Abstract:

Objective To explore the CT imaging features of cervical lymph node tuberculosis.Methods A retrospective analysis was conducted to analyze the CT imaging data of 66 patients with surgical excision and pathological confirmed cervical lymph tuberculosis in the Fifth People’s Hospital of Suzhou from August 2015 to August 2017. Among them, there were 28 (42.4%) males and 38 (57.6%) females. Patients were aged 15-75 years, with an average age of (31.7±12.9) years. The lesion location, CT classification and imaging signs of all patients were analyzed.Results Among the 66 cases with cervical lymph tuberculosis, 65 (98.5%) cases had multiple lesions, 1 (1.5%) case had single lesion, 39 (59.1%) cases had bilateral lesions, and 27 (40.9%) cases showed unilateral lesion. As for the location distribution, lesions in 59 cases (89.4%) were distributed in multiple node levels, but only 7 cases (10.6%) had lesions in single level. The most common levels of cervical lymph node tuberculosis were as follows: 35 (53.0%) cases in Ⅱb level, 30 (45.5%) cases in Ⅰa level, 30 (45.5%) cases in Ⅰb level, 26 (39.4%) cases in Ⅳb level, 23 (34.8%) cases in Ⅱa level, 22 (33.3%) cases in Ⅲ level, and 18 (27.3%) cases in Ⅳa level. Lymph nodes CT classification and imaging findings were as follows.Type Ⅰ: homogeneous enhancement type was observed in 49 (74.2%) cases, showing tuberculous nodules and granuloma; Type Ⅱ: envelop enhancement was detected in 24 (36.4%) cases, manifested as caseous necrosis of lymph nodes, envelop enhancement, and no enhancement in the central low-density area; Type Ⅲ: edge enhancement was detected in 34 (51.5%) cases, manifested as lymph node envelope necrosis, segregation, marginal enhancement, no enhancement in the central low-density area, and disappearance of the surrounding fat gap; Type Ⅳ: non-uniform reinforcement type (or fusion type) was found in 44 (66.7%) cases, of which 8 (12.1%) cases were complicated with sinus tract, manifested as lymph node caseous necrosis, destruction and invasion to the surrounding tissues, inhomogeneous marginal enhancement, disappearance of the normal structure of lymph nodes, disappearance of the surrounding fat space, and visible sinus tract. In most cases (90.9%, 60/66), peripheral tissue invasion from the primary lesions was found in varying degrees.Conclusion Cervical lymph node tuberculosis has the characteristics of lesion distribution in multiple lymph node levels, multiple CT classification types and multiple imaging sings. The method of CT-enhanced examination can display the pathological changes of lesions with high quality, and has a high diagnostic value.

Key words: Tuberculosis, lymph node, Neck, Diagnostic imaging, Pathology, clinical