The practice of pediatrics . egion; at another time fistula? and ulcers over both sidesof the neck cover large masses of lymph nodes. A solitary lymph nodemay be involved, or the nodes which constitute a group may coalesceto form a large tumor mass, or the infection may extend from one groupto a neighboring group until several are involved. Sometimes thesevarious collections may coalesce to form a large tumor mass. Thisaffection is often bilateral (Fig. 70). Sometimes the capsule of the nodes is involved in the inflammation23 354 INFECTIOUS DISEASES going on within. This leads to thickening as
The practice of pediatrics . egion; at another time fistula? and ulcers over both sidesof the neck cover large masses of lymph nodes. A solitary lymph nodemay be involved, or the nodes which constitute a group may coalesceto form a large tumor mass, or the infection may extend from one groupto a neighboring group until several are involved. Sometimes thesevarious collections may coalesce to form a large tumor mass. Thisaffection is often bilateral (Fig. 70). Sometimes the capsule of the nodes is involved in the inflammation23 354 INFECTIOUS DISEASES going on within. This leads to thickening as well as adhesion to theneighboring organs. On account of the connective-tissue growth thenodes become fixed and immovable. The mass becomes adherentto the skin. The skin becomes edematous, tense, and discolored; theaffected area prominent and gradually thins out; eventually it per-forates and the abscess empties itself; a fistula remains, which leadsinto the abscess cavity. If the process continues for a longer time Fig. 70. Tuberculosis of cervical and axillary lymph nodes in an eight-year-old boy. ulcerations of the skin persist and granulations appear at the other cases, where the nodes lie more deeply, the abscess may passbetween the layers of the fascia or along the sheaths of the great vesselsand perforate the skin at some distance—over the clavicle or at thesternal notch, even over the anterior surface of the thorax. In thesecases persistent fistulous tracts remain. Bronchial Lymph Nodes.—The bronchial nodes may be enlargedwithout causing pressure symptoms; on the other hand, serious dis- TUBERCULOSIS 355 turbances may be produced. Pressure on the trachea and bronchicauses narrowing of the air passages, resulting in dyspnea. Cough isan early symptom of pressure. It is frequently paroxysmal in char-acter and may resemble the cough of pertussis, except that there isno crowing inspiration. The paroxysms may be violent and exhaust-ing, ending in vomiting. As
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectchildren, bookyear190
