Page 1 of 2: A 30 yr. Old patient presents with asymptomatic doughy soft

kalika · Credits: 12507 My Scrapbook My Reading List 12 Books

A 30 yr. Old patient presents with asymptomatic doughy soft 2 cm swelling of the lateral side of neck which has been present for months . the swelling recently enlarged as a result of an upper respiratory tract infection . the most likely diagnosis is

A. scrofula
B. hodgkin’s ds.
C. Cat scratch fever
D. Cervicofacial actinomycosis

dr_siba21 · Credits: 167 My Scrapbook

is that(D) cirvicofacial actinomycosis

dr_siba21 · Credits: 167 My Scrapbook

is that(D) cervicofacial actinomycosis

docsa · Credits: 9043 My Scrapbook

dr_siba21 · Credits: 167 My Scrapbook

scrofula caused by M. scrofulaceum generally cause chronic cervical lymphandenitis in children

in hodgkin's disease, enlargement of lymph nodes should have with symtomps of three constitutinal symptoms of fever, night sweats and weight loss greater than 10% of body wt.

in cat scratch disease, by Bartonella henselae bacteria from the scratch by a cat usually with symptoms.

but in cervicofacial actinomycosis, there is a greater chance of infection and subsequent enlargement of the lymph node.

still i am not clear about my answer. what is the answer give?

kalika · Credits: 12507 My Scrapbook My Reading List 12 Books

thnx doc its d cervicofacial actinomycosis only

Akil · Credits: 28124 My Scrapbook

In Hodgkins....the consistency is classically rubbery..not soft. I doubt if any lymph node swelling is actually soft.

Classically a lymph node swelling is firm..unless caseous necrosis occurs! (eg. in children in TB- COLD ABSCESS).

It has been rightly pointed out that classically cat scratch disease is after a cat scratch.....but it is almost impossible to use this as a significant historical data nor is it reliable since many might have had this exposure to cat scratch and might not be actually be affected... INTERESTINGLY THE CAT DOES NOT RESPOND TO SKIN ANTIGEN TEST! So relying on this historical data is NOT advisable. The historical data of significance that is mentioned and rightly pointed out by Dr.Siba is that cat scratch disease is symptomatic! The lymph node enlarged by itself is painful!

Now is this an actinomycotic abscess a soft tissue swelling or a lymph node swelling? It is basically a soft tissue swelling with an early acute phase which later enters chronic phase. In this early acute phase it is firm and indurated! It is in the later phase does it become soft due to abscess formation classically starting in the centre of the induration.....

I doubt if it is lymph node swelling actually!(does actinomycosis cause abscess of lymph node similar or comparable to that formed in TB?) I again reiterate that excepting when there is necrosis of lymph node the lymph node swelling is FIRM on palpatiion! Probably it is two swellings which are unrelated, but the patient by himself/herself relates them to be same! Probably the actinomycotic soft tissue swelling persists and but a non specific cervical lymphadenopathy secondary to infection is what made the patient seek medical advice.(because actinomycosis is asymptomatic and the patient does NOT seek medical advice unless the swelling becomes big or it forms draining sinus etc!).

Akil · Credits: 28124 My Scrapbook

I think it is a soft tissue swelling...rather than a lymph node because of the reasons already cited above in my previous post!

Bye to all. I guess I wont Sign In here again for some time!

Regards,
Akil

Akil · Credits: 28124 My Scrapbook

I didnt want to Sign In.....but thought i will give this info...since i came across this!

docsa · Credits: 9043 My Scrapbook

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