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Tuberculosis - cervical lymph nodes and lung

Case contributed by Alexandra Stanislavsky
Diagnosis almost certain

Presentation

Fevers and an enlarging neck mass.

Patient Data

Age: 30 years
Gender: Male

Large, centrally necrotic, lobulated mass in the path the lower internal jugular chain on the left, consistent with a matted group of enlarged, necrotic lymph nodes (scrofula).

Review of the lung apices reveals a right upper lobe opacity with central cavitation.

Increased soft tissue density projected over the left upper chest, and patchy right apical opacities which happen to overlie the 1st rib.

Case Discussion

CT of the neck demonstrates a large, centrally necrotic, lobulated mass in the path the lower internal jugular chain on the left, consistent with a matted group of enlarged, necrotic lymph nodes (scrofula).

Review of the lung apices reveals a right upper lobe opacity with central cavitation.

Although subtle, both of these findings are observed on the chest x-ray: increased soft tissue density projected over the left upper chest, and patchy right apical opacities which happen to overlie the 1st rib.

The patient was a resident of a tuberculosis endemic area and TB treatment commenced while cultures are in progress.  Quantiferon assay positive.

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