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What Causes Swelling On Neck?
Question: My wife is having swelling on the right side of neck since October 2014.
We have got FNAC done four times, 3 times it came negative and only once it was positive.
Skin test was partial positive. ESR was 62. CT Scan/X-ray came clean. Biopsy was also done and result was no malignancy found with reactive Hyperplacia.
On the basis of FNAC, TB treatment was started and for two months she was on AKT4 with no improvement in swelling, instead it appears to have grown a little.
Since the size hasn't reduced and doc advised to go for FNAC again last week, which came negative.
Now we are referred for surgery to take out the entire node/swelling and its analysis.
She doesnt have any other symptoms.. no fever/sweating/appetite good/Loss of weight.
We want to exhaust all possible options to rule out TB or any other disease and dont intend to go for surgery due to possible side effects.
Pls advise!
We have got FNAC done four times, 3 times it came negative and only once it was positive.
Skin test was partial positive. ESR was 62. CT Scan/X-ray came clean. Biopsy was also done and result was no malignancy found with reactive Hyperplacia.
On the basis of FNAC, TB treatment was started and for two months she was on AKT4 with no improvement in swelling, instead it appears to have grown a little.
Since the size hasn't reduced and doc advised to go for FNAC again last week, which came negative.
Now we are referred for surgery to take out the entire node/swelling and its analysis.
She doesnt have any other symptoms.. no fever/sweating/appetite good/Loss of weight.
We want to exhaust all possible options to rule out TB or any other disease and dont intend to go for surgery due to possible side effects.
Pls advise!
Brief Answer:
get done excision biopsy and send for MDR TB.
Detailed Answer:
Hello dear, thanks for your question on HCM.
I can understand your situation and problem.Thanks for the detailed history and reports. I have gone through the reports you have attached.
She is on standard anti TB drugs and still her swellings are increasing in size, this suggest possibility of
1. MDR Tuberculosis (Multi Drug resistant Tuberculosis)
2. Other infections like Resistant anaerobic bacterial infection or fungal infection.
So excision biopsy of enlarged Lymphnodes is needed. And get done routine culture, anaerobic culture and AFB culture and sensitivity.
Anaerobic bacteria needs special culture for growth.
Possibility of MDR tuberculosis is high in her case. For the diagnosis of MDR TB, AFB culture and sensitivity is must.
So excision biopsy is needed in her case to establish proper diagnosis.
And no need to worry much for side effects of surgery. It is very safe surgery.
And definitely needed in her case so consult ENT surgeon for excision and discuss all these with him.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your wife.
Thanks.
get done excision biopsy and send for MDR TB.
Detailed Answer:
Hello dear, thanks for your question on HCM.
I can understand your situation and problem.Thanks for the detailed history and reports. I have gone through the reports you have attached.
She is on standard anti TB drugs and still her swellings are increasing in size, this suggest possibility of
1. MDR Tuberculosis (Multi Drug resistant Tuberculosis)
2. Other infections like Resistant anaerobic bacterial infection or fungal infection.
So excision biopsy of enlarged Lymphnodes is needed. And get done routine culture, anaerobic culture and AFB culture and sensitivity.
Anaerobic bacteria needs special culture for growth.
Possibility of MDR tuberculosis is high in her case. For the diagnosis of MDR TB, AFB culture and sensitivity is must.
So excision biopsy is needed in her case to establish proper diagnosis.
And no need to worry much for side effects of surgery. It is very safe surgery.
And definitely needed in her case so consult ENT surgeon for excision and discuss all these with him.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your wife.
Thanks.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Thanks for answering my query.
If we highly suspect that it could be MDR TB, then can we not start treatment on trial basis before going for Surgery. This way we can avoid Surgery.
And if it is some other infections as stated by you ''Other infections like Resistant anaerobic bacterial infection or fungal infection'' , How can they be investigated? What all test do we need to go for their diagnosis?
Not sure whether its usual or not, however i find it very surprising that FNAC has been done 4 times over the past 4 months and except once, 3 times its outcome was negative. Moreover there was no pus found all the times.
Please advise the best possible way forward.
If we highly suspect that it could be MDR TB, then can we not start treatment on trial basis before going for Surgery. This way we can avoid Surgery.
And if it is some other infections as stated by you ''Other infections like Resistant anaerobic bacterial infection or fungal infection'' , How can they be investigated? What all test do we need to go for their diagnosis?
Not sure whether its usual or not, however i find it very surprising that FNAC has been done 4 times over the past 4 months and except once, 3 times its outcome was negative. Moreover there was no pus found all the times.
Please advise the best possible way forward.
Brief Answer:
get done excision biopsy.
Detailed Answer:
Hello dear, thanks for your follow up query.
Treatment for MDR TB should be started empirically, because the drugs used are having toxic side effects and the duration of treatment is almost 2 years. So no scope of MDR TB treatment without confirm report.
For this AFB culture and sensitivity is needed. And for this tissue sample is needed. So excision biopsy(surgery) is must.
For the diagnosis of fungal infection fungal culture is needed.
For the diagnosis of anaerobic infection , special anaerobic culture is needed.
And for all these culture, you need tissue sample. And tissue sample is available only after Excision biopsy. So get done surgery to reach the final diagnosis.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your wife.
Thanks.
get done excision biopsy.
Detailed Answer:
Hello dear, thanks for your follow up query.
Treatment for MDR TB should be started empirically, because the drugs used are having toxic side effects and the duration of treatment is almost 2 years. So no scope of MDR TB treatment without confirm report.
For this AFB culture and sensitivity is needed. And for this tissue sample is needed. So excision biopsy(surgery) is must.
For the diagnosis of fungal infection fungal culture is needed.
For the diagnosis of anaerobic infection , special anaerobic culture is needed.
And for all these culture, you need tissue sample. And tissue sample is available only after Excision biopsy. So get done surgery to reach the final diagnosis.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your wife.
Thanks.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Answered by
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