Quotation from: Manual of Surgery

Written by: Alexander Miles and Alexis Thomson


#Diagnosis.#--A cold abscess is to be diagnosed from a syphilitic gumma,
a cyst, and from lipoma and other soft tumours. The differential
diagnosis of these affections will be considered later; it is often made
easier by recognising the presence of a lesion that is likely to cause a
cold abscess, such as tuberculous disease of the spine or of the
sacro-iliac joint. When it is about to burst externally, it may be
difficult to distinguish a tuberculous abscess from one due to infection
with pyogenic organisms. Even when the abscess is opened, the
appearances of the pus may not supply the desired information, and it
may be necessary to submit it to bacteriological examination. When the
pus is found to be sterile, it is usually safe to assume that the
condition is tuberculous, as in other forms of suppuration the causative
organisms can usually be recognised. Experimental inoculation will
establish a definite diagnosis, but it implies a delay of two to three
weeks.

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