Presentation
Neck swelling slowly increasing in size in a young man.
Patient Data
Soft tissue mass with internal hypodensity most in keeping with a conglomerate of necrotic lymph node seen at the right base of the neck and supraclavicular region. The area measures approximately 56 x 36 x 46 mm. The mass distorts the overlying skin margin; however, no focal erosions are seen.
There is compression of the inferior right internal jugular vein adjacent to the mass however faint opacification is seen of the vein throughout this region. A focal non-occlusive filling defect is seen at the inferior portion of the right internal jugular vein as it joins the subclavian vein.
The thyroid and salivary glands are normal.
The lung apices are clear.
No suspicious bone lesion identified.
Conclusion: A conglomerate of lymph nodes with internal necrosis seen at the inferior right neck. The differential for this appearance includes infective lymphadenopathy including tuberculosis or malignancy such as squamous cell carcinoma nodal metastases, less likely in this age group.
Local mass-effect results in partial compression of the right internal jugular vein with small non-occlusive thrombus seen in the inferior right internal jugular vein.
Case Discussion
Ultrasound-guided aspiration was positive for TB.
Cervical lymphadenitis is a common presentation of extrapulmonary tuberculosis.
It is a common presentation in endemic regions and its incidence is on the increase in HIV and immunocompromised patients.
Low-density lymph nodes are a characteristic feature of TB of the neck, necrotic metastasis can give a similar appearance, especially in head and neck squamous cell cancer, but for the age group of this patient would it be very atypical.
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