Presentation
Weight loss with increasing mass in right neck. Recent night sweats and fevers. No unwell contacts. Moved from Pakistan 5 years ago.
Patient Data
Multiple, linked collections in the right supraclavicular fossa, extending deep to the musculature. Largest dimension at least 10 cm, but incompletely assessed on US. Thick irregular walls, with internal cystic content. No left sided abnormality or suprahyoid nodal masses.
(The last two images marked LEFT are right sided post aspiration / biopsy).
Large thick-walled nodal abscesses in right level IV and supraclavicular fossa, the largest measuring approximately 6 x 5 x 6.5 cm. The smaller anterior component involves the deep margin of the right sternocleidomastoid, and the larger posterior component is inseparable from the scalene and levator scapula muscles, its inferomedial aspect abutting the right brachial plexus components.
No other definite nodal involvement in the suprahyoid neck, although multiple abnormal prominent nodes are in the infrahyoid neck in the right posterior cervical triangle (levels III, IV and V, short axis diameter up to 8 mm) and in the upper right paratracheal region (short axis diameter up to 5 mm) extending into the mediastinum, with a partly imaged large part-calcified precarinal node (partially included on the field of view of the CT neck, short axis diameter at least 19 mm).
Focal right apical airspace opacification and volume loss and nodular consolidation.
Normal included intracranial appearances.
Normal upper aerodigestive tract. Normal major salivary glands. No other neck mass. Normal opacification of major head and neck vessels.
Normal included skeleton.
Case Discussion
Neck and included chest appearances are suspicious for tuberculous lymphadenitis.
This was confirmed on the aspirate and biopsy results, with full sensitivities. Good clinical response.
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