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(a) Image showing tracheal compression; (b): High-resolution computed tomography of the thorax showing soft-tissue density lesion noted in the right paratracheal region displacing and partially compressing trachea and displacement of the adjacent vessels, thyroid gland to contralateral side probably lymph nodal mass
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On local examination, he had multiple right-sided anterior and posterior cervical lymphadenopathy of size 4 cm x 5 cm which was firm, tender, and not matted [Figure 1a]. There was evidence of soft-tissue density lesion in the carinal and subcarinal region, possibly enlarged lymph nodes [Figure 1b].
Biopsy showing monocytoid B-cell lymphocytes with round, angulated nuclei, and some contain clear cytoplasm admixed with neutrophils on histopathology, partially effaced architecture, increased immunoblasts, and atypical lymphocytes in sinusoids, and polymorphous inflammatory cells suggesting the diagnosis of infectious mononucleosis
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IM [Figure 2]. IM was suspected and a Paul-Bunnell test was done which was positive.