Purpose or Case Report: The purpose of this exhibit is to make radiologists and clinicians aware of the radiological manifestations of Tularemia. There should be strong consideration for Tularemia in the differential in any patient with the classic symptoms, diffuse cervical lymphadenopathy with evidence of necrosis, and enlarged adenoids. Ultrasound and CT may demonstrate suppurative lymphadenopathy suggestive of infection; while chest radiography may demonstrate bilateral or lobar infiltrates. The radiological findings, prognosis, and clinical manifestations are to be discussed.
Methods & Materials: The authors present a case of a 7-year-old male, with no significant past medical history that presented to the ED with intermittent fevers, soar throat, and painful right sided palpable neck mass for 9 days.
Results: Upon admission, real time sonography and color flow images of the neck soft tissues demonstrated a right neck mass, corresponding to the area of palpable abnormality. A central area of decreased echogenicity within this nodal mass likely represented necrosis.

After a complicated hospital course, despite many re-admissions, the patient was ultimately found to have ulceroglandular tularemia, when the Francisella titers yielded positive results. Upon re-admission, a surgical consultation was obtained to perform an incision and drainage of the complex right neck suppurative lymphadenitis. Following successful incision and drainage the patient was given a PICC line, started on Gentamycin 5mg/kg/day IV q8h, and subsequently discharged.
Conclusions: To conclude, we would like to make radiologists and clinicians aware of the radiological manifestations of Tularemia. We aim to educate radiologists and clinicians regarding the imaging characteristics, prognosis, and clinical manifestations of Tularemia.

Ultrasound may demonstrate lymphadenopathy suggestive of infection. These nodes may be suppurative, as in the case presented. Computed Tomography often will demonstrate the extent of the lymphadenopathy. On Chest radiography, tularemia pneumonia is often the presenting finding, which include bilateral or lobar infiltrates. Hilar lymphadenopathy and pleural effusions are often associated findings. Cavitary lesions may be present, which are better delineated on CT.