The patient was a 38-year-old woman. Her main complaint was "deep abdominal pain and discomfort for nearly a month", accompanied by nausea and vomiting. After anti-infection treatment, abdominal CT revealed space-occupying lesions on the anterior edge of the inferior vena cava, which were diagnosed as a pancreatic tumor or enlarged lymph node. Ten days later, abdominal MRI showed abnormal signals at the hepatic hilum and near the celiac trunk, which led to the diagnosis of enlarged lymph nodes. The overall initial diagnosis was proposed as "pancreatic space-occupying lesions".
The patient's clinical signs, blood routine, biochemical examinations, and duodenoscopy were all normal, and no abnormalities were observed in serum tumor markers AFP, CEA, CYFRA21-1, SCC, NSE, HE4, CA125, CA19-9, CA15-3, CA50, CA242, or CA72-4. Since the patient refused a biopsy of the tumor, 18F-FDG PET-CT was performed in order to understand the nature of the tumor and the condition of the systemic lymph nodes. As shown on 18F-FDG PET-CT (Figure 1), a soft-tissue mass about 2.8 cm in diameter was present in the hilar area, with punctate high-density shadows, unclear borders, and abnormal concentration of imaging agent. The maximum standardized uptake value (SUVmax) was 9.4 on initial imaging, but had became 12 2 hours later ony delayed imaging. Enhanced CT (Figure 2) revealed no vascular envelopment in the mass. Based on these results, the patient was diagnosed with tuberculosis of celiac lymph nodes. This diagnosis was confirmed by the strong positive result from the tuberculin test. Five months after antituberculosis treatment, the patient's clinical symptoms had disappeared. Follow-up checking using 18F-FDG PET-CT imaging (Figure 3) showed that the mass had become smaller with a diameter of about 1.5 cm, along with increased internal punctate high-density shadow and SUVmax reduced to 8.1. These follow-up findings demonstrated effective antituberculosis treatment and led to continued treatment for the patient.