Unusual Presentation of a Caseating Lymphadenitis Causing Abnormal Lymphadeno-Duodenal Communication

Abstract

Aim: To describe the imaging features of a case of abnormal lymphadeno-duodenal communication caused by caseating lymphadenitis. Presentation of Case: The case discussed is of a thirty-five year old Indian woman who presented with abdominal pain, vomiting, fever, loss of appetite and later diagnosed with abnormal lymphadeno-duodenal communication caused by caseating lymphadenitis. Discussion: Caseating lymphadenitis is a chronic disease process that occurs anywhere in the human body and its prevalence varies from region and country. Here, we report a case of lymph node with caseous necrosis causing abnormal lymphadeno-duodenal communication which was diagnosed by Computed tomography. This poses a great diagnostic challenge for a variety of reasons which include its non-specific symptoms, wide range of causes and the complications in the case of a delayed diagnosis. Abdominal involvement can occur in the peritoneum and the mesentery. Imaging plays a very important role to assess the cause of caseating lymph nodes and identify the complications. Conclusion: As abnormal lymphadeno-duodenal communication is an unusual condition and rarely reported, it is important to consider the possibility of tuberculosis as one of the underlying etiology. A high index of suspicion needs to be maintained for timely diagnosis and accurate treatment.