Presentation
Cough and weight loss.
Patient Data
Thickening of the right paratracheal stripe with tracheal deviation to the left. Lungs and pleural spaces are clear. Mild splaying of the carinal suggests subcarinal lymphadenopathy. Heart size is within normal limits. No hilar masses.
CT advised for further assessment.
There is significant mediastinal and cervical lymphadenopathy:
- subcarinal region: soft tissue density mass measuring 4.6 x 5.9 x 2.8 cm causing mild splaying of the carina
- right paratracheal region: multiple lymph nodes, largest measuring 1.7 cm
- right cervical region: enlarged level 4 lymph nodes
There is a focal area ground glass opacity with surrounding nodularity in the lateral segment of the left lower lobe. Multiple small pulmonary nodules throughout both lungs affecting all lobes. These are predominantly peripheral without an upper lobe predominance and likely represent granulomas from tuberculosis infection. The airways are normal. The pleural spaces are clear.
No suspicious bony abnormality identified.
Conclusion
- Subcarinal, right paratracheal and lower right cervical lymphadenopathy. The latter would be ultrasound accessible for FNA.
- Multiple small pulmonary nodules throughout both lungs.
- In the clinical context these findings are consistent with tuberculosis lymphadenitis, possibly primary.
Case Discussion
Good example of thickening of the right paratracheal stripe.
Further history after the CT: 8 months constitutional symptoms of malaise, lethargy, 15 kg unexplained weight loss, nausea and dry cough. Eritrean refugee.
Subsequent positive Quantiferon gold test suggestive of TB.
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