bubble_chart Overview

Cervical lymph nodes, referred to as "scrofula" in Chinese medicine, are commonly seen in children and young adults. The bacilli typically invade through the tonsils or dental caries, with a minority of cases secondary to pulmonary or bronchial subcutaneous node lesions. However, the disease only manifests when the body's resistance is weakened. The disease course usually lasts 1 to 3 months or longer. Multiple enlarged lymph nodes are present, scattered and movable. As the disease progresses, they may fuse into masses, become fixed and immobile, eventually leading to caseous necrosis and the formation of cold abscesses, which may rupture and develop into chronic sinuses. Chest X-rays may reveal subcutaneous node lesions.

bubble_chart Clinical Manifestations

There are multiple enlarged lymph nodes of varying sizes on one or both sides of the neck, usually located along the anterior and posterior borders of the sternocleidomastoid muscle. In the {|###|}initial stage (first stage){|###|}, the enlarged lymph nodes are firm, painless, and movable. As the disease progresses, periadentitis occurs, causing the lymph nodes to adhere to the skin and surrounding tissues. The lymph nodes may also adhere to each other, forming a fused, immobile nodular mass. In the {|###|}advanced stage{|###|}, caseous necrosis and liquefaction of the lymph nodes occur, leading to the formation of a cold abscess. When the abscess ruptures, it discharges pus resembling bean dregs or thin rice soup, eventually forming a persistent {|###|}sinus{|###|} or chronic {|###|}ulcer{|###|}. The edges of the ulcer appear dark red and undermined, with pale, {|###|}edema{|###|}-tous granulation tissue. Lesions at different stages may coexist in the lymph nodes of the same patient. If the patient's resistance improves and appropriate treatment is administered, the {|###|}subcutaneous node{|###|} lesions may cease progression and calcify.

A small number of patients may experience systemic toxic symptoms such as low-grade fever, {|###|}night sweating{|###|}, loss of appetite, and weight loss.

bubble_chart Diagnosis

Based on the history of subcutaneous node disease and local signs, especially when a cold abscess has formed or when it has ulcerated to form a persistent sinus or ulcer, a definitive diagnosis can often be made. If necessary, a chest X-ray can be performed to determine the presence of pulmonary lesions. For pediatric patients, a subcutaneous node test can aid in diagnosis. If there is only cervical lymph node enlargement without the formation of a cold abscess or ulcer.

bubble_chart Treatment Measures

Treatment measures:

Systemic anti-tuberculosis therapy can be applied for this disease. A few localized and mobile cases, or larger lymph nodes, may be surgically removed. For cold abscesses that have not ruptured, aspiration of pus and injection of anti-tuberculosis drugs can be performed. For chronic suppurative sinuses that have already ruptured, incision and curettage with anti-tuberculosis dressing changes may be used.

(1) Systemic treatment: Pay appropriate attention to nutrition and rest. Take isoniazid orally for 1-2 years; for those with systemic toxic symptoms or subcutaneous node lesions elsewhere in the body, add sodium para-aminosalicylate or rifampicin orally, or supplement with intramuscular streptomycin injections.

(2) Local treatment

1. For a few localized, larger, and mobile lymph nodes, surgical removal may be considered. During surgery, take care not to injure the accessory nerve.

2. For cold abscesses that have formed but not yet ruptured, potential aspiration of pus may be performed. Insert the needle from the normal skin around the abscess, aspirate as much pus as possible, then inject 5% isoniazid solution or 10% streptomycin solution into the abscess cavity for irrigation, leaving an appropriate amount in the cavity. Repeat twice weekly.

3. For cold abscesses that have ruptured to form ulcers or sinuses, if secondary infection is not obvious, curettage may be performed, carefully removing all subcutaneous node lesion tissues. Do not suture the wound and use streptomycin solution for dressing changes.

4. For cold abscesses with secondary suppurative infection, incision and drainage should be performed first. After the infection is controlled, curettage may be performed if necessary.

bubble_chart Prevention

Promote health education and cultivate good habits of not spitting anywhere. Children should receive the BCG vaccine. Maintaining oral hygiene, early treatment of dental caries, and removal of diseased tonsils also hold certain significance in prevention.