Aspect scanographique des adénopathies mésentériques et rétropéritonéales de la maladie de Whipple

The most characteristic CT image of abdominal involvement in Whipple's disease is the presence of spontaneously hypodense mesenteric and retroperitoneal adenopathies. This hypodensity of the lymph nodes is the consequence of an accumulation of lipid components originating from multiple mechanisms, the most relevant of which is incomplete macrophage degradation of the responsible bacterial agent (T. Whipplei). Pathologists have long described particular macroscopic aspects of the adenopathies of Whipple's disease in the form of multiple gaps with a lipid content which give the tissue an appearance described as “Swiss cheese (Gunther et al., 2015)” or “honeycomb”. We conducted a review about the specific CT image of abdominal lymph nodes in Whipple's disease, correlated to the anatomo-pathological aspect leading to the diagnostic. Here, retrospective analysis of sectional imaging examinations in a multicenter cohort of seven cases of authenticated Whipple's disease allowed specification of the technical conditions for data acquisition and for scanning images to objectify the hypodensity of the lymph nodes masses corresponding to the observed aspects in pathological anatomy. A comprehensive review of the complex pathophysiology of abdominal Whipple's disease followed by examination of CT images (MRI and PET-CT in some cases) in light of the anatomo-pathological data in the literature, allowed us to better understand the semiology. In addition to interest in the positive diagnosis of the disease, it is important to emphasize the contribution of this fine semiology to the differential diagnosis in relation to other causes of lymph useful nodes hypodensity due to lipid overload.