Scrofula – The King’s Evil. Sonographic features of tuberculous cervical lymphadenitis,
Gerald Orpen1,2, Mary Walsh1,2, Marie Stanton2, Therese Herlihy2, Victoria Chan1, 1Mater Misericordiae University Hospital, 2University College Dublin
Background:
Tuberculosis (TB) is on the rise in non-endemic countries. Factors linked with its resurgence include human migration, multi-drug resistance and acquired immunodeficiency syndrome (AIDS). Extrapulmonary TB can manifest as tuberculous cervical lymphadenitis (TCL), historically known as scrofula. This poster describes the application of ultrasound (US) in a case of TCL. A 23-year old Nepalese woman presented to an Irish hospital with night sweats, neck pain, right-sided supraclavicular swelling and a non-productive cough.
Ultrasound Findings:
Over a period of 9 months, ultrasound was used to aid the diagnosis of TCL, assist therapeutic intervention and monitor the effectiveness of anti-microbial treatment. Early sonographic findings demonstrated normal nodal appearances – echogenic fatty hilum with associated vascular elements. Raised clinical suspicion warranted intervention by means of a core needle biopsy. During the procedure, a hypoechoic mass with an inhomogenous echotexture was visualised, likely representing a TB abscess. TCL was confirmed after the detection of heavy acid-fast bacilli during laboratory testing. Ultrasound-guided fine needle aspiration was used to acquire a sample of purulent material for drug sensitivity testing. Follow-up ultrasound imaging demonstrated more pronounced features of cervical adenopathy – hypoechoic rounded nodes, displaced vasculature and posterior acoustic enhancement. A large purulent abscess was also detected. The abscess spontaneously discharged on two occasions. Final ultrasound evaluation demonstrated residual fluid without adenopathy, indicating resolution of TCL.
Conclusion:
In addition to its role in assisting the diagnosis of scrofula, ultrasound has a part to play in the ongoing monitoring of response to treatment in complex cases of tuberculous cervical lymphadenitis.