Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Surgery Final Year Case Presentation Tuberculous Lymphadenitis Clinical Examination Discussion and Treatment
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-1_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-1_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-1_3.jpg)
A 18 yr old male mr.Dinesh kumar
coming from guindy who is a student
belonging to low socioeconomic status
presenting with chief complaints of
swelling in the right side of the neck for 8
months
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-2_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-2_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-2_3.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-2_4.jpg)
H/O PRESENTING ILLNESS
The patient was apparently normal 8
months back after which he developed
swelling ? right side of the neck
Insidious in onset
Duration-8 months
initially small size gradually
progressive to attain the current size
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-3_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-3_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-3_3.jpg)
No h/o pain / discharge
No h/o evening rise of temperature
No h/o loss of weight/appetite
No h/o night sweats
No h/o trauma
No h/o cough with hemoptysis
no h/o epistaxis , nasal block
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-4_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-4_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-4_3.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-4_4.jpg)
No h/o oral ulcers
No h/o ear pain,ear discharge,
No h/o abdominal pain, hemetemesis,melena
No h/o swollen testis
no h/o hoarseness of voice
No h/o difficulty in turning head
No h/o deviation of tongue
No h/o frequent fainting
No h/o difficulty in shrugging of shoulders
No h/o swelling elsewhere in the body
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-5_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-5_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-5_3.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-5_4.jpg)
PAST HISTORY
No h/o similar complaints in the past
No h/o DM/HT/TB/asthma/jaundice
No h/o previous surgery/hospitalization
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-6_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-6_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-6_3.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-6_4.jpg)
PERSONAL HISTORY
Consumes non-vegetarian diet
Normal bowel and bladder habits
No h/o alcoholism/smoking
h/o contact with TB patient
FAMILY HISTORY:
Father is a known TB patient
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-7_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-7_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-7_3.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-7_4.jpg)
GENERAL EXAMINATION
Conscious,oriented
Poorly built and nourished
No pallor/icterus/cyanosis/clubbing/pedal
edema/generalised lymphadenopathy
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-8_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-8_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-8_3.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-8_4.jpg)
VITALS
Pulse rate- 74/min normal in rate
,rhythm,volume,character,all peripheral
pulses are felt,no vessel wall thickening
RR-18/min abdominothoracic type
BP-120/80 mm/hg measured in right
upper arm in sitting posture
Temperature-afebrile
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-9_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-9_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-9_3.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-9_4.jpg)
LOCAL EXAMINATION
INSPECTION:
swelling- 2 in numbers
swelling 1
Rt side of neck,lower,along
sternocledomastoid in the anterior
triangle
5*4cm in size
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-10_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-10_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-10_3.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-10_4.jpg)
Extension
Upper -3cm from angle of mandible
Lower-3cm from clavicle
Medial-3cm from midline
Lateral-8 cm from midline
Hemispherical in shape
Smooth surface ,
Skin over the swelling normal
No scars, sinuses, dilated veins
No visible pulsation / cough impulse
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-11_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-11_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-11_3.jpg)
Swelling 2:
right lower lateral aspect in the anterior
triangle
3*3 cm
Extend :
upper-5cm from angle of mandible
lower-8cm from angle of mandible
medial-8cm from midline
lateral-7cm from spine
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-12_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-12_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-12_3.jpg)
Hemispherical in shape
Smooth surface
Skin over the swelling normal
No scars , sinuses, dilated veins
No visible pulsations/ cough impulse
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-13_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-13_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-13_3.jpg)
Oral cavity:
no growth ,no ulcer , dental caries
present , poor oral hygiene
Nasal cavity:
free , septum appears to be in
midline
Ear :
normal , no discharge
Scalp : normal
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-14_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-14_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-14_3.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-14_4.jpg)
Palpation
Not warmth, not tender
Inspectory findings of site, size, shape,
extend are confirmed
Smooth surface , freely mobile
Skin over the swelling pinchable
Non tender
Firm in consistency
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-15_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-15_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-15_3.jpg)
No fluctuation
No translucency
No cough impulse
No pulsations
No fixity to skin
Surrounding areas- normal
Plane of swelling-deep to deep cervical
fascia
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-16_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-16_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-16_3.jpg)
Percussion:
dull note
Auscultation :
no bruit
Movement :
no restriction of movement
Spine, cranium- normal
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-17_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-17_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-17_3.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-17_4.jpg)
OTHER SYSTEMS
Abdomen :
soft, non tender, no organomegaly / free
fluid, hernial orifice-free, external genitalia
- normal
CVS- S1 S2 heard no murmurs
RS-normal vesicular breath sounds heard
no added sounds
CNS-no focal neurological deficit
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-18_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-18_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-18_3.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-18_4.jpg)
DIAGNOSIS
RIGHT SIDED CERVICAL
LYMPHADENOPATHY involving level 3
nodes
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-19_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-19_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-19_3.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-19_4.jpg)
DIFFERENTIAL DIAGNOSIS
TUBERCULOUS LYMPHADENITIS
HODGKINS LYMPHOMA
SECONDARIES NECK
Syphilis
HIV
LEUKEMIA
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-20_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-20_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-20_3.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-20_4.jpg)
INVESTIGATIONS
ROUTINE;
Blood- TC , DC, Hb%, ESR, urea, sugar
ECG
RFT
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-21_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-21_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-21_3.jpg)
SPECIFIC
FNAC
X-RAY CHEST
MANTOUX TEST
USG NECK
SPUTUM CULTURE , SENSITIVITY
ACID FAST STAINING
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-22_1.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-22_2.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-22_3.jpg)
![](f1a8b86a-922a-44b6-bb02-b5bb0c69c809-22_4.jpg)
TREATMENT
ANTI-TUBERCULAR THERAPY
CATEGORY- 1
INTENSIVE PHASE ? 2 MONTHS
ISONIAZID
RIFAMPICINE
PYRAZINAMIDE
ETHAMBUTOL
CONTINUATION PHASE- 4 MONTHS
ISONIAZID
RIFAMPICIN
This post was last modified on 08 August 2021