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Fig. 5.103 A-D. Calcification in tuberculous lymphadenitis is not difficult to recognize in the chest or abdomen, but may occur unexpectedly wherever there are lymph nodes. A Calcified lymph nodes in the groin of a child and B in another patient, behind the knee. These small calcifications must be differentiated from parasites and early tumoral calcinosis. There is seldom a clinical history of significance. C Heavily calcified lymph nodes in the neck of a child from the Pacific Islands with a discharging sinus (D). This is the scrofula well known for centuries and in this child was, in fact, caused by M. scrofulaceum.

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Fig. 5.104 A-F Tuberculosis of the breast. It can be very difficult clinically to distinguish between a breast abscess, tumor, and tuberculosis. If there is a discharging sinus, tuberculosis is more likely. A A large lobulated mass in the right side of the breast of this African patient was firm and painless. The sinus (B) was flat with little surrounding reaction. The ulcer had been present for some months and was initially painless, but is now probably secondarily infected. C The sinus tract between the tuberculous abscess and the skin shows clinically as a bulge in the skin, often close to the nipple. This is an important feature of the mammograms. D Craniocaudal mammogram of the left breast shows an ill-defined density in the upper outer quadrant connected by the dense linear tract (solid arrow) to localized skin thickening (open arrow) and a bulge above it (arrow head). E An oblique mediolateral mammogram showing the skin thickening and the change in the outline of the breast mass. F The craniocaudal mammogram of a different patient with a smaller breast but showing a similar change in outline and the dense masses. The sinus tract is clearly seen (arrowhead) and there is localized skin thickening close to the nipple (arrow). Ultrasonography can also be used to show a fluid collection and sometimes the sinus tract also. (C-F courtesy of Dr. D. Makanjuola and Clin Radiol, 1996).