THROAT - Cold abscess

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?
Three stages:
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.



General                                                                                   Local

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               


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