Dr. P.Sudheer kumar
Narayana medical college & hospital
An Abscess is a collection of pus within the
It is cold because it is not accompanied by the
classical signs of inflammation
Almost always a sequel of tubercular
infection anywhere in the body commonly in
the lymph nodes & bone.
Any osteoarticular tubercular lesion is a result
of a hematogenous dissemination from a
primarily infected visceral focus
Primary focus may be in Lungs,lymph glands
of mediastinum/mesentry/cervical region or
kidneys or other viscera.
Phagocytosis of tubercle bacilli by RES
The characteristic microscopic lesion is the
tuberculous granuloma– a collection of
epithelioid and multinucleated giant cells
Within the tubercle, small patches of caseous
necrosis appear. These may coalesce into a
larger yellowish mass, or the centre may break
down to form an Abscess.
It is formed by collection of products of
liquefaction & the reactive exudation
It penetrates the ligaments in articular
disease, bone & periosteum in osseous disease
Migrates in various directions following the path
of least resistance along fascial planes,blood
vessels and nerves, to distant sites
Mostly composed of
Commonly at Neck &
Also at Groin,back,side
of chest wall
These are sequel of
tubercular infection of
spine,ribs & posterior
medistinal group of
Sinus or ulcer
superadded infection with pyogenic organisms
Constitutional symptoms like low grade
fever, cough , weight loss,loss of appetite
Symptoms of primary tuberculosis
Local Pressure effects due to swelling
c-spine: exudate collects behind prevertebral
fascia & protrude as retropharyngeal abscess
causing dysphagia, dysphonea, hoarseness of voice
& respiratory obstruction
abscess may track down to enter
trachea, esophagus or pleural cavity. It may spread
laterally into the sternomastoid muscle & forms an
abscess in the neck.
T-spine: exudate confined locally as paravertebral
it may enter into spinal canal & compress spinal
cord leading to Early onset pott’s paraplegia
it can penetrate anterior longitudinal ligament to
form mediastinal abscess .
pass downwards through medial arcute ligament
to form a lumbar abscess.
Lumbar spine -abscess can have pus track along
the psoas muscle towards the groin & presents as
Flexion deformity of hip can develop due to
it.(pseudo hip flexion)
Can gravitate beneath inguinal ligament to appear
on the medial aspect of thigh
exudate can follow vessels to form an abscess in
scarpa’s triangle or gluteal region
Mantoux / Tuberculin skin test
ESR may be markedly elevated (neither
specific nor reliable).
ELISA : for antibody to mycobacterial antigen-
6 , sensitivity of 60% – 80%.
Fnac & Biopsy
Percutaneous , CT scan ̶ guided needle biopsy
of bone lesions is a safe procedure that also
allows therapeutic drainage of large
Biopsy is confirmative
Microbiology studies to confirm
• Ziehl-Neelsen staining: Quick and inexpensive
• Bone tissue or abscess samples stain for
acid-fast bacilli (AFB), & isolate organisms for
culture & drug susceptibility.
• Culture results - few weeks.
• Positive only in 50% of cases.
Radionucleotide Scan T 99m
Increased uptake in up to 60 per cent patients
with active tuberculosis.
Avascular segments and abscesses show a cold
spot due to decreased uptake.
Highly sensitive but nonspecific.
Aid to localise the site of active disease and to
detect multilevel involvement
ANTI TUBERCULAR DRUGS
Same as tuberculosis elsewhere in the body.
The chemotherapy is continued for 18 months.
•Palpable Cold abscess must be drained as early as
possible & instil 1gm Streptomycin +/- INH in solution
•Technique: Zig-Zag aspiration using Wide bore needle
from non-dependent area to prevent sinus formation
Open drainage may be performed if
aspiration failed to clear it.
Drainage using non-dependent incision,later
closure of wound without placing a drain
Correcting underlying bony lesion/defect.