Left lateral cervical mass with draining sinuses, manifestation of tuberculosis.
This article highlights the case of a left lateral cervical mass in an 89-year-old male smoker patient, who worked as a taxi and bus driver. The patient presented to the emergency with a left, deep purplish cervical swelling with draining sinuses. The patient’s history revealed that the painless erythematous nodular swelling had appeared 3 months ago, on the left side of his neck. He did not complain of any other symptoms of weight loss or fever. However, did experience an occasional dry cough and mucous expectoration ever since he stared smoking, 70 years ago.
His past medical history revealed that he underwent surgery for benign prostate hypertrophy 15 years ago.
The patient also presented to the emergency 6 months earlier because of an acute hypertensive episode secondary to pulmonary oedema. Doctors treated him with intravenous diuretics and prescribed valsartan-hydrochlorothiazide therapy once a day. Examination showed the patient to be a tall and thin man with normal skin colour and physical appearance. However, his left lateral neck lesion included draining sinuses and purulent material. In addition to scarce low-pitched expiratory wheezes. The patient’s cardiovascular examination was prevalent of a mild systolic murmur in the right intercostal space, consistent with a moderate aortic regurgitation.
The patient’s chest X-ray was unremarkable. Whereas the Mantoux test showed an induration of 10 mm.
Doctors advised a CT scan which showed minimal fibrous bands of the right upper lobe in the upper zone area. Similarly, a small calcified nodule was present at the periphery of the apical-posterior segment of the left upper lobe. For further evaluation, doctors advised a fiberoptic bronchoscopy which showed a diffusely red and hyperemic bronchial mucosa. The findings were intense in the right upper lobe, with presence of small anthracotic areas.
Bronchoalveolar lavage fluid of the apical-posterior segment of the upper lobe showed an increase in lymphocytes, neutrophils and macrophages and scarcity of epithelial cells. However, there were no signs of malignancy. Microscopic examination and surgical biopsy was consistent with epithelial granuloma and central coagulative necrosis with the presence of M. tuberculosis complex. The draining sinuses also revealed the presence of M. tuberculosis complex.
Doctors diagnosed the left lateral cervical mass as a secondary manifestation of tuberculosis. The diagnosis was confirmed with histopathological examination. Doctors treated the patient with a four- (4-) drug antituberculous regimen. A month after the initiation of this regimen, oral steroids were also added, because of an enlargement of the lymph nodes. 4 weeks after this regimen, the patient showed complete remission of the neck growth. The treatment was continued for 6 months.
Left Lateral Cervical Mass with Draining Sinuses https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683832/