Cold Abscess in the Neck: Causes, Symptoms, Diagnosis, and Treatment

Cold Abscess

• Tuberculous lymphadenitis: Cold abscess is seen commonly in anterior triangle of neck
• Tuberculosis ofcervical spine: Cold abscess is seen commonly in posterior triangle of neck.

• It is commonly seen in young individuals but can occur in any age group.
• Swelling in neck is smooth, non-tender, soft, flctuating,non-transilluminant, non-mobile and is notadherentto skin.
• There is presence of neck pain, neck rigidity and restricted movements of cervical spine.
• Rust sign: With change in position and often when patient is seated, he support his head with hands and forearm.
• There is presence of evening fever, loss of weight and appetite.
• Mattd lymph nodes adjacent to cold abscess should be palpable.

• Oral cavity, chest and tonsils of the patient are thoroughly examined.
• ESR is raised
• Mantoux test is positive. This test is useful but not reliable.
• Presence of anemia and lymphocytosis
• Chest X-ray show pulmonary tuberculosis
• FNAC of cold abscess under microscopic examination show epithelioid cells.
• Fluid obtained by FNAC should be stained by ZiehlNeelsen stain which reveals acid-fast bacilli
• X-ray neck is done in cervical spine tuberculosis to identify reduced joint space, vertebral destruction, soft tissue shadow.
• MRI of cervical spine, ultrasonography or CT scan neck are needed to confim anatomical location and number of lesions.

• Anti-tubercular treatment is given to the patient.
• Non-dependent aspiration of cold abscess.
• Diseased neck nodes should be excised.
• Immobilization of cervical spine by plaster jacket/collar for 4 months.
  Cervical spine fusion by open surgical method,if diseased spine is unstable.