A Case of Reactive Cervical Lymphadenopathy with Fat Necrosis Impinging on Adjacent Vascular Structures

Abstract

A tender neck mass in adults can be a diagnostic challenge due to a wide differential diagnosis, which ranges from reactive lymphadenopathy to malignancy. In this report, we describe a case of a young female with an unusually large and tender reactive lymph node with fat necrosis. The diagnostic imaging findings alone mimicked that of scrofula and malignancy, which prompted a complete workup. Additionally, the enlarged lymph node was compressing the internal jugular vein in the setting of oral contraceptive use by the patient, raising concern for Lemierre's syndrome or internal jugular vein thrombosis. This report shows how, in the appropriate clinical context, and especially with the involvement of adjacent respiratory or neurovascular structures, aggressive diagnostic testing can be indicated.

A case of upper left extremity deep vein thrombosis with right side middle lobe syndrome

“…The next most common cause for reactive lymphadenitis in the supraclavicular region is infectious, mainly viral, and hence, the cause could be an acute/subacute occult viral infection in the lung, with MLS being an important supporting factor. As a rule, swollen nodes other than supraclavicular/level V nodes usually result from reactive lymphadenopathy or infectious/viral lymphadenitis [ 9 ]. Although viral etiology was considered, there was no definite evidence of it.…”