CT manifestations of cervical tuberculous lymphadenitis

Cervical tuberculous lymphadenitis is a commonly encountered disease, especially in Korea. Differentiation from other metastatic lymphadenopathies and benign conditions such as cystic neck masses is important. CT findings of tuberculous lymphadenopathy in the abdomen and thorax are frequently reported in the literature, though there are only a few articles concerning cervical tuberculous lymphadenopathy. The authors retrospectively analyzed CT findings of 42 cases with cervical tuberculous lymphadenitis regarding distribution, contour, enhancing pattern, changes in the adjacent fascial plane, and dermal and subcutaneous manifestations. We concluded that the following are suggestive of tuberculous lymphadenitis: the presence of conglomerated nodal masses with central lucency, thick irregular rim of contrast enhancement and inner nodularity, varying degree of homogenous enhancement in smaller nodes, dermal and subcutaneous manifestations of inflammation such as thickening of the overlying skin, engorgement of the lymphatics and thickening of the adjacent muscles, and a diffusely effaced fascial plane. There were only a few cases of central low densities with calcifications on CT scan. However, common CT patterns of tuberculous adenitis may also be seen in other diseases, such as lymphoma and metastatic lymphadenopathy, and a thorough clinical examination and detection of primary lesions may be more helpful in differentiating these lymphadenopathies.