Tuberculous neck mass

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

This patient presented to the ED with a tender lump at the base of the left neck. He has febrile. There were no respiratory symptoms.

Patient Data

Age: 30 years
Gender: Male

Chest radiograph in the ED

Modality: X-ray

Lungs and pleural spaces are clear. The heart and mediastinal contours are normal in appearance. There is asymmetry of the soft tissues of the lower neck with increased volume/density on the left.

Modality: Ultrasound

targeted at the CXR abnormality

In the left supraclavicular region medially, there is a 3cm heterogenous mass with anechoic elements and little, if any internal colour Doppler signal. The mass is adjacent to the IJV which may be compressed.

CT neck and chest with intravenous contrast

Modality: CT

The asymmetric soft tissue is again visible on the topogram. CT confirms a mixed solid and cystic mass with adjacent inflammatory change. Lungs clear. No bone destruction. The impression was that of a necrotic lymph mass.

Case Discussion

This mass was aspirated under US guidance. Microbiology confirmed acid-fast bacilli in the aspirate from the mass, and the patient was commenced on anti-tuberculosis therapy.

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Case Information

rID: 24269
Case created: 4th Aug 2013
Last edited: 27th Feb 2016
System: Head & Neck
Inclusion in quiz mode: Included

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