Enlarged Abdominal Nodes Research Articles

Imaging features of multicentric Castleman's disease in HIV infection

AIM: To describe the computed tomography (CT) features of human immunodeficiency virus (HIV)-associated Castleman's disease. MATERIALS AND METHODS: Nine HIV-positive patients with biopsy-proven Castleman's disease were studied. Clinical and demographic data, CD4 count, histological diagnosis and human herpes type 8 (HHV8) serology or immunostaining results were recorded. CT images were reviewed independently by two radiologists. RESULTS: CT findings included splenomegaly ( n=7) and peripheral lymph node enlargement (axillary n=8, inguinal n=4). All nodes displayed mild to avid enhancement after intravenous administration of contrast material. Hepatomegaly was evident in seven patients. Other features included abdominal ( n=6) and mediastinal ( n=5) lymph node enlargement and pulmonary abnormalities ( n=4). Patterns of parenchymal abnormality included bronchovascular nodularity ( n=2), consolidation ( n=1) and pleural effusion ( n=2). On histological examination eight patients (spleen n=3, lymph node n=9, lung n=1 bone marrow n=1) had the plasma cell variant and one had mixed hyaline-vascular/plasma cell variant. The majority had either positive immunostaining for HHV8 or positive serology ( n=8). CONCLUSION: Common imaging features of multicentric Castleman's disease in HIV infection are hepatosplenomegaly and peripheral lymph node enlargement. Although these imaging features may suggest the diagnosis in the appropriate clinical context, they lack specificity and so biopsy is needed for diagnosis. In distinction from multicentric Castleman's disease in other populations the plasma cell variant is most commonly encountered, splenomegaly is a universal feature and there is a strong association with Kaposi's sarcoma.

Disseminated mycobacterial infection in AIDS patients: abdominal US features and value of fine-needle aspiration biopsy of lymph nodes and spleen

We evaluated the efficacy of abdominal ultrasound (US) and fine-needle aspiration biopsy (FNAB) in the diagnosis of disseminated mycobacteriosis (DM) in acquired immunodeficiency syndrome (AIDS). Twelve AIDS patients (nine male, three female; age range, 22-43 years) with DM underwent abdominal US within 2 days after admission with 3.5- to 5-MHz convex probes and a 7.5-MHz linear probe. All patients underwent FNAB of one or two enlarged abdominal lymph nodes. Eight patients underwent FNAB of the spleen. The aspirated specimens were stained with acid fast for quick examination and cultured for isolation of mycobacteria. Abdominal US showed enlarged, hypoechoic, round or oval, abdominal lymph nodes (diameter, 10-35 mm; mean, 18 mm) in all patients; splenomegaly (spleen diameter, 14-22 cm; mean, 16.8 mm) in all patients; numerous splenic abscesses (diameter, 3-20 mm) in nine patients; hepatomegaly (right hepatic lobe thickness, 14.5-17 cm) in all patients; small intestinal wall thickening in five patients (maximum bowel wall thickness, 7-15 mm); mild to moderate ascites in six patients; pleural effusion in four patients; bilateral enlargement of the kidneys with hyperechogenicity of the cortex in three patients; and a retroperitoneal tubercular abscess in one patient. No complication occurred after FNAB of lymph nodes and spleens. Fast-acid stain of spleen and/or lymph node FNAB specimens allowed early diagnosis of mycobacteriosis in 12 of 12 cases (100%). Cultures of lymph node aspirates grew mycobacteria in six of 12 patients (50%). Spleen aspirates grew mycobacteria in nine of nine patients (100%). Blood cultures were positive in four of 12 patients (33%). Mycobacterium tuberculosis was diagnosed in six patients and M. avium in five. Abdominal US features can suggest DM in AIDS patients. Spleen and/or lymph node FNAB indicated the specific diagnosis in 100% of patients.

T-cell lymphocytic leukaemia and lymphoma in a horse

Extract A 10-year-old Thoroughbred gelding showed rapid weight loss over about 1 week. Clinically, it had increased respiration and heart rates, dark red mucous membranes with petechial haemorrhages, and a bilateral keratitis. Routine haematological examination showed a lymphocytosis with increased numbers of small hyperchromatic lymphocytes in circulation, but no anaemia. On necropsy, many enlarged abdominal lymph nodes were seen and there was a large amount of fluid in the peritoneal cavity and pericardial sac. Histopathologically, small lymphocytes infiltrated most tissues including the bone marrow, lymph nodes, liver, gastrointestinal tract and cornea. These were identified as T-lymphocytes by the use of immunohistochemistry and CD3 (positive), CD20 (negative) and CD 79a (negative) markers. A T-cell lymphocytic leukaemia and multicentric lymphoma with generalised tissue infiltration were therefore diagnosed.

Fifty-three year old woman with chylothorax and mediastinal and abdominal lymph node enlargement

Fifty-three year old woman with chylothorax and mediastinal and abdominal lymph node enlargement

Imaging findings of mantle cell lymphoma involving gastrointestinal tract.

Clinical manifestations and imaging findings of mantle cell lymphoma involving gastrointestinal tract were evaluated. The subjects were 7 cases of mantle cell lymphoma involving the gastrointestinal tract. All cases were pathologically confirmed in our hospital during the period from April 1994 to July 2000. Five patients were male and 2 were female, and their age ranged from 49 to 63 years (average 57.4). The objectives were: 1) characteristics and distribution of multiple polyposis, 2) presence, location and enhancement pattern of bowel wall thickening or mass formation, 3) presence of splenomegaly, 4) presence and location of abdominal lymph node enlargement, 5) involved extra-abdominal organs, 6) combined cancer and location, and 7) other findings. All mantle cell lymphomas occurred in elderly persons, over 40 years, and most showed multiple polyposis (6/7), bowel wall thickening or mass formation (6/7), lymph node enlargements (6/7) and extra- abdominal involvement (5/7). All cases of polyposis involved the small bowel and colon, and the size of the polyps ranged from 0.1-4.0cm. Four of 6 patients showed combined sessile and polypoid polyps, while the other 2 showed only sessile polyps. Most of or some of the polyps in 3 patients showed small central ulcerations. Most of the patients (5/6) showed an uncountable number of polyps. Polyposis was predominant in the rectum, ascending colon, rather than other sections in the colon, and the ileum were almost always involved by polyposis. Bowel wall thickening or mass formation developed exclusively in the ascending colon, rectum or ileum. Extra- abdominal involvement developed either simultaneously or nonconcurrently with gastrointestinal involvement. Some of patients showed splenomegaly (3/7), appendiceal enlargement (2/7), and intussusception (1/7), and some had associated adenocarcinomas (3/7).

Lymphangioleiomyomatosis: CT of diurnal variation of lymphangioleiomyomas.

To evaluate the imaging and clinical features of lymphangioleiomyomas and to describe the phenomenon of diurnal variation in the size of lymphangioleiomyomas in patients with lymphangioleiomyomatosis. One hundred twenty-eight patients with lymphangioleiomyomatosis underwent chest and abdominopelvic computed tomography (CT). Thirteen patients underwent CT in the morning and afternoon of the same day to assess diurnal variation in lymphangioleiomyoma size. Twenty-seven of 128 patients (21%) had 54 lymphangioleiomyomas. The vast majority (96%) of these masses contained material of low attenuation at CT. Associated CT findings included enlarged abdominal lymph nodes, pleural effusions, ascites, and dilatation of the thoracic duct. The prevalence of lymphangioleiomyomas was 15% in patients who had mild pulmonary disease, 19% in patients who had moderate disease, and 26% in patients who had severe disease. Diurnal variation in size of masses was demonstrated in 12 of 13 patients. Seven of the 27 patients who had masses underwent biopsy; all seven were confirmed to have lymphangioleiomyomas. The most common symptoms associated with lymphangioleiomyomas were bloating, abdominal pain, and edema of the lower extremities. The majority of the patients reported worsening of symptoms as the day progressed. Lymphangioleiomyomas are common in patients with lymphangioleiomyomatosis. Diurnal variation in size may explain worsening of symptoms during the day.

Lymphadenomegaly in patients with chronic liver disease

Abdominal lymphadenomegaly is a frequent ultrasonographic finding in patients with chronic liver disease. Its clinical significance is not well understood. The aim of this study was to determine the relationship between this finding and several characteristics of liver disease in 44 patients with chronic liver disease (79.5% due to hepatitis C virus). To do this, all patients underwent simultaneous liver biopsy and abdominal ultrasonography, in which the number and localization of the enlarged abdominal lymph nodes were confirmed. Viral load in patients with chronic hepatitis C virus infection was determined. No significant differences were found in serum hepatitis C RNA concentrations between patients who presented lymphadenomegaly and those who did not. However, the presence of lymphadenomegaly was associated with greater histological activity. If this finding were confirmed in studies with larger samples, the presence of ultrasonographically-detected enlarged abdominal lymph nodes in patients with chronic liver disease due to hepatitis C virus infection would indicate more severe histological lesions.

Lymphangioleiomyomatosis: abdominopelvic CT and US findings.

To describe the abdominal computed tomographic (CT) and ultrasonographic (US) findings in patients with thoracic lymphangioleiomyomatosis (LAM) and to relate the prevalence of the findings to the severity of pulmonary disease. Eighty patients with LAM underwent chest and abdominopelvic CT and abdominopelvic US. The images were reviewed prospectively by one radiologist, and the abdominal findings were recorded and correlated with the severity of pulmonary disease at thin-section CT. Sixty-one (76%) of 80 patients had positive abdominal findings. The most common abdominal findings included renal angiomyolipoma (AML) in 43 patients (54%), enlarged abdominal lymph nodes in 31 (39%), and lymphangiomyoma in 13 (16%). Less common findings included ascites in eight (10%), dilatation of the thoracic duct in seven (9%), and hepatic AML in three (4%). A significant correlation (P =.02) was observed between enlarged abdominal lymph nodes and increased severity of lung disease. There are characteristic abdominal findings in patients with LAM that, in conjunction with the classic thin-section CT finding of pulmonary cysts, are useful in establishing this diagnosis.

Lack of detection of hepatitis C virus replicative intermediate in abdominal lymph nodes

Deep abdominal lymph node enlargement has been detected by ultrasound examination in patients with hepatitis C virus (HCV) infection. To clarify the potential for extrahepatic existence and/or replication of HCV in such abdominal lymph node, positive- and negative-strand HCV RNA were investigated in abdominal lymph node mononuclear cells (MNC) as well as in the serum of patients with HCV. The study population consisted of eight hepatocellular carcinoma (HCC) patients positive for antibody to HCV (anti-HCV). Lymph nodes of hepatoduodenal ligament were resected at surgery for HCC. Both HCV RNA strands were examined using highly strand-specific r Tth reverse transcription-polymerase chain reaction (r Tth RT-PCR) followed by Southern blotting analysis. Positive-strand HCV RNA was detected in three (37.5%) abdominal lymph node MNC and in seven (87.5%) serum samples. Negative-strand HCV RNA was not detected in abdominal lymph node MNC, while it was observed in two (25%) serum samples. Histologically, the lymph nodes taken from subjects showed reactive follicular hyperplasia with or without the presence of HCV RNA. These observations suggest that HCV is located in the abdominal lymph nodes, but does not replicate within them. Negative-strand HCV RNA detected in serum samples may have been due to contamination with circulating HCV RNA from hepatocytes.

Mycobacteremia in Patients With the Acquired Immunodeficiency Syndrome

Bacillemia is a key event in the pathogenesis of tuberculosis. Although current evidence indicates that Mycobacterium tuberculosis bacteremia is rare in patients seronegative for the human immunodeficiency virus, it has been increasingly reported in patients with the acquired immunodeficiency syndrome (AIDS). To determine clinical and laboratory characteristics of patients with AIDS and tuberculosis with and without bacillemia. Fifty patients with AIDS with clinical suspicion of disseminated mycobacterial disease were prospectively selected. Three consecutive blood samples were collected for culture using a standardized protocol. Mycobacterium was isolated from any body site in 42 patients (84%). Bacillemia was detected in 30 (71.4%) of these 42 patients: 11 (28.2%) caused by Mycobacterium avium-intracellulare complex and 19 (71.8%) caused by M tuberculosis. Blood culture was the only method used to confirm the diagnosis in 5 (15%) of the 33 tuberculosis cases. Tuberculosis in patients with AIDS developed with nonspecific insidious symptoms, a remarkable elevated alkaline phosphatase level, and without the classic miliary radiological pattern. We could demonstrate 2 previously unrevealed clinical characteristics of bacteremic tuberculosis in patients with AIDS: a shift to the left in the white blood cell count and abdominal lymph node enlargement. In patients with tuberculosis, the in-hospital mortality rate was higher among patients with bacillemia, although the posttreatment survival rate was comparable. Blood culture is a valuable tool to confirm the clinical diagnosis of disseminated tuberculosis in patients with AIDS and can distinguish patients with characteristic clinical findings and outcome. Abdominal ultrasonography may be an additional helpful tool to identify these patients.

ENLARGED ABDOMINAL LYMPH NODES IN CIRRHOSIS.

Not infrequently, CT scans detect enlarged abdominal lymph nodes in patients with advanced cirrhosis, and this may raise concern about the possibility

Enlarged abdominal lymph nodes in end-stage cirrhosis: CT-histopathologic correlation in 507 patients.

To determine the frequency, distribution, size, and cause of enlarged abdominal lymph nodes in patients with end-stage cirrhosis. Preoperative computed tomographic (CT) scans from 507 hepatic transplantation patients with end-stage cirrhosis were reviewed for the presence, size, and location of enlarged (short-axis diameter > 1 cm) abdominal lymph nodes. Enlarged lymph nodes were identified and resected at surgery. Resected livers were evaluated for malignant neoplasms. CT findings were correlated with histopathologic results. Enlarged abdominal lymph nodes were detected with CT in 253 (50%) of the patients. The enlarged nodes were 1.1 x 1.1 to 3.0 x 4.5 cm in size and were most common in the portacaval space and porta hepatis. The frequency of enlarged nodes varied according to type of cirrhosis: They were most common in patients with primary biliary cirrhosis (86% [43 of 50]) and least common in patients with alcohol-induced cirrhosis (37% [42 of 113]). Histologic evaluation revealed that the enlarged lymph nodes were due to benign nodal hyperplasia in 251 patients and malignant neoplasm in two patients. Enlarged abdominal lymph nodes are common in patients with all forms of end-stage cirrhosis. In the absence of other evidence of malignancy, enlarged nodes in these patients should be considered a benign process, with no additional evaluation warranted.

The role of computed tomographic examination of the pelvis in the management of testicular germ cell tumours

Aim: To clarify the role of pelvic CT in the imaging of patients with germ cell testicular tumours(GCTT). Patients and methods: A retrospective analysis was undertaken of all CT examinations performed on patients with GCTT at a regional oncological centre over a 3-year-period. Patient notes were reviewed and data on histology, tumour marker levels, therapy and clinical course obtained. The review interpretation was combined with the original radiological report and clinical data to arrive at a consensus result. Results: Four hundred and forty-three examinations on 167 patients were included. One hundred and nineteen examinations (27%) demonstrated abdominal and/or pelvic lymph node enlargement. Nodal metastasis was entirely or predominantly ipsilateral in 73/77 examinations from left-sided primary tumours (95%) and 35/42 examinations from right-sided tumours (83%). Pelvic nodal enlargement was identified in 37 examinations from 16 patients. Thirteen of these sixteen patients possessed an identifiable risk factor for pelvic nodal metastasis; the remaining three had unequivocal nodal metastases in the abdomen. Combined abdominopelvic CT increased the effective dose equivalent (EDE) by 2.6mSv (74%) compared with abdominal examination alone. Three hundred pelvic CT examinations were performed on 117 patients without risk factors for pelvic nodal metastasis. For this cohort the radiation burden from pelvic CT was 0.78 manSv, giving a risk of induction of a single fatal cancer of 3.9%. Conclusion: We advocate pelvic CT only at the time of staging, except in patients with a risk factor for pelvic nodal metastasis. Any unequivocal abdominal lymph node enlargement should be regarded as a risk factor. Implementation of this policy would safely reduce pelvic CT examinations in patients with testicular tumours by nearly 50%, with a consequent reduction in patient radiation exposures and a resource saving.

Acute human schistosomiasis mansoni.

The acute schistosomiasis is the toxemic disease that follow the Schistosoma cercariae active penetration trough screen in the immunologicaly naive vertebrate host. The clinical picture starts two to eight weeks after the first contact with the contaminated water. Susceptible patients present a syndrome comprising fever, diarrhea, toxemia and hepatosplenomegaly. Diagnosis is based on epidemiological and clinical features, presence of Schistosoma eggs in the feces, enlargement of abdominal lymph nodes by ultrasonography and by detection of high antibodies levels against the antigen keyhole limpet haemocyanin. Different rates of cure have been observed with specific medication and for the most severe clinical presentations the use of steroids reduces the systemic and allergic manifestations.

Recurrent esophageal carcinoma: CT evaluation after esophagectomy.

Computed tomographic (CT) scans were retrospectively reviewed for evidence of (a) intragastric soft-tissue mass or gastric wall thickening, (b) extragastric soft-tissue mass or mediastinal lymph node enlargement (local-regional disease), (c) abdominal lymph node enlargement, and (d) metastatic disease to distant organs. Fifty-eight patients with a clinical suspicion of recurrent esophageal carcinoma underwent CT. The thoracic level of local-regional recurrence was compared with the level of the primary tumor. Proof of recurrence status was obtained in 52 of 58 patients. Of the 58 patients, 36 (62%) had CT findings of recurrence, 16 (28%) had no CT findings of recurrence, and six (10%) had CT findings questionable for recurrence. CT accuracy for determining recurrence status was 87%. There was no correlation between the level of primary tumor and that of recurrence. At CT, tumor recurrences were most commonly seen as some combination of local-regional disease, distant metastases, and abdominal lymph node enlargement. CT findings isolated to one region were seen only occasionally.

The Growing Teratoma Syndrome: A Woman with Nonseminomatous Germ Cell Tumor of the Ovary

A 38-year-old woman underwent an incomplete surgical excision of multiple peritoneal nodules from nonseminomatous germ cell tumor of the ovary. Tumor markers normalized with combination chemotherapy but contrasted with abdominal node enlargement. Surgical resection failed to remove abdominal masses completely and histologic examination revealed mature teratoma without malignant cells. Nodules continued to grow, infiltrating the liver parenchyma and causing small bowel necrosis and urinary tract obstruction. According to the literature, this female patient presents the typical features of the growing teratoma syndrome. This syndrome was described in treated nonseminomatous germ cell tumors of the testis. Moreover, this patient had an unexpected very high CA 19-9 level. Treatment by low-dose interferon-α-induced a subjective improvement and a slight decrease in the size of teratomatous cysts.

Simultaneous occurrence of t(14;18) and t(8;22) common acute lymphoblastic leukemia

A young male patient progressed rapidly from localized abdominal lymph node enlargement to overt acute lymphoblastic leukemia. Despite aggressive treatment, he died of progressive CNS leukemia 5 months after initial presentation. At diagnosis, karyotypic analysis of an abdominal lymph node revealed the coexistence of t(14;18) (q32;q21), specific for follicular lymphoma, and t(8;22) (q24;q11), a variant Burkitt translocation. Such cases might be considered as a model for a general mechanism of tumor progression with cascade-like involvement of oncogenes.

Infection by Mycobacterium Avium Intracellulare in AIDS: Endoscopic Duodenal Appearance Mimicking Whipple's Disease

We report the case of a 24-year-old woman who presented with diarrhea, weight loss and abdominal lymph node enlargement. A diagnosis of infection by Mycobacterium avium intracellulare with a clinical picture similar to Whipple's disease was established. The endoscopic study of the duodenum revealed multiple yellow nodules that became confluent in the second portion, entirely replacing the normal mucosa. These endoscopic findings have not been described previously in intestinal infection by Mycobacterium avium intracellulare.

Computerized tomography in the evaluation of abdominal involvement in paracoccidioidomycosis

A tomografia computadorizada foi utilizada para avaliar o comprometimento abdominal em 25 doentes deparacoccidioidomicose. Existiam lesões intra-abdominais em, respectivamente, 75%e23% dos doentes com asformas aguda ("juvenil") e crônica ( do adulto '). A alteração mais freqüente foi o aumento dos gânglios linfáticos abdominais (12/25 casos); outras lesões foram: calcificação de gânglios linfáticos em 4 casos; obstrução das vias biliares em 5 doentes ictéricos; abscessos ou calcificação esplénica em 3 casos; 2 doentes mostraram lesões incomuns: aumento e irrgularidade do pâncreas em um e múltiplos abscessos nos músculos psoas em outro. Conclui-se que a tomografia computadorizada é procedimento útil na avaliação da disseminação da paracoccidioidomicose ao abdome e no diagnóstico de suas complicações abdominais.

Computed tomography in the detection of abdominal metastases from malignant melanoma.

Malignant melanoma is an unpredictable and often virulent cutaneous malignancy. Although computed tomography is the most sensitive method for detection of intrathoracic metastases, its value in the assessment of abdominal spread has not been fully defined. We evaluated the sites of CT-identified metastases in 70 patients with pathologically confirmed malignant melanoma. Results were correlated with Clark's level, Breslow thickness, site of the primary, and clinicopathologic stage. CT detected enlarged abdominal or pelvic lymph nodes in 75% of patients with Clark's level 5 lesions but only in 24% and 33% of those with level 3 and 4, respectively. Patients with deep primary lesions of the lower extremities had a high frequency of pelvic node metastases. Liver and splenic metastases were detected in up to 25% of patients with level 4 or 5 melanoma. Adrenal and subcutaneous metastases were frequently discovered as were unsuspected nodules at the lung bases.