Tuberculosis Involving Other Sites
Tuberculous lymphadenitis (scrofula) is by no means rare in many parts of the tropics; one study in Uganda showed that 41% of all enlarged cervical nodes were tuberculous. While tuberculosis is the most common cause of lymphadenopathy under the age of 30
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P. E. S. Palmer: The Imaging of Tuberculosis
Tuberculosis Involving Other Sites Tuberculous Lymphadenopathy
Abdominal tuberculosis (see p. 69)
is usually of a carcinoma or, in the more acute cases, a pyogenic breast abscess. Mammography shows the palpable mass as a diffu~e density, which, when there is fluid, may change In shape and density on the two standard mamm~ graphic projections. There may be one or ~ore SInus tracts connecting the mass to the thIckened, overlying skin. In some patients the skin bulges (Fig. 104C), probably at the stage before the sinus tract has formed. The underlying breast stroma is coarse, and may be reticulated. There is almost always nipple retraction. The breast size is often reduced. Ultrasonography can be used to confirm the fluid, but does not give much further information. In some patients there will be minimal regional lymphadenopathy, but in others the lymph nodes are normal. The usual mammographic diagnosis is "chronic breast inflammation or breast abscess;' but many of the masses will suggest malignancy. Recognition of the sinus tract and the skin thickening should suggest tuberculosis, particularly when there is little surface pain clinically. Unfortunately, many sinus tracts become secondarily infected and there is then a pyogenic breast abscess: only histology will show the underlying tuberculosis. (The differential diagnosis, apart from malignancy and pyogenic abscess, will include, in the painless lesion, syphilis, mycotic infections, and parasites such as guinea worm.)
Tuberculous lymphadenitis (scrofula) is by no means rare in many parts of the tropics; one study in Uganda showed that 41 % of all enlarged cervical nodes were tuberculous. While tuberculosis is the most common cause of lymphadenopathy under the age of 30 years (unless the patient has Burkitt's lymphoma) there will also be a significant number of elderly patients in whom cervical lymphadenopathy is tuberculous in origin. Ultrasonography can accurately demonstrate the lymphadenopathy (as can CT or MRI), but cannot establish the etiology. Most lymph nodes will appear as hypoechoic masses with a regular outline; often multiple enlarged nodes are present. Ultrasonography is most useful for the accurate follow-up of resolution during treatment. During the acute stage there are no changes of radiological significance; when the infection. has healed, calcification frequently follows. CalcIfied lymph nodes may be seen not only in the neck, but in the axilla, around the shoulder, in the inguinal region, in the popliteal fossa, and elsewhere (Fig. 103). All must be differentiated from other causes of soft tissue calcification, e. g., parasites, or, in the limbs, from tumoral calcinosis. This is usually possible because calcified tuberculous gran~o mas are irregular in size and shape but, more Importantly, their anatomical situation may suggest the Tuberculosis of the Parotid Gland diagnosis. Calcified tuberculomas may be seen in the liver and Tuberculosis of the parotid gland is uncommon, but spleen, but have
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