Cervical tuberculous lymphadenitis: CT findings

Cervical tuberculous lymphadenitis (CTBL) is still an important cause of neck mass in many countries. The purpose of this study is to analyze the CT findings of CTBL and compare them with those of malignant lymphadenopathies and pyogenic abscesses in the neck.

We retrospectively reviewed the CT scans of 32 CTBLs, 25 malignant lymphadenopathies, and 12 pyogenic abscesses in the neck. Attenuation value, enhancement pattern, and surrounding fat plane were evaluated.

The CT findings of CTBL were classified into four types: type 1, homogeneous soft tissue density; type 2, central low density and peripheral rim enhancement with relative preservation of surrounding fat planes; type 3, multilocular central low densities and peripheral rim enhancement with obliteration of surrounding fat planes; and type 4, large confluent low density with peripheral rim enhancement and loss of lymph node architecture. Among the 32 cases of CTBL, type 3 was most frequently noted (59.4%) followed by type 2 (21.9%), type 4 (15.6%), and type 1 (12.5%). The enhancing rim of CTBL was usually thick and irregular in contrast to some malignant lymph nodes showing thin and regular rim enhancement. The degree of surrounding fat plane obliteration was less in type 4 CTBL than in pyogenic cervical abscess.

Cervical tuberculous lymphadenitis usually shows a central low density and peripheral rim enhancement that tends to be thick and irregular compared with a malignant lymphadenopathy. Multilocular low densities with peripheral enhancement and a large confluent low density with less degree of fat plane obliteration than a pyogenic abscess are suggestive features of advanced CTBL.