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Scalene Lymph Node Involvement in Primary and Disseminated Coccidioidomycosis: Evidence of Extrapulmonary Spread in Primary Infection

Ann Intern Med. 1962;56(6):911-924. doi:10.7326/0003-4819-56-6-911
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Since its description by Daniels in 1949 (1), the scalene node biopsy has become a useful adjunct in the diagnosis of certain intrathoracic diseases. Sarcoidosis (1-3), tuberculosis (4, 5), metastatic neoplasms (6, 7), and lymphomas (8) are frequently detected by this procedure, and it may also be of prognostic value in patients with primary lung cancer (9, 10). There have been occasional cases of histoplasmosis (11), silicosis (1, 12), silicotuberculosis (13), streptobacillus infection (14), infectious mononucleosis (15, 5), and plasmacytoma (16) where tissue or microbiological diagnosis was established by this procedure.

It is surprising that coccidioidomycosis, a disease often involving


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