CT of the neck demonstrates a large, centrally necrotic, lobulated mass in the path the lower internal jugular chain on the left, consistent with a matted group of enlarged, necrotic lymph nodes (scrofula).

Review of the lung apices reveals a right upper lobe opacity with central cavitation.

Although subtle, both of these findings are observed on the chest x-ray: increased soft tissue density projected over the left upper chest, and patchy right apical opacities which happen to overlie the 1st rib.

The patient was a resident of a tuberculosis endemic area and TB treatment commenced while cultures are in progress.  Quantiferon assay positive.