Published on 21/03/2015 by admin
Filed under Pediatrics
Last modified 21/03/2015
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Chapter 30 LYMPHADENOPATHY
Theodore X. O’Connell
Lymph nodes in children may be palpated as early as the neonatal period, and they continue to enlarge through puberty. Most normal children have palpable cervical, inguinal, and axillary adenopathy. As a general rule, a lymph node is considered enlarged if it measures more than 10 mm in its longest diameter. Exceptions to this rule include epitrochlear nodes, which are abnormal if greater than 5 mm in diameter, and inguinal nodes, which are abnormal only if greater than 15 mm in diameter. Palpable supraclavicular, iliac, and popliteal nodes should always be considered abnormal.
Hyperplastic lymph nodes that develop in response to viral infection are small, discrete, mobile, nontender, and bilateral. Pyogenic nodes tend to be unilateral, large, warm, and tender with surrounding erythema and edema. Chronic infections are associated with nodes with discrete margins adherent to underlying tissue and minimal signs of inflammation. Nodes associated with malignancy are generally firm, discrete, and nontender. These nodes are usually rubbery and do not have surrounding inflammation. These nodes become matted together over time and fixed to the skin or underlying structures.
In general, rapidly growing lymph nodes without a confirmed, compatible diagnosis require prompt tissue biopsy. Regressing or fluctuating lymphadenopathy usually can be observed as it is rarely associated with malignancy or serious systemic illness. However, if the lymphadenopathy persists and a diagnosis is required, biopsy is the most definitive option. Persistent lymphadenopathy beyond 8 weeks without an obvious source also should be considered for biopsy.
Bacterial
• Actinomycetes
• Anaerobic bacteria
• Atypical mycobacteria
• Bartonella henselae
• Brucellosis
• Diphtheria
• Francisella tularensis
• Gram-negative enterios
• Group A streptococcus
• Mycobacterium tuberculosis
• Staphylococcus aureus
• Salmonella spp.
• Syphilis
• Yersinia spp.
Congenital
• Branchial cleft cyst
• Bronchogenic cyst
• Cystic hygroma
• Epidermoid cyst
• Sternocleidomastoid tumor
• Thyroglossal duct cyst
Fungal
• Aspergillosis
• Blastomycosis
• Candida
• Coccidioidomycosis
• Cryptococcus
• Histoplasmosis
• Sporotrichosis
Malignancy
• Hodgkin’s disease
• Leukemia
• Lymphoproliferative disorders
• Metastatic disease
Instant Work-ups A Clinical Guide to Pediatrics
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