Presentation
Right sided neck mass.
Patient Data
The superior mediastinum is bulky including both the left and right paratracheal regions. This appearance could be due to lymphadenopathy. Heart size is within normal limits. Lungs and pleural spaces are clear. No pneumothorax.
Multiple nodal masses are identified in the lower neck at level IV on the right and level VII bilaterally, supraclavicular regions bilaterally and in the mediastinum. The majority of masses have low density centers. The largest mass is located in a right supraclavicular position medially, has a lobulated outline and an internal attenuation of 0 Hounsfield units, and measures 5.2 cm x 6 cm x 3.5 cm. In the mediastinum, there is right paratracheal, right peribronchial, anterior mediastinal and right hilar lymph node enlargement with individual nodes measuring up to 1.5 centimeters short axis. There is a minor nodularity associated with the left oblique fissure, otherwise lungs and pleural spaces are clear. The visible bones and sternoclavicular and costal sternal joint appear normal. Limited views of upper abdomen unremarkable.
The large right neck collection was drained.
MICROSCOPY
- Auramine-Rhodamine Stain: + (10-99 Acid Fast Bacilli DETECTED per 100 HPF)
- Ziehl-Neelsen Stain: + (10-99 Acid Fast Bacilli DETECTED per 100 HPF)
MYCOBACTERIAL CULTURE
- 1.Mycobacterium tuberculosis ISOLATED
ANTIGEN TESTING (ON ISOLATE)
- MPT64 Antigen Identification Test: M.tuberculosis Complex DETECTED
MYCOBACTERIUM CULTURE SCREEN
- MGIT bottle 9 days POSITIVE
Case Discussion
Cystic appearing nodes such as this, especially in an appropriate demographic, are characteristic of TB lymphadenitis.