Cervical lymph node subcutaneous node (tuberculosis of cervical lymph nodes) is more common in older children and often coexists with subcutaneous nodes in other parts of the body. The primary lesion is located in the tonsils, with a few cases in the adenoids of the upper pharynx. The route of pestilence is through lymphatic and hematogenous spread.

bubble_chart Clinical Manifestations

1. The onset is slow, presenting as painless lymph node enlargement. It is unilateral, located in the anterior or posterior cervical triangle, with one or several nodes that are movable, non-adherent, non-tender, and slightly firm. Occasionally, parents may notice the enlarged lymph nodes when the child turns their head.
2. When the condition worsens, subcutaneous node inflammation may spread to surrounding tissues, causing several lymph nodes to adhere to each other and to subcutaneous tissues, forming a larger immobile mass.
3. Further deterioration leads to caseous necrosis and central liquefaction, forming a cold abscess. The skin appears purplish-red with a fluctuant sensation, eventually rupturing and discharging thin, grayish-white pus containing caseous material. This forms an ulcer or sinus that persists for a long time, ultimately healing into an irregular, permanent scar.
4. Mild cases show no systemic symptoms, while more severe cases exhibit chronic subcutaneous node toxicity symptoms and nutritional disturbances.
5. It is often accompanied by subcutaneous node hypersensitivity, such as phlyctenular conjunctivitis or erythema nodosum.

bubble_chart Auxiliary Examination

Positive OT or PPD test; increased erythrocyte sedimentation rate; caseous material can be aspirated from lymph nodes, and subcutaneous node bacteria can be found in smears and cultures. Histopathological examination of enlarged, non-adherent lymph nodes by biopsy can confirm the diagnosis.

1. Larger lymph nodes can be surgically removed, and lymph node biopsy can also achieve therapeutic purposes. Anti-subcutaneous node drugs should be used before and after surgery, with INH administered for 1 to 1.5 years and SM intramuscularly injected for 1 to 3 months.
2. For local lymph nodes that have formed cold abscesses, local puncture can be performed to aspirate the pus, followed by injection of 5% INH or 10% SM 1–2 ml every 2–3 days. Care must be taken to puncture from healthy skin and strictly adhere to aseptic techniques to avoid introducing infection and prevent the formation of fistulas.
3. If a cold abscess has ruptured, drainage should be maintained. For cases with poor drainage, incision and curettage of caseous material should be performed, and antibiotics should be added if secondary infection occurs.
4. For complications such as herpetic conjunctivitis and erythema nodosum, patients highly sensitive to subcutaneous node bacteria may be given prednisone at 1 mg/(kg·d) for 2–4 weeks. Large doses of vitamin C should also be administered concurrently.

bubble_chart Differentiation

1. Acute suppurative lymphadenitis of the neck: Sudden onset, rapid progression, accompanied by inflammation of nearby tissues such as acute tonsillitis, pharyngitis, fever, obvious local redness, swelling, and tenderness, elevated white blood cell count and neutrophils, effective with antibiotics.
2. Chronic lymphadenitis of the neck: Grade I lymph node enlargement, fewer in number, mobile. When the focus of infection flares up acutely, the lymph nodes enlarge accordingly and shrink again after the infection is controlled. It can persist for months or years without subsiding.
3. Hodgkin's disease (lymphoreticuloma): Progressive, painless enlargement of lymphoid tissue, relatively firm, non-tender. When the involvement is extensive, mediastinal lymph nodes are often enlarged simultaneously, with rapid progression and frequent occurrence of compressive symptoms. Characteristic Reed-Sternberg cells ("mirror-image" nuclei) can be found on biopsy.