Subhendu Choudhury1, Ruma Guha2, Arvind Kumar Verma3, S. N. Banerjee4
ABSTRACT: INTRODUCTION: The proportion of extra-pulmonary presentation of tuberculosis is on the rise in comparison to pulmonary tuberculosis. Neck is the commonest extra-pulmonary site of tuberculosis in our country. Absence of typical features of tuberculosis makes its detection difficult in the neck. Association of tuberculosis and HIV has been documented. Delayed diagnosis may be prognostically and epidemiologically disastrous. MATERIALS AND METHODS: A two years’ prospective study from 2011-2013, was done in the Dept. of ENT of Bankura Sammilani Medical College and Hospital using conventional investigative procedures to review the different presentations of tuberculosis in the neck, to assess its incidence and to identify its association with HIV, if any. RESULTS: A total of 314 patients with suspected tubercular lesions in the neck were screened and 72 (Male=43, Female=29) of them were confirmed positive for tuberculosis. Cervical lymphadenitis was found to be the commonest tubercular affection in the neck followed by tubercular laryngitis and deep neck abscess. Coexistent pulmonary tuberculosis was common only with laryngeal tuberculosis. HIV screening was negative for all the patients in this series. CONCLUSION: Absence of the typical clinical features of tuberculosis, absence of the history of tubercular affections elsewhere in the body and varied clinical presentation make identification of tuberculosis difficult in the neck. Fine needle aspiration cytology (FNAC) is a sensitive, specific and cost effective tool for detection of neck tuberculosis. Histopathology is confirmatory. A battery of tests is often required to arrive at a diagnosis. Awareness and a high index of suspicion are required for the diagnosis of tubercular lesions in the neck.
