Differential Diagnosis for a Liquefied Necrotic Lymph Node

• Single Most Likely Diagnosis
  • Tuberculous lymphadenitis: This condition is characterized by the formation of caseous necrosis within lymph nodes, which can appear as liquefaction on ultrasound. The presence of a single large lymph node with heterogeneous echotexture and central necrosis, along with mild inflammatory changes in the surrounding soft tissue, supports this diagnosis.
• Other Likely Diagnoses
  • Metastatic lymphadenopathy: Malignant cells can cause necrosis within lymph nodes, especially if the primary tumor is aggressive. The irregular margins and heterogeneous echotexture of the lymph node could suggest metastatic disease.
  • Reactive lymphadenitis: This condition can occur in response to infection or inflammation elsewhere in the body. While the presence of central necrosis is less common in reactive lymphadenitis, it cannot be ruled out without further evaluation.
  • Cat-scratch disease: This bacterial infection can cause lymphadenopathy with necrosis, although it is typically associated with a history of cat exposure and scratch.
• Do Not Miss Diagnoses
  • Lymphoma: Both Hodgkin and non-Hodgkin lymphoma can present with lymphadenopathy, and necrosis can occur, especially in aggressive subtypes. Missing a diagnosis of lymphoma could have significant consequences for patient outcomes.
  • Squamous cell carcinoma metastasis: This type of cancer can cause necrotic lymphadenopathy, particularly if the primary tumor is located in the head and neck region.
• Rare Diagnoses
  • Kikuchi-Fujimoto disease: This rare condition is a form of histiocytic necrotizing lymphadenitis that can present with lymphadenopathy and necrosis.
  • Kimura disease: This chronic inflammatory disorder can cause lymphadenopathy and eosinophilia, although necrosis is less commonly reported.
  • Castleman disease: This rare lymphoproliferative disorder can present with lymphadenopathy, although necrosis is not a typical feature.