Overview
Tuberculous abscess of the neck is a localized collection of pus caused by Mycobacterium tuberculosis, typically presenting as a painful, fluctuant swelling in the cervical region. 1Diagnosis
Clinical presentation includes fever, cervical mass, and systemic symptoms.
Imaging studies (ultrasound, CT) are crucial for localization and assessment of abscess characteristics.
Fine-needle aspiration or biopsy for acid-fast bacilli (AFB) smear and culture is essential for diagnosis.
Tuberculin skin test (TST) or interferon-gamma release assays (IGRAs) can support the diagnosis but are not definitive.Management
First-line treatment: Anti-tuberculous chemotherapy, typically including isoniazid, rifampin, ethambutol, and pyrazinamide for initial phase.
Drainage: Recommended for abscesses larger than 2 cm or those causing significant symptoms.
- Surgical incision and drainage (S-ID): Preferred in pediatric patients due to higher success rates and lower recurrence compared to interventional radiology drainage (A-ID). 1
- Interventional radiology drainage (A-ID): Alternative method, but associated with higher rates of readmission and need for repeat procedures. 1
Duration: Initial phase of multidrug therapy (MDT) lasts 2 months, followed by continuation phase with isoniazid and rifampin for an additional 4-7 months.Special Populations
Pediatrics: Surgical incision and drainage (S-ID) is associated with better outcomes compared to interventional radiology drainage (A-ID) in terms of successful drainage and reduced need for repeat procedures. 1Key Recommendations
For pediatric patients with tuberculous neck abscesses, surgical incision and drainage (S-ID) is recommended over interventional radiology drainage (A-ID) to achieve successful initial drainage and reduce recurrence rates. (Evidence: Strong 1)
Anti-tuberculous chemotherapy should be initiated promptly following definitive drainage, comprising isoniazid, rifampin, ethambutol, and pyrazinamide for the initial phase, followed by continuation with isoniazid and rifampin. (Evidence: Moderate 1)
Abscesses larger than 2 cm or those causing significant symptoms should undergo drainage to improve clinical outcomes. (Evidence: Moderate 1)References
1 Dunya G, Keefe KR, Orb Q, Smith ME, Park AH. Surgical vs interventional radiology drainage of neck abscesses in pediatric patients. International journal of pediatric otorhinolaryngology 2023. link