Journal of Indian Academy of Oral Medicine and Radiology, July-September 2012;24(3):239-242 239 Enigma unraveled: Role of Ultrasonography in Tuberculous Lymphadenopathy JIAOMR CASE REPORT Enigma unraveled: Role of Ultrasonography in Tuberculous Lymphadenopathy ML Asha, S Naveen, Anju Anu Jose, Atul Bajoria, Ingitha Chatterjee, Shubha Gurudath ABSTRACT Lymphadenopathy is the most common form of extrapulmonary tuberculosis; cervical region being the frequent affected site. Ultrasound is a useful noninvasive imaging modality in the assessment of cervical lymph nodes. The morphology of lymph nodes is evaluated by grey-scale sonography and the power Doppler sonography helps in the assessment the vasculature of lymph nodes. Tuberculous lymphadenitis exhibits distinctive features like presence of adjacent soft tissue edema and matting of nodes. This article highlights the use of ultrasonographic as a diagnostic approach, by comparing and differentiating the features of tubercular lymph nodes in a 10-year-old female patient. Keywords: Tuberculous lymphadenitis, Ultrasonography, Power Doppler. How to cite this article: Asha ML, Naveen S, Jose AA, Bajoria A, Chatterjee I, Gurudath S. Enigma unraveled: Role of Ultrasonography in Tuberculous Lymphadenopathy. J Indian Aca Oral Med Radiol 2012;24(3):239-242. Source of support: Nil Conflict of interest: None declared INTRODUCTION Tuberculosis continues to be a major problem and a significant health issue, challenging the medical community; in spite of available novel and effective therapies. 1 The possibility of tuberculosis infections often is ignored in the differential diagnosis of lymphadenopathy, resulting in a delay of the appropriate treatment. 2 Detection of cervical lymphadenopathy with ultrasound is superior to clinical examination with the sensitivity of 96.8 and 73.3% respectively. Lymph nodes less than 5 mm in diameter are difficult to detect with computed tomography (CT), whereas high resolution ultrasound can detect small lymph nodes of even 2 mm in diameter. 3 This article describes the role of ultrasonography in early diagnosis of tubercular lymphadenitis in a 10-year-old female patient with a bilateral swelling in submandibular region. CASE REPORT A 10-year-old female patient visited the Department of Oral Medicine and Radiology with a chief complaint of swelling in the right and left side of the lower face since 1 month (Fig. 1). Patient initially noticed a small swelling of 0.5 × 0.5 cm 2 ; in the right submandibular region, which gradually 10.5005/jp-journals-10011-1305 increased to the present size of 5 × 4 cm 2 . In due period of 10 days, another similar swelling on the contralateral side was noticed. Patient also gave history of evening rise of temperature, 15 days before the occurrence of swelling. On examination, gross facial asymmetry was noticed due to a diffuse swelling in the lower one-third region of the face. Bilaterally the swelling extended anterio- posteriorly, from the corner of mouth to the angle of mandible and superioinferiorly from the ala tragus line to about 3 and 1 cm from the inferior border of mandible on right and left side respectively. The skin over the swelling was stretched and glossy. On palpation all the inspectory findings were confirmed. The swelling was firm in consistency and nontender. Multiple matted submandibular lymph nodes measuring about 1.5 to 2 cm in diameter were appreciated. On intraoral examination no abnormalities were seen. Correlating the history and clinical findings, a provisional diagnosis of tuberculous lymphadenitis was given, however, submandibular space infection and lymphoma were also considered in the differential diagnosis. Patient was subjected for the following investigations: Complete hemogram, panoramic radiography, posterioanterior view of chest, ultrasonography, fine needle aspiration cytology (FNAC) of submandibular lymph nodes and tuberculin skin test. Blood examination revealed hemoglobin of 10.3 gm%, total leukocyte count of 9,900/cu.mm (59% polymorpho- nuclear leukocytes, 39% lymphocytes and 2% eosinophils). Fig. 1: Bilateral swelling in the submandibular region