Lymphatics And Lymph Node Enlargement
Causes of Enlargement of Lymph Node in Neck
1. Inflammatory: due to microorganism.
- Bacterial as: Streptococcus, Mycobacterium, Treponema pallidum, Actinomycosis.
- Viral as: Lymphogranuloma venereum, Infectious mononucleosis, HIV
- Parasite as: Wuchereria bancrofti
- Fungus as: Blastomycosis.
2. Lymphatic leukemia.
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3. Autoimmune disorders:
- Systemic lupus erythematous
- Rheumatoid arthritis
- Sclerosis.
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4. Neoplasms: Malignant neoplasm involves lymph node like.
- Malignant lymphoma
- Hodgkin’s disease
- Lymphosarcoma
- Malignant melanoma.
5. Secondaries in lymph nodes.
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Clinical Features of Tubercular Lymphadenitis
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- Swelling in the neck is present, which is fim and mattd.
- Cold abscess is soft, smooth, non-tender, flctuant, without involvement of the skin. It is not warm.
- As a result of increased pressure, cold abscess ruptures out of the deep fascia to form collar stud abscess which is adherent to the overlying skin.
- Once collar stud abscess bursts open, discharging sinus is formed. It can be multiple, wide open mouth, often undermined, non-mobile with bluish color around the edge. It is usually not indurated.
- Tonsils may be studded with tubercles and so clinically should always be examined.
- Associated pulmonary tuberculosis should also be looked for. In 20% cases of tuberculous lymphadenitis, there may be associated pulmonary tuberculosis or it may be a primary focus.
- Cervical spine is examined for tuberculosis.
- Axillary nodes, when involved are due to retrograde lymphatic spread from neck nodes or blood spread.
- Inguinal lymph nodes are involved occasionally through blood.
- Bluish hyperpigmented involved overlying skin is called as scrofuloderma.
- Tuberculous pus with caseating cheesy creamy material is infective as it contains multiplying organisms.
- Atypical mycobacterial tuberculosis can occur occasionally.
- Such disease may be resistant to drug therapy.
- Sinus may persist due to firosis, calcifiation, secondary infection inadequate reach of drug tomaintain optimum concentration in caseation
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Management of Tubercular Lymphadenitis
Drugs:
Antitubercular drugs have to be started:
- Rifampicin 450 mg OD on empty stomach. It is bactericidal.
- INH: 300 mg OD. It is bactericidal.
- Ethambutol 800 mg OD. It is bacteriostatic.
- Pyrazinamide 1500 mg OD (or 750 mg BD). It is bactericidal.
Duration of treatment is usually 6–9 months.
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Aspiration: When there is cold abscess, initially it is aspirated. Wide bore needle is introduced into the cold abscess in a nondependent site along a “Z” track (in zigzag pathway) so as to prevent sinus formation.
Incision and drainage: Ifcold abscess recurs, then it should be drained. Drainage is done through a nondependent incision. After draining the caseating material, wound is closed without placing a drain.
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Surgical removal: Surgical removal of tubercular lymph nodes are indicated when
- There is no local response to drugs
- When sinus persists.
It is done by raising skin flps and removing all caseating material and lymph nodes. Care is taken not to injure major structures.
Excision of the sinus tract is often essential when sinus develops.
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Question.2. Name etiological agent, pathognomic diagnostic feature, and treatment (only modalities) of matted lymph nodes in neck.
Answer.
Etiological Agent
Since mattd lymph nodes in neck are seen in tuberculosis, the etiological agent is Mycobacterium tuberculosis.
Pathognomic diagnostic Feature
Matting of lymph nodes in neck is itself a pathognomic diagnostic feature of tuberculosis.
Mattng is due to involvement of capsule. Nodes are firm and non-tender.
Treatment (Only Modality)
Anti-tubercular treatment should be given to the patient.
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