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
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.
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.
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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