CTICasesTuberculous Lymphadenitis in a Cirrhotic Patient
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Imaging findings
Chest CT reveals bulky, non-necrotic mediastinal, paratracheal, and subcarinal lymphadenopathy, as well as cervical lymphadenopathy. The abdominal portion of the scan demonstrates a cirrhotic liver, splenomegaly, and signs of portal hypertension. Fine-needle aspiration of a cervical node is positive for acid-fast bacilli and Mycobacterium tuberculosis PCR.
Key takeaways
Tuberculous lymphadenitis (scrofula) is a classic manifestation of primary tuberculosis or reactivation in patients with impaired T-cell immunity, such as those with HIV or severe hepatic cirrhosis. Unlike the typical hyperattenuating, necrotic lymph nodes classically seen in tuberculosis, infected nodes in highly immunocompromised patients may appear minimally necrotic or solid, mimicking lymphoma or sarcoidosis.
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