Cold Abscess Causes, Investigations And Treatment

Cold Abscess Causes Investigations And Treatment

Question 1. Write a short note on the Cold Abscess
Or
Write in brief about the Cold Abscess

Answer.

Cold Abscess Definition

A cold abscess is also known as Tuberculous Abscess.
The abscess shows no signs of acute inflammation, which is why it is known as a cold abscess.
It occurs most commonly in the neck, groin, psoas region, and paraspinal area.

Cold Abscess Areas Of Origin or Cold Abscess Causes

• In tuberculous lymphadenitis, the cold abscess is commonly seen in the anterior triangle of the neck.
• In tuberculosis of the cervical spine, cold abscesses occur in the posterior triangle of the neck.

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Cold Abscess Clinical Features

• It is more common in younger age groups and is seen at any age.
• There is the presence of swelling over the neck, which is smooth, soft, fluctuant, non-tender, non-transilluminate, and has restricting mobility.
• With the change in posture when the patient is seated, he supports his heawith hisis hands and forearm. This is known as Rust’s sign.
• There is also the presence of evening fever, loss of weight, appetite,e, and anemia.
• Mattd lymph nodes are present adjacent to colabscessesss, which are palpable. The abscesss shows no signs of acute inflammation.

Cold Abscess Investigations

• ESR is raised.
• Mantoux test is positive.
• Presence of anemia and lymphocytosis
• Chest X-ray shows pulmonary tuberculosis
• On FNAC, epithelioid cells are seen.
• X-ray of the neck in the tuberculous cervical spine is done to identify reduced joint space, vertebral destruction, and soft tissue shadow.
• MRI of the cervical spine and a US/CT scan of the neck are needed to confirm the anatomical location and number of lesions.

Cold Abscess Sequelae

• Secondary infection occurs in a cold abscess, and it becomes tender.
• Collar stud abscess fors, as pressure increases in coldabsces ss it provides a way through the deep fascia to reach the subcutaneous plane and adhere to the skin.
• Formation of the sinus.
• Disease spread to other lymph nodes and organs.

Cold Abscess Differential Diagnosis

• Branchial cyst and other cystic swellings of the neck.
• Secondaries of neck lymph nodes
• Secondaries in the cervical spine.

Cold Abscess Treatment

• Anti-tubercular drugs should be started.
• Zig-zag aspiration by wide bore needle in non-dependent aspiration of cold abscess.
• Excision of affected lymph nodes
• The cervical spine should be immobilized by a plaster jacket for 4 months.
• Drainage using non-dependent incision and later closure of wound without placing the drain.

Question 2. Describe the differentiating features of Acute Abscess and Cold Abscess.

Answer.