Woman with RLQ pain
Differential Diagnosis of Mesenteric Lymphadenitis:
Infectious- Bacteria (Yersinia enterocolitica, Y. Pseuodotuberculosis, Mycobacterium tuberculosis, beta-hemolytic streptococcus, staphylococcus) or viral (coxsackieviruses A and B, rubeola virus, HIV, cat scratch disease and adenovirus serotypes 1, 2, 3, 5, and 7)
Lymphoma
Metastatic disease
Chronic granulomatous disease
Drug reaction
Sarcoidosis
Diagnosis: Pathology proven necrotizing granulomatous lymphadenitis with eosinophils
Mesenteric lymphadenitis - Key points:
Mesenteric lymphadenitis is enlargement and inflammation of lymph nodes in the small bowel mesentery.
Patients present clinically with vomiting, diarrhea, and fever. They also complain of RLQ pain and tenderness.
More commonly seen in children < 15 years of age.
CT will demonstrate enlarged mesenteric lymph nodes, most commonly in the RLQ. There may also be ileal wall thickening (33%) and colonic wall thickening (18%).
Diagnosis criterion by CT requires the presence of 3 or more enlarged lymph nodes usually in the RLQ with short axis diameter > 5mm.
Very important to differentiate this from appendicitis.
If mild, treatment is usually supportive. If symptoms are severe, then treatment consists of broad-spectrum antibiotics. Surgery is reserved for cases with suppuration and/or abscess, with signs of peritonitis, or if acute appendicitis cannot be excluded with certainty.
Reference: AuntMinnie
http://education.auntminnie.com/QMachine.ASP?UID=1YI0TV9E&PageId=1&Sess=7844202
Differential Diagnosis of Mesenteric Lymphadenitis:
Infectious- Bacteria (Yersinia enterocolitica, Y. Pseuodotuberculosis, Mycobacterium tuberculosis, beta-hemolytic streptococcus, staphylococcus) or viral (coxsackieviruses A and B, rubeola virus, HIV, cat scratch disease and adenovirus serotypes 1, 2, 3, 5, and 7)
Lymphoma
Metastatic disease
Chronic granulomatous disease
Drug reaction
Sarcoidosis
Diagnosis: Pathology proven necrotizing granulomatous lymphadenitis with eosinophils
Mesenteric lymphadenitis - Key points:
Mesenteric lymphadenitis is enlargement and inflammation of lymph nodes in the small bowel mesentery.
Patients present clinically with vomiting, diarrhea, and fever. They also complain of RLQ pain and tenderness.
More commonly seen in children < 15 years of age.
CT will demonstrate enlarged mesenteric lymph nodes, most commonly in the RLQ. There may also be ileal wall thickening (33%) and colonic wall thickening (18%).
Diagnosis criterion by CT requires the presence of 3 or more enlarged lymph nodes usually in the RLQ with short axis diameter > 5mm.
Very important to differentiate this from appendicitis.
If mild, treatment is usually supportive. If symptoms are severe, then treatment consists of broad-spectrum antibiotics. Surgery is reserved for cases with suppuration and/or abscess, with signs of peritonitis, or if acute appendicitis cannot be excluded with certainty.
Reference: AuntMinnie
http://education.auntminnie.com/QMachine.ASP?UID=1YI0TV9E&PageId=1&Sess=7844202
全站熱搜
留言列表
