DOI: 10.1148/radiol.2421060025
(Radiology 2007;242:318.)
© RSNA, 2007
Regarding "Case 90: Disseminated Tuberculosis"
Jorge Ahualli, MD
Department of Computed Tomography, Centro Radiológico Luis Méndez Collado, Muñecas 444, San Miguel de Tucumán, Tucumán 4000, Argentina
e-mail: joahualli{at}sinectis.com.ar
Editor:
I read with interest the article by Dr Pérez-Solís and colleagues (1) entitled "Case 90: Disseminated Tuberculosis," in the January 2006 issue of Radiology, and I congratulate the authors on their impressive report.
The authors expressed that enlarged lymph nodes with a low-attenuation center and a contrast material–enhanced rim on abdominal computed tomography (CT) scans can be observed in tuberculosis, metastasis from testicular tumors, Whipple disease, and lymphoma after radiation therapy.
However, I consider it very important to include cavitating mesenteric lymph node syndrome (CMLNS) in the differential diagnosis. CMLNS is a documented but uncommon and poorly understood complication of celiac disease that is characterized by the presence of multiple cystic masses containing thin milky fluid or thick creamy material that is typically present along the jejunoileal mesentery. Findings at histopathologic examination reveal the mesenteric masses to be pseudocystic lymph nodes with a central cavity containing chylous fluid and a thin peripheral rim composed of fibrous material and scant elements of atrophic lymph node structures. At CT, multiple cystic mesenteric masses are identified that have central low attenuation, indicating fluid, and that occasionally have fatty material (2–4).
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References
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- Pérez-Solís D, Luyando LH, Callejo-Ortea A, Crespo-Hernández M. Case 90: disseminated tuberculosis. Radiology 2006;238:366–370.[Free Full Text]
- Lucey BC, Stuhlfaut JW, Soto JA. Mesenteric lymph nodes seen at imaging: causes and significance. RadioGraphics 2005;25:351–365.[Abstract/Free Full Text]
- Méndez-Uriburu L, Ahualli J, Méndez-Uriburu J, et al. CT appearances of intraabdominal and intrapelvic fatty lesions. AJR Am J Roentgenol 2004;183:933–943.[Free Full Text]
- Huppert BJ, Farrell MA, Kawashima A, Murray JA. Diagnosis of cavitating mesenteric lymph node syndrome in celiac disease using MRI. AJR Am J Roentgenol 2004;183:1375–1377.[Free Full Text]
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