CTICasesMiliary Tuberculosis with Scrofula
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Imaging findings
Chest radiographs demonstrate a diffuse, random nodular pattern throughout both lungs, consistent with a miliary pattern. Contrast-enhanced CT reveals a cystic, necrotic lymph node in the lower neck and left supraclavicular region, along with a rim-enhancing cystic chest wall mass in the right anterior chest wall and retrosternal space with associated clavicular cortical erosion. The lung windows show randomly distributed micronodules with areas of consolidation, particularly in the upper and mid-lung zones.
Key takeaways
Miliary tuberculosis can present with extensive extrapulmonary manifestations, including scrofula (tuberculous cervical lymphadenitis) and tuberculous abscesses of the chest wall (empyema necessitans mimic). In immunocompromised patients, such as those with HIV and low CD4 counts, necrotic and rim-enhancing lymphadenopathy can be highly prominent, and a primary tuberculous pattern with upper lobe consolidative tendencies may be observed.
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