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Updated: June 24, 2025
In a cold abscess, such as that which results from tuberculous disease of the vertebræ, the clinical appearances are those of a soft, fluid swelling without heat, redness, pain, or fever. When toxic symptoms are present, they are usually due to a mixed infection. A tuberculous abscess results from the disintegration and liquefaction of tuberculous granulation tissue which has undergone caseation.
Tuberculous infiltration of the marrow in the surface cancelli breaks up the spongy framework of the bone into minute irregular fragments, so that it disintegrates or crumbles away caries. When there is an absence of caseation and suppuration, the condition is called caries sicca.
Less frequently the trabecular framework is added to by the formation of new bone, resulting in a remarkable degree of sclerosis, and if, following upon this, there is caseation of the tubercle and death of the affected portion of bone, there results a sequestrum often of considerable size and characteristic shape, which, because of the sclerosis and surrounding endarteritis, is exceedingly slow in separating.
In superficial bones, such as the sternum, the formation of tuberculous granulation tissue in the deeper layer of the periosteum, and its subsequent caseation and liquefaction, is attended by the insidious development of a doughy swelling, which is not as a rule painful, although tender on pressure.
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