What is Cold abscess?
Slowly progressing non-reacting (hence white and cold instead of hyperaemic and hot) and low tension (so painless) abscess resulting from caseation is called cold abscess.
What are the clinical features of cold abscess?
1) History of softening following pre-existing solid neck swelling
2) Nodes mainly in the posterior triangle
3) Absence of signs of inflammation
4) Constitutional symptoms of tuberculosis like evening rise of temperature, anorexia, weight loss
5) Secondary infection of the abscess
6) Matted lymph node palpable on deeper aspect
7) Aspiration reveals caseous material.
8) Tenderness of cervical spine may be present if bony involvement.
What is the pathology of cold abscess?
a) Stage of lymphadenitis: Painless, mobile, discrete lymph nodes.
b) Stage of periadenitis: Mass of the matted node fixed to the skin.
c) Late stage :The node can undergo several changes by
i) Healing by fibrosis
ii) Caseation and liquefaction
iii) Cold abscess bursting either through deep fascia into
subcutaneous tissue forming collar stud abscess or forming a sinus through skin.
What investigations required for cold abscess?
1) Complete blood count shows lymphocytosis.
2) ESR is raised.
3) Tuberculin test is positive.
4) X ray chest.
Non Specific Specific Non Dependent Aspiration surgery
a) Bed rest Antitubrculous a) Biopsy for
b) Vitamins drugs Confirmation
Triple drug therepay b( Localised group
Rifampicin 600 mg not responding
Isoniazid 300 mg to AKT
Ethambutol 800 mg c) Persistent sinus for 2 months