Elastography and dopplerography in the diagnosis and treatment of purulent and fibrous processes of the lymph nodes in tuberculosis

Background: Tuberculous lymphadenitis is a common form of extrapulmonary tuberculosis, often posing diagnostic challenges due to its similarity to other forms of lymphadenopathy. Traditional diagnostic methods rely on invasive procedures, which may not be accessible in resource-limited settings. The integration of ultrasonography (US), Doppler imaging, and elastography offers a promising noninvasive alternative for differentiating purulent and fibrotic processes in lymph nodes. Objective: To evaluate the diagnostic accuracy of ultrasonography, Doppler imaging, and elastography in differentiating purulent and fibrotic lymph nodes in patients with tuberculous lymphadenitis. Methods: A total of 150 patients with suspected tuberculous lymphadenitis underwent ultrasonography, Doppler imaging, and elastography at the Research Institute of Phthisiology and Pulmonology. Ultrasonography assessed lymph node size, echogenicity, and corticomedullary differentiation. Doppler imaging evaluated vascularization, while elastography measured tissue stiffness using strain ratios. Microbiological confirmation was performed using fine-needle aspiration cytology (FNAC) or biopsy as the gold standard. Results: Ultrasonography identified pathological lymph node enlargement in 66.7% of cases, while Doppler imaging revealed high central vascularization in 58% of patients. Elastography results indicated low stiffness in 67.2% of lymph nodes, suggesting purulent content, whereas 22% of nodes demonstrated high stiffness, indicating fibrosis. The combined imaging approach achieved a sensitivity of 93% and specificity of 88%. Conclusions: The combination of ultrasonography, Doppler imaging, and elastography provides a highly accurate, noninvasive method for evaluating lymph nodes in tuberculous lymphadenitis, effectively distinguishing between purulent and fibrotic processes. This approach offers a practical alternative to invasive methods, particularly valuable in resource-limited diagnostic settings.