidate the correct diagnosis and help patients avoid unnecessary procedures.…”

Coeliac lymph node abscess: A case report of a rare manifestation of extrapulmonary tuberculosis

“…In addition, it can be used to monitor response to treatment and identify recurrence. 10 However, it is not widely available, especially in resource-limited settings as in our country.…”

“… 9 Furthermore, isolated coeliac lymph node TB can mimic pancreatic neoplasms, lymphoma or metastatic cancer both clinically and radiologically. 9 , 10 TB at other sites or a contact history of TB can aid in arriving at a diagnosis but this is present in less than 30% of patients. 5 In addition, the chest x-ray shows evidence of pulmonary TB in only 10%–68.5%.…”