A cystic lateral swelling of neck may be due to cold abscess. Cold abscess is an abscess which arises from tuberculous origin. It is called cold as it is not as hot and red as pyogenic abscess. It is also much less painful than pyogenic abscess.

Causes-

1.   Actinomycosis.

2.   Gumma degeneration.

3.   Leprosy.

4.   From caseation of the tuberculous lymphadenitis in the cervical region. The cold abscess is seen in the anterior triangle.

5.   From tuberculosis of cervical spine. In this case, the cold abscess is usually present in the posterior triangle.

Symptoms-

1.   Seen in children.

2.   History of pain in neck, solid swelling previously in the region of cold abscess.

3.   Swelling in the neck which is painless.

4.   Evening rise of temperature, anorexia, loss of weight, anemia, coughing.

5.   Family history of tuberculosis.

6.   Swelling is cystic, soft with an indistinct margin. Fluctuation test is positive. Matted lymph nodes may be palpable at the margin and in the depth of cold abscess.

Investigations-

1.   Blood test.

2.   Sputum examination.

3.   Mantoux test.

4.   Other lymph node biopsy.

5.   X-ray of the neck.

6.   X-ray of the chest.

Treatment-

1.   Anti tubercular drugs.

2.   High protein diet.

3.   Vitamin supplements.

4.   Operative treatment.