Presentation
Discharging mass on neck.
Patient Data
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There is a 3.7 x 3.3 x 3.1 cm heterogeneous lesion in the supraclavicular region, largely within the sternocleidomastoid muscle.
It has an irregular enhancing wall, with central low density.
The right internal jugular vein is immediately posterior to the collection.
Small filling defects are noted within the left and right brachiocephalic veins and SVC.
No enlarged cervical lymph node.
Bilateral pulmonary nodules are noted in the lung apices, unchanged from the previous CTA chest.
No suspicious osseous lesion.
Conclusion: Right supraclavicular abscess largely within involving the right sternocleidomastoid.
Small filling defects within the left and right brachiocephalic veins and the SVC have the appearance of non-occlusive thrombus.
Case Discussion
Ultrasound guided aspirate revealed tuberculosis.
Tuberculous cervical lymphadenitis, also known as scrofula and King's evil, continues to be seen in endemic areas and in the industrialised world particularly among the immunocompromised.
The presentation is, usually, with one or more cervical masses. Cervical nodes are the most commonly affected nodes in tuberculous lymphadenitis, accounting for approximately 63% of cases, followed by mediastinal (27%) and axillary nodes (8%).
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