Pancreatic Tuberculosis: A Clinical and Imaging Review of 32 Cases
Pancreatic Tuberculosis: A Clinical and Imaging Review of 32 Cases
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DOI：
10.1097/rct.0b013e31816c82bc
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发表时间：
2009-01-01
影响因子：
1.3
通讯作者：
Thapar, Vinay B.
中科院分区：
文献类型：
--
作者：
Nagar, Arpit M.;Raut, Abhijit A.;Thapar, Vinay B.
背景：胰腺结核是一种罕见的疾病，医学文献中已有描述胰腺结核影像特征的轶事报道。对诊断为胰腺结核的384例腹部结核患者的CT和B超表现进行了分析，并对其临床表现和实验室检查进行了总结。材料和方法：对384例腹部结核的临床资料进行分析，发现32例(8.33%)胰腺受累。其中男22例，女10例，年龄19~，平均42.5岁，均为1999~2004年我所发现的胰腺结核患者。我们回顾了所有患者的临床、放射学(超声和CT特征)和实验室检查结果。诊断标准为腹水腺苷脱氨酶水平14例，淋巴结细针吸取细胞学检查9例，胸片发现肺结核9例。抗结核治疗6个月后，25例抗结核治疗有效，3例耐药结核，2例死亡，2例失访。结果：男女之比为2.2：1，发病高峰在40岁(30~39岁)。症状持续时间为2个月至1个月，平均6个月。最常见的症状是局限于上腹部的腹痛。16例HIV-1感染患者血清阳性。14例有肺部结核病史，18例以胰腺及胰周受累为主要表现，超声表现为5例胰腺肿大不均匀，7例均可见单发或多发低回声，20例均有低回声。在29例患者中，CT表现为胰腺内低密度聚集与胰周淋巴结病相关。3例患者有复杂的胰腺肿块病变。结论：胰腺结核具有不同的影像表现。胰腺占位性病变合并胰腺周围淋巴结病的患者应考虑胰腺结核的诊断可能性。
Background: Tuberculosis of the pancreas is a rare entity, and anecdotal reports describing imaging features of pancreatic tuberculosis have been described in medical literature. The imaging features including computed tomography (CT) and ultrasonography in diagnosed cases of tubercular involvement of the pancreas are described, with an overview of clinical features and laboratory investigations.Materials and Methods: We analyzed records of 384 patients of diagnosed cases of abdominal tuberculosis for involvement of pancreas and detected 32 patients (8.33%) who had pancreatic involvement. This included 22 men and 10 women with an age range of 19 to 64 years (mean age of 42.5 years), who were detected to have pancreatic tuberculosis from 1999 to 2004 in our institute. We reviewed the clinical, radiologic (ultrasonographic and CT features), and laboratory findings of all patients. The criteria for diagnosis of tuberculosis were based on ascitic fluid adenosine deaminase level in 14 patients, fine-needle aspiration cytology of lymph nodes in 9 patients, and presence of pulmonary tuberculosis on chest radiograph, which was found in 9 patients. On follow-up, 6 months after antituberculous treatment, 25 patients showed response to anti-Koch's treatment, 3 patients had drug-resistant tuberculosis, 2 patients died, and 2 patients were lost to follow-up.Results: The male/female ratio was 2.2:1. The maximum number of patients was in the fourth decade (30-39 years). The duration of symptoms was spanning between 2 and I I months, with a mean duration of 6 months. The most common symptom was abdominal pain localized to the epigastrium. Sixteen patients were seropositive for HIV-1 infection. Fourteen patients had history of tuberculosis of the lungs, whereas 18 patients had pancreatic and peripancreatic involvement as the primary manifestation.Ultrasonography showed bulky inhomogenous pancreas in 5 patients, solitary or multiple hypoechoic collections were observed in all 7 and 20 patients, respectively. CT findings demonstrated hypodense collections within the pancreas associated with peripancreatic lymphadenopathy in 29 patients. Three patients had a complex pancreatic mass lesion.Conclusions: Pancreatic tuberculosis can present with a variable spectrum of imaging findings. Tuberculosis of the pancreas should be considered as a diagnostic possibility in patients who present with a pancreatic space occupying lesion associated with peripancreatic lymphadenopathy.