Presentation
Neck mass on external US below thyroid gland. Normal TFTs and thyroid nuclear scan. ? mass
Patient Data
The lesion in question corresponds to a uniform soft tissue density rounded mass located below the inferior lobes of the thyroid gland, above the sternal notch and left brachiocephalic vein, and both common carotid arteries. It is 2.8 x 2.0 x 2.9cm (LR x AP x SI) and slightly less dense than the adjacent thyroid gland. It appears separate to the inferior border of the thyroid gland and the left brachiocephalic vein on the coronal series.
The are enlarged bilateral jugular and right axillary lymph nodes. None of these demonstrate calcification or central necrosis. No superior mediastinal lymphadenopathy. No lesion identified within the imaged upper zones of the lungs.
Conclusion
The lesion in question is an enlarged pathological lymph node, with the presence of other enlarged lymph nodes in the jugular chains and right axilla. Differential diagnosis includes lymphadenopathy secondary to malignancy (such as breast or lymphoma) and infection (tuberculosis needs consideration given the patient is from Somalia).
Case Discussion
Mammograms were negative and there is no history of prior malignancy.
The patient subsequently had a Quantiferon gold test (for TB) which was positive.
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