Objective: To study the diagnostic pathway for tuberculous lymphadenitis from initial referral to the commencement of antituberculous therapy with the object of identifying potentially avoidable delays. Design: Retrospective case series study. Setting: District General Hospital, England, UK. Subjects: Thirty-four patients with head and neck tuberculous lymphadenitis diagnosed by a positive histological specimen over the 3-year period 1998–2000. Results: There were no clear pathways for referral and management. There were substantial variations in the management between different specialties and even sometimes within the same specialty. There was evidence of poor communication between various teams. Conclusions: The study shows that for the management of head and neck tuberculous lymphadenitis, there is a need for a ‘hospital’ or ‘trust’ approach. It also reinforces the arguments for a dedicated ‘neck lump clinic’ with easy access both from the general practitioners and from other specialties within the hospital and for a protocol for handling biopsy specimens from nodes.