A Case of Tuberculous Lymphadenitis as a Cause of Bile Duct Stenosis

Toshitaka Okuno, Hiroshi Hasegawa, Takahisa Kyogoku, Katsuhiro Sano, Ryuichiro Ikegawa, Yoshikazu Takamine, Masazo Hayashi and Kimio Hashimoto*

Department of Surgery and Department of Pathology*, Nishi-Kobe Medical Center

We report a case of tuberculous lymphadenitis with bile duct stenosis. A 62-year-old man with symptoms of biliary tract obstruction was found in ultrasonography and CT to have a mass in the head of the pancreas that compressed the common bile duct. CT also showed a soft tissue mass with ring enhancement. A tuberculin skin test was positive and chest X-ray showed upper lobe infiltration. Under a diagnosis of tuberculous lymphadenitis, we conducted open biopsy of the lymph node and choledoch-duodenostomy, biopsy specimen showed epithelioid granuloma with caseous necrosis. Mycobacterium tuberculosis was identified by sputum culture. Antituberculous therapy was conducted postoperatively, and the patient has not suffered further illness. Cases of tuberculous lymphadenitis with bile duct stenosis are rare, and only 8 cases have been reported in Japan. CT is thus useful in such preoperative diagnosis.

Key words
tuberculous lymphadenitis, bile duct stenosis, obstructive jaundice

Reprint requests
Toshitaka Okuno Department of Surgery, Nishi-Kobe Medical Center
5-7-1 Kojidai, Nishi-ku, Kobe City, 651-2273 JAPAN

Accepted
June 30, 2004

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