Soft tender mass on neck

A 4-year-old male child who presented 4 days ago with 3 weeks history of fever, cough, poor appetite, and weight loss. He started having tonic seizures about 3 days ago and has several episodes in 24 hours. On examination, he appeared chronically ill-looking evidenced by bony prominences and over-hanging skin folds. A soft, mildly tender mass, with crepitus (poping bubble sound) upon palpation, is noted anteriorly on the neck and extends to the ears bilaterally. He is currently being managed for sepsis on background malnutrition. What could be responsible for this mass.


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Thanks Dr. Vipin Bihari Jain

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Tuberculoma DD lipoma
As the picture shows the boy is emaciated poorly nourished having a swelling whole of ant neck extending on both side laterally and downward with the obliteration of the supra sternal notch. Clinical features of the swelling cystic with crepitus. This may be the sequele of pulmonary tuberculosis resulting in empyema necessitans with rupture of the sub pleural bullae giving rise to surgical emphysema Pt need to be clinically evaluated PECT of chest with other relevant investigation.
There are many causes of lumps in the neck. The most common lumps or swellings are enlarged lymph nodes. These can be caused by bacterial or viral infections, cancer (malignancy), or other rare causes. Swollen salivary glands under the jaw may be caused by infection or cancer.
? Tuberculoma confirm by FNAC.Here h/o fever, weight loss, several episodes of seizures, poor appetite etc. ? TBM. Adv CXR, CBC,MT TEST,ABG, LFT, KFT, CSF, MRI BRAIN and if seizures continue EEG brain to be done.
D/D 1.Tuberculous lymph node mass 2.Lymphoma 3.Cystic hygroma 4.Branchial cleft cyst . 5.Abscess - tubercular or pyogenic 6.A thyroid mass . A rare possibility of spontaneous sub cutaneous emphysema
Possibilities Suppurative inflammatory mass? Pyogenic TB Infected cyst Adv FNAC Work up for TB and Bact culture if pus is obtained
Tubercular lymphadenitis mass Needs further investigation and evaluation to conclude and treatment plan.
Pneumothorax with surgical emphysema neck Needs investigations to rule COVID, TB, MENINGITIS
I think it subcutaneous emphysema. Since crepitud are presents on examination.
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