The Role of Contrast-Enhanced Ultrasound in the Differential Diagnosis of Tuberous Vas Deferens Tuberculosis and Metastatic Inguinal Lymph Nodes

Abstract

Purpose: To retrospective analysis and summary the features of tuberous vas deferens tuberculosis (VD TB) and inguinal metastatic lymph nodes (MLN) in routine ultrasound (US) and contrast-enhanced US (CEUS) as well as to assess the utility of CEUS in differentiating between the two diseases. Methods: The US and CEUS findings of patients with pathologically confirmed tuberous VD TB (n = 17) and inguinal MLN (n = 28), including the number of lesions, presence of bilateral disease, differences in internal echogenicity, a conglomeration of lesions, and blood flow within the lesions, were retrospectively analyzed. Results: Routine US showed no significant difference in the number of lesions, nodule size, internal echogenicity, sinus tract, or skin rupture; however, significant differences were observed between the two conditions in the conglomeration of lesions (χ2 = 6.455; p = 0.023) and the degree, intensity, and echogenicity pattern on CEUS (χ2 = 18.865, 17.455, and 15.074, respectively; p = 0.000 for all). Conclusions: CEUS can show the blood supply of the lesion, and judge the physical condition of the lesion better than US. Homogeneous, centripetal, and diffuse enhancement should prompt a diagnosis of inguinal MLN, whereas lesions with heterogeneous and diffuse enhancement on CEUS should be considered as VD TB. CEUS has great diagnostic value in differentiating between tuberous VD TB and inguinal MLN.

Comments and Illustrations of Ultrasound Findings in Extrapulmonary Tuberculosis Manifestations

“…There are three different types of vas deferens tuberculosis: the uniformly thickened wall type, the tuberous type, and the abscess type. When passing through the inguinal canal, the tuberous type of vas deferens tuberculosis must be differentiated from inguinal lymph nodes of various origins [125]. During ultrasound, the lesions are predominantly 1-3 cm in size, but smaller and larger lesions are also observed.…”

“…They form conglomerates. Less than a fifth have calcification [125]. Vas deferens tuberculosis lesions have proven to be heterogeneously and diffusely enhanced via CEUS [125].…”

“…Less than a fifth have calcification [125]. Vas deferens tuberculosis lesions have proven to be heterogeneously and diffusely enhanced via CEUS [125]. Heterogeneous enhancement was categorized as septal, annular, or nodule-in-nodule enhancement [125].…”