CWH C1308088

 A

It looks like you’re mentioning TB (tuberculosis) associated with supraclavicular lymphadenitis. Let’s break this down carefully.

1. Supraclavicular Lymphadenitis

• Definition: Enlargement or inflammation of lymph nodes above the clavicle.

• Clinical significance: Particularly in adults, supraclavicular lymphadenopathy is often concerning because it can indicate systemic infections (like TB) or malignancies (especially lymphoma or metastatic cancer).

• Side-specific clues:

  • Left-sided (Virchow’s node): Often associated with abdominal malignancies.

  • Right-sided: May be linked to thoracic malignancies.

2. Tuberculous Lymphadenitis

• Also called: Scrofula when cervical lymph nodes are involved.

• Cause: Mycobacterium tuberculosis infection of the lymph nodes.

• Epidemiology: Common in TB-endemic countries; can occur in both children and adults.

• Clinical features:

  • Painless, firm, gradually enlarging lymph nodes

  • May develop caseation (necrotic material inside)

  • Can form sinus tracts or ulcers if untreated

  • Often accompanied by systemic TB symptoms: fever, night sweats, weight loss

3. Diagnosis

• Clinical evaluation: Palpation of lymph nodes, checking for tenderness, consistency, mobility, and signs of sinus formation.

• Investigations:

  • Fine-needle aspiration cytology (FNAC): Shows granulomatous inflammation with caseation.

  • Excision biopsy: Sometimes needed for definitive diagnosis.

  • Chest X-ray: To check for pulmonary TB.

  • TB tests: Mantoux (PPD), IGRA tests.

  • Microbiological tests: Acid-fast bacilli staining, culture, or PCR for Mycobacterium tuberculosis.

4. Management

• Anti-TB therapy (ATT): Standard regimen for extrapulmonary TB (usually 6–9 months).

• Surgery: Rarely needed; only if there is abscess formation or diagnostic uncertainty.

• Follow-up: Monitor lymph node regression and watch for recurrence.

5. Important Points

• High index of suspicion is needed in endemic areas.

• Rule out malignancy in adults presenting with supraclavicular lymphadenopathy.

• Do not drain TB lymph nodes unless abscess forms; incision can lead to persistent sinuses.

If you want, I can make a concise table comparing TB lymphadenitis vs other causes of supraclavicular lymphadenopathy, which is very useful clinically.

Do you want me to do that?