Tuberculous lymphadenitis

Case contributed by A.Prof Frank Gaillard

Presentation

Right sided neck mass.

Patient Data

Age: 25 years
Gender: Male

Chest x-ray

Modality: X-ray

The superior mediastinum is bulky including both the left and right paratracheal regions. This appearance could be due to lymphadenopathy.  Heart size is within normal limits. Lungs and pleural spaces are clear. No pneumothorax. 

 

CT neck and chest

Modality: CT

Multiple nodal masses are identified in the lower neck at level IV on the right and level VII bilaterally, supraclavicular regions bilaterally and in the mediastinum. The majority of masses have low density centres. The largest mass is located in a right supraclavicular position medially, has a lobulated outline and an internal attenuation of 0  Hounsfield units, and measures 5.2 cm x 6 cm x 3.5 cm. In the mediastinum, there is right paratracheal, right peribronchial, anterior mediastinal and right hilar lymph node enlargement with individual nodes measuring up to 1.5 centimetres short axis. There is a minor nodularity associated with the left oblique fissure, otherwise lungs and pleural spaces are clear. The visible bones and sternoclavicular and costal sternal joint appear normal. Limited views of upper abdomen unremarkable.

Conclusion:

Multiple nodal masses with appearances typical for tuberculous lymphadenitis (scrofula). Lungs and pleural spaces are clear apart from some fissural nodularity.

The large right neck collection was drained. 

MICROSCOPY

  • Auramine-Rhodamine Stain:  + (10-99 Acid Fast Bacilli DETECTED per 100 HPF)
  • Ziehl-Neelsen Stain:       + (10-99 Acid Fast Bacilli DETECTED per 100 HPF)


MYCOBACTERIAL CULTURE

  • 1.Mycobacterium tuberculosis                        ISOLATED

 

ANTIGEN TESTING (ON ISOLATE)

  • MPT64 Antigen Identification Test:  M.tuberculosis Complex DETECTED


MYCOBACTERIUM CULTURE SCREEN

  • MGIT bottle               9   days                 POSITIVE

 

Case Discussion

Cystic appearing nodes such as this, especially in an appropriate demographic, are characteristic of TB lymphadenitis. 

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Case Information

rID: 26628
Case created: 31st Dec 2013
Last edited: 6th Feb 2017
Systems: Head & Neck, Chest
Inclusion in quiz mode: Included

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