Scrofula – The King’s Evil. Sonographic features of tuberculous cervical lymphadenitis,

Gerald Orpen1,2, Mary Walsh1,2, Marie Stanton2, Therese Herlihy2, Victoria Chan1, 1Mater Misericordiae University Hospital, 2University College Dublin


Tuberculosis (TB) is on the rise in non-endemic countries. Factors linked with its resurgence include human migration, multi-drug resistance and acquired immunodeficiency syndrome (AIDS). Extrapulmonary TB can manifest as tuberculous cervical lymphadenitis (TCL), historically known as scrofula. This poster describes the application of ultrasound (US) in a case of TCL. A 23-year old Nepalese woman presented to an Irish hospital with night sweats, neck pain, right-sided supraclavicular swelling and a non-productive cough.

Ultrasound Findings:

Over a period of 9 months, ultrasound was used to aid the diagnosis of TCL, assist therapeutic intervention and monitor the effectiveness of anti-microbial treatment. Early sonographic findings demonstrated normal nodal appearances – echogenic fatty hilum with associated vascular elements. Raised clinical suspicion warranted intervention by means of a core needle biopsy. During the procedure, a hypoechoic mass with an inhomogenous echotexture was visualised, likely representing a TB abscess. TCL was confirmed after the detection of heavy acid-fast bacilli during laboratory testing. Ultrasound-guided fine needle aspiration was used to acquire a sample of purulent material for drug sensitivity testing.  Follow-up ultrasound imaging demonstrated more pronounced features of cervical adenopathy – hypoechoic rounded nodes, displaced vasculature and posterior acoustic enhancement. A large purulent abscess was also detected. The abscess spontaneously discharged on two occasions. Final ultrasound evaluation demonstrated residual fluid without adenopathy, indicating resolution of TCL.


In addition to its role in assisting the diagnosis of scrofula, ultrasound has a part to play in the ongoing monitoring of response to treatment in complex cases of tuberculous cervical lymphadenitis.

View poster here