Tuberculous lymphadenitis

• Caustive organism:
T.B bacilli "Mycobacterium tuberculosis".
 Initial sites of infection:

Cervical L.N. : from T.B. lesions in tonsils or

pharynx.

Mediastinal L.N.: from pulmonary T.B.

Mesenteric L.N.: from Intestinal T.B.

 Routes of infection:

Lymphatic borne: reach lymph nodes by

lymphatics So, affect the cortex.

Blood borne: reach the L.N. through blood

supply So, affect the medulla.
 Pathological types:
Caseous type: low immunity, common in
children.The L.N. is destructed and replaced by
caseous material .

Fibrous type: marked fibrosis with minimal

caseation or lymphoid hyperplasia.

Lymphadenoid type: Marked lymphoid

hyperplasia with no caseation or fibrosis so,
the glands become enlarged, discrete, rubbery
as Lymphadenoma.
 Fate of T.B. Lymphadenitis:

1- Resolution.
2- Calcification Silent infection.
3- Caseation cold abscess or sinus formation.
4- General dissemination / Miliary T.B
Stages of tubercular lymphadenitis
• Stage of infection and lymphadenitis
• Stage of periadenitis with matting
• Stage of caseating necrosis and cold abscess
formation
• Stage of formation of color stud abscess
• Stage of sinus formation
 Clinical features
• Neck swelling , firm and matted
• Cold abscess
• Color stud abscess
• Discharging sinus , multiple , undermined ,
bluish colored
• Tonsil may be studded with tubercules
• Associated pulmonary tuberculosis
 Differential diagnosis
• Non specific lymphadenitis
• Lymphoma , CLL
• Secondaries in neck
• Branchial cysts
• HIV with lymph node involvement
• Actinomycosis
 Cold abscess
• Deep to deep fascia
• No evidence of sign of inflammation
• Not warm, non tender , smooth , soft and
fluctuant ,
• Skin is free , no redness
• Contains cheesy caseating material
• May form collar stud abscess , sinus
 Investigations
• Haematocrit , ESR
• FNAC , smear for AFB and culture
• Open biopsy
• CXR
• PCR
 Treatment
• ATT
• Aspiration
• Surgical drainage