Pharyngeal and Retropharyngeal Tuberculosis with Nodal Disease Radiology: Volume 254: Number 2—February 2010

New words Dysphagia [dis ˈ feid ʒ iə] 吞咽困难 Oropharynx [ ˌ əurə ˈ færiŋks] 口咽 Hypopharynx [,haipə‘færiŋks] 下咽，喉咽 Nasopharynx [D.J.:,neizəu‘færiŋks] 鼻咽 piriform sinus 梨状窝

History A 58-year-old otherwise healthy woman reported intermittent swelling of several years duration on the right side of her neck. Computed tomography (CT) of the neck was performed. 20 months after the original examination was performed, she presented again with continued gradual progression of swelling on the right side of her neck and new dysphagia. Repeat CT was performed at this time.

Imaging Findings There is an enhancing mass involving the right posterolateral oropharynx and palatine tonsillar fossa. There are calcifications and multiple enhancing vessels within the mass.

There is submucosal inferior extension of the mass to the hypopharynx, effacing the right piriform sinus. In both a and b, there are prominent bilateral cervical lymph nodes which demonstrate patchy abnormal enhancement.

Coronal reformatted image shows the oro- and hypopharyngeal mass containing coarse calcifications

Axial contrast-enhanced CT images obtained through the neck 20 months after initial presentation. at the level of the (a) hyoid bone, there has been interval development of a multiseptated thick-walled rim-enhancing retro- and parapharyngeal collection with deep soft-tissue extension on the right.

Piriform Sinuses Hypopharyngeal extension and calcifications are seen again

Discussion The differential diagnosis for pharyngeal mass on the basis of the initial imaging study includes malignancy, however, the prominent submucosal component, vessels, and calcifications would be unusual. Minor salivary neoplasm, lymphoma, and neurogenic tumor are also considerations, but again, the calcifications and prominent vessels would be atypical.

Extranodal head and neck TB is rare, comprising less that 1% of all cases. Pharyngeal TB, which refers to mucosal or submucosal disease, usually occurs secondary to hematogenous dissemination from pulmonary disease. The oropharynx is the most common site, but the oral cavity, nasopharynx and hypopharynx can be involved. The appearance of extranodal TB of the head and neck is usually that of a nonspecific soft-tissue mass that may contain calcifications. the presence of enlarged vessels was an atypical feature.

Conclusion TB should be considered in the differential diagnosis of soft tissue masses of the head and neck, particularly when the imaging findings and clinical presentation are atypical. The presence of necrosis, rim enhancement, calcifications, nodal disease, and pulmonary findings may suggest the proper diagnosis.