TUBERCULOUS LYMPHADENITIS.pptx

Tuberculosis

1. TUBERCULOUS LYMPHADENITIS By Supritha J.P 9 th term

2. What is tuberculous lymphadenitis ? Tuberculous lymphadenitis is also know as scrofula or king’s evil Etiology : Mycobacterium tuberculosis It is the most common site of extrapulmonary TB .

3. Commonest site to be affected is the lymph nodes of the neck Out of these jugulodigastric is usually infected Second most common is the posterior cervical group

4. MODE OF SPREAD OF INFECTION Through tonsils (Adenoids also) Occasionally through blood Rarely through sibsons fascia from apex of lung

5. Stages of Tuberculous lymphadenitis

6. There are mainly 2 types 1) Caseating type (80%) 2) Hyperplastic type (15%)

7. Clinical presentation : Depends on the stage in which the patient presents ; the various symptoms that can be present are 1)Swelling in the neck that is firm , matted 2) Cold abscess – Smooth ,fluctuant, non tender , not involving the skin 3)Collar stud abscess – Adherent to the underlying skin 4) Discharging sinus Other associated presentations : Tonsils studded with tubercles Involvement of axillary , inguinal lymph nodes Scrofuloderma - Bluish hyperpigmentation of skin Cold abscess in spine

8. Differential diagnosis Non specific lymphadenitis Lymphoma Metastatic secondaries Brachial cyst

9. Investigations General investigations : CBC,ESR , peripheral smear Specific investiations 1)Ultrasound neck Shows node size ,matting ,cold abscess ,track , number of nodes 2)FNAC Epitheloid cells are diagnostic 3)Open node biopsy ( When FNAC is inconclusive ) Other tests : Hiv testing , cd4 counts , wbc counts Chest Xray Ct neck and chest to study nodal status

10. Treatment Anti Tubercular drugs – HRZE for 6 to 9 months 1)If cold abscess present : Aspiration – non dependent – z track 2)If it recurs – Incision and drainage 3)If persistent –surgical removal Indications : 1. There is no local response to drugs 2. when sinus persists 4) Excision of sinus tract

11. Aspiration

12. Sinus excision

13. THANKYOU