Case 8
History:
35 year old male from El Salvador with bilateral palpable non-tender neck masses
Findings:
Enhanced CT scan of the neck show bilateral and midline large hypodense lesions with thick, irregular rim enhancement. Also note the presence of a right thyroid gland lesion.
Diagnosis:
Scrofula
Discussion:
Scrofula is an old term initially used to describe chronic lesions of the neck, that now are thought to have likely been tuberculosis. Note that in U.S. pediatric population over 90 percent of the cases are non-tuberculous mycobacterium, represented by mycobacterium-avium-complex (MAC) and are considered a surgical disease. Tuberculous lymphadenitis of the neck is transmitted from person to person via inhalation of small aerosols. After infecting the lungs, dissemination through the lymphohematogenous system to extrapulmonary sites occurs. The disease causes rubbery, painless enlargement of the cervical lymph nodes. If left untreated, the nodes may become ulcerated, producing draining sores. Fevers, chills, sweats, and weight loss can occur in 20 percent of individuals. With proper treatment recovery is usually complete. Complications include scarring formation of a draining fistula in the neck (especially after biopsy).
