Hepatic hilar tuberculosis lymphadenitis diagnosed by endoscopic ultrasound-guided fine needle aspiration: a case report and literature review

BACKGROUND: Hepatic hilar tuberculosis lymphadenitis is a rare condition that often mimics other diseases, leading to diagnostic challenges due to its nonspecific clinical presentation. It can be easily mistaken for a malignant tumor, complicating the diagnostic process. CASE PRESENTATION: A 34-year-old woman was incidentally found to have a space-occupying lesion in the porta hepatis during a routine physical examination. Imaging revealed an irregular mass located posterior to the portal vein and in the head of the pancreas. Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) was performed, yielding necrotic material, multinucleated giant cells, and epithelioid cells, suggestive of tuberculosis. Acid-fast bacilli were detected on smear, confirming the diagnosis of porta hepatis tuberculosis. MANAGEMENT AND OUTCOME: After the initiation of anti-tuberculosis therapy, follow-up CT scans demonstrated a reduction in lesion size with partial calcification. EUS-FNA played a crucial role in providing a timely cytological and histopathological diagnosis, enabling early treatment and avoiding unnecessary surgical interventions such as exploratory laparotomy. CONCLUSION: This case underscores the utility of EUS-FNA in diagnosing rare conditions like hepatic hilar tuberculosis lymphadenitis, highlighting its value in differentiating tuberculosis from malignancy and guiding appropriate clinical management.