Presentation
Neck swelling and night sweats.
Patient Data
Multiple rim enhancing, lobulated right neck collections are confirmed on CT extending from the right subocciptal region to the right supraclavicular level. There is exophytic protrusion of a right posterior-lateral neck collection.
The largest collection extends from the posterior margin of the right IJV (which appears indented) with no appreciable fat plane between the IJV and the collection (level II). Bilateral internal jugular veins are patent.
No left cervical or left supraclavicular lymphadenopathy. Heterogeneous appearance of the thyroid gland.
Bovine two vessel aortic arch, with common origin of the brachiocephalic trunk and left common carotid. Anterior and posterior cerebral circulation is patent. Right dominant transverse sinus, normal anatomical variant. Imaged cerebral venous sinuses are patent, allowing for the phase of the study.
Lymph nodes in the superior mediastinum do not meet CT size criteria.
No apical lung lesions. No pneumothorax.
No acute or aggressive osseous lesions.
Impression
Multiple rim enhancing, lobulated right neck collections, as described above, which could reflect necrotic metastatic lymphadenopathy, infective collections (including atypical organisms and TB) or lymphoma.
Initial FNA MCS and cytology was negative and lymphoproliferative disease was suspected. Core biopsy was then performed and positive for AFB.
Case Discussion
The patient was started on active TB treatment. The patient was from SE asia but had not been back for several years.
Unable to process the form. Check for errors and try again.