Clinical and CT characteristics of abdominal tuberculous lymphadenopathy: a comparative analysis of hematogenous and non-hematogenous dissemination.

Objectives: To elucidate the differences in clinical and CT manifestations between abdominal tuberculous lymphadenopathy (ATBL) resulting from hematogenous and non-hematogenous dissemination.

Methods: A retrospective analysis was conducted on the clinical records and CT data of 178 untreated ATBL patients from January 2012 to March 2023. Patients were categorized into two groups: hematogenous dissemination (75 cases) and non-hematogenous dissemination (103 cases). The clinical characteristics of the two groups of patients were compared, and the CT imaging features of ATBL (such as location, size, and enhancement degree) were evaluated. Statistical analyses were performed using Student's t-test or Mann-Whitney U test and Chi-squared test to identify significant differences between the groups.

Results: The study found that the non-hematogenous dissemination group had a higher prevalence of males, younger patients, abdominal distension, and positive tuberculin skin test (TST) results, along with higher CD4⁺ T cell counts and lymphocyte counts. Conversely, the hematogenous group exhibited more HIV-positive patients, positive results of smear microscopy for acid-fast bacilli (AFB) staining, pleural effusion, and cough and sputum production. Significant differences were noted in the distribution, size, fusion, and enhancement patterns of ATBL between the two groups. ATBL in the hematogenous dissemination group predominantly involved the upper and lower para-aortic regions, the hepatoduodenal ligament, the portocaval space, the hepatogastric ligament, and the iliac vessels region. In contrast, the non-hematogenous dissemination group had more involvement in the mesenteric region. Lymph nodes in the hematogenous dissemination group were larger diameters, with irregular mass fusion and mixed enhancement pattern, while homogeneous enhancement was more common in the non-hematogenous dissemination group.

Conclusion: There are differences in the clinical and CT manifestations of ATBL caused by hematogenous versus non-hematogenous dissemination.