18F-FDG PET-CT Diagnosis of Tuberculosis in Celiac Lymph Nodes

The special location of abdominal tuberculosis makes it difficult for biopsy, while its clinical and imaging characteristics make it indistinguishable from tumors. Here, we report a female patient that was initially misdiagnosed with pancreatic cancer, but eventually correctly diagnosed with tuberculosis in the celiac lymph nodes using F-18-FDG PET-CT. She was 38 years old. Her main complaint was "deep abdominal pain and discomfort for nearly a month", accompanied by nausea and vomiting. Diagnosis of pancreatic tumors or enlarged lymph nodes was initially made based on CT scan results. Abdominal MRI revealed enlarged lymph nodes. F-18-FDG PET-CT imaging revealed a soft-tissue mass about 2.8 cm in diameter in the hepatic hilar area with a maximum standardized uptake value (SUVmax) of 9.4, and delayed imaging measured the SUVmax at 12. Enhanced CT showed no vascular envelopment in the mass. Based on these results, the patient was diagnosed with tuberculosis in the celiac lymph nodes. Her tuberculin test was strongly positive. After 5 months of antituberculosis treatment, the mass had reduced to about 1.5 cm in diameter and SUVmax reduced to 8.1, as demonstrated by F-18-FDG PET-CT imaging. Abdominal lymphnode tuberculosis is easy to misdiagnose, but timely F-18-FDG PET-CT imaging combined with tuberculin testing may reduce misdiagnosis and mistreatment.