Chest roentgenography in tuberculous cervical lymphadenopathy

The primary site of infection in tuberculous cervical lymphadenitis is lungs, from where bacilli reach gland through circulation. This study was done in the department of chest medicine, NRS Medical College, Kolkata, and was designed to find out chest x-ray abnormalities in apparently chest asymptomatic confirmed tuberculous cervical lymphadenitis without associate disease. The diagnosis of tuberculous cervical lymphadenitis was confirmed by fine needle aspiration cytology and/or smear for acid-fast bacillus, and chest x-ray (PA view) was done in all confirmed cases (n = 183). Normal chest x-ray was found in 132 cases (72.13%) and abnormal chest x-ray in 51 cases (27.87%). Pulmonary infiltration, the commonest radiological finding was detected in 32 cases (17.49%), hilar enlargement in 17 cases (9.29%), right paratracheal opacity in 2 (1.09%), obliteration of costophrenic angles in 3 cases (1.64%) and miliary mottling in one case (0.55%). Upper zonal predominance of lung parenchymal infiltrations was noted in 12.57% and right lung involvement in 16.39%. Single zone was affected in 9.84% cases and multiple zones were involved in 7.65% cases. We observed right hilar enlargement in 6.56%, left hilar lymphadenopathy in 4.37% and bilateral hilar lymphadenopathy in 2.73% cases. We concluded that routine chest x-ray PA view should be done in all tuberculous lymphadenitis before categorisation and starting of treatment.