Case 5

This is a CT study of the neck, chest and abdomen; I can appreciate multiple groups of lymph nodes which are matted together in the mediastinum, in the para and pre-tracheal regions, and in the abdomen in the coeliac, peri-portal, para-aortic and aortocaval regions. These lymph nodes show rim enhancement with hypo-attenuation and hypo-enhancement in the centre, representing central caseation necrosis.

There is splenomegaly, with multiple hypodense and hypo-attenuating small nodules of uniform size that are distributed diffusely in the spleen. These represent micro-abscesses.

There is no involvement of the lungs or musculoskeletal system.

The findings represent a systemic granulomatous infection by mycobacterium tuberculosis, manifesting as tuberculous lymphadenopathy and splenic micro-abscesses.

The differential diagnosis includes sarcoidosis and lymphoma- however the lymphadenopathy in these conditions would not have a low attenuation centre and would show homogeneous enhancement.  

I would contact referring physician and inform of findings; I would recommend placing the patient in isolation and screening close contacts. Image guided core biopsy of the lymph nodes can be done for tissue diagnosis.