Case contributed by Ryan Thibodeau
Diagnosis certain


Constant hiccups for the past four days. Evaluate for thoracic mass.

Patient Data

Age: 50 years
Gender: Male

There is bulky right axillary lymphadenopathy. The largest right axillary lymph node measuring approximately 5.0 x 2.7 cm.

Histologic findings of right axillary lymph node dissection reveal confluent granulomatous reaction throughout the lymph node, associated with necrosis.  Special stains for acid fast and fungal organisms (AFB, GMS, DPAS, and mucicarmine) demonstrate rare foci with beaded acid-fast rods, consistent with mycobacterial organisms.  No other organism is demonstrated.

A CT head was ordered to evaluate for intracranial bleed or mass.


There is extensive right parieto-occipital and temporal lobe hypodensity with associated sulcal effacement. There is 1.2 cm leftward midline shift. There is dilation of the left lateral ventricle relative to the right. A relatively hyperdense component within the surrounding vasogenic edema measuring 1.8 x 2.2 cm at the right parieto-occipital junction and may represent an underlying mass.