Diagnostic problems of tuberculous cervical adenitis (scrofula)

This study was designed to review the diagnostic procedure for tuberculous cervical adenitis and propose a simple protocol for the work-up of patients with suspected tuberculous cervical adenitis. Moreover, it served to increase physician awareness of tuberculosis as possible cause of cervical mass.

We performed a retrospective study of 57 patients with tuberculous cervical adenitis who were treated at North West Armed Forces Hospital, Tabuk, Saudi Arabia between March 1989 and April 1993. The results of diagnostic procedures, chest x-ray, tuberculin test, fine-needle aspiration, microbiology culture, and histopathology were reviewed.

Forteen percent showed changes in chest x-ray, 92% had positive tuberculin test, and 50% of the culture material grew Mycobacterium tuberculosis. All specimens for histopathology were suggestive of tuberculosis.

A thorough history and physical examination, tuberculin test, and fine-needle aspiration will help arrive at an early diagnosis of tuberculous cervical adenitis and allow early commencement of treatment before final diagnosis can be made by incisional biopsy and culture. Tuberculosis should be included in the differential diagnosis of neck mass.