Abstract
A 32-year-old man consulted a local hospital for epigastric pain and was diagnosed as obstructive jaundice. He was referred and hospitalized in our hospital. One year ago, he had treatment of pulmonary tuberculosis. Contrast-enhanced abdominal multi-detector row CT (MD-CT) showed a low density mass with an enhanced rim at hepatic portal region. PTBD was done and revealed a smooth narrowing of the upper part of common biliary duct. Based on these results, we suspected that an enlarged lymph node at hepatic portal region caused obstructive jaundice. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of the lymph node at hepatic portal region was done. The pathology of specimen showed caseating granulomas and polymerase chain reaction analysis for tuberculosis of the specimen was positive. Thus we diagnosed as tuberculous lymphadenitis at hepatic portal region which caused obstructive jaundice. Antituberculosis medications were started and the size of the lymph node reduced gradually. After 6 months, biliary drainage tube was removed, and the patient stayed well without development of jaundice.
