Differential diagnosis of intestinal tuberculosis and primary small intestinal lymphoma using endoscopy and computerized tomography / 中华胃肠外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To analyze the characteristics of intestinal tuberculosis(ITB) and primary small intestinal lymphoma(PSIL) in order to provide clue for the differential diagnosis.</p><p><b>METHODS</b>Data of 24 cases of ITB and 23 cases of PSIL confirmed by surgery and pathology were retrospectively analyzed. The clinical features, endoscopic and CT scan were compared. All the patients had complete clinical and CT data. Twenty cases of ITB and 20 PSIL had complete endoscopic data.</p><p><b>RESULTS</b>ITB was associated with significantly higher proportion of patients with fever(58.3% vs. 4.3%), night sweating(50.0% vs. 8.6%), pulmonary tuberculosis(54.2% vs. 4.3%) and ascites(54.2% vs. 21.7%) than PSIL(all P<0.05), and lower proportion of patients with abdominal mass (4.2% vs. 39.1%), hematochezia (8.3% vs. 47.8%), and perforation (0 vs. 39.1%)(all P<0.01). Endoscopic examination showed circumferential ulcer and rodent ulcer in 40% and 35% of the patients with ITB, and massive lesion and polypoid lesion in 55% of the patients with PSIL(P<0.05). Multi-segmental lesions, layered thickening, pneumatosis intestinalis, edematous ring, bowel lumen narrowing, hollow lymph nodes, and comb sign were more common in ITB(P<0.05), while single segmental lesions, eccentric thickening, and intussusception were more common in PSIL(P<0.05). The enhancement of intestinal wall of ITB were higher than that of PSIL(P<0.05), while the thickening and lymph nodes enlargement of PSIL were higher than that of ITB(P<0.05).</p><p><b>CONCLUSION</b>The clinical characteristics differ between ITB and PSIL and the differential diagnosis can be made by combining endoscopy and CT.</p>