Lymphadenopathy

Enlarged lymph nodes are commonly found in children. Lymphadenopathy might be caused by proliferation of cells intrinsic to the node, such as lymphocytes, plasma cells, monocytes, or histiocytes, or by infiltration of cells extrinsic to the node, such as neutrophils and malignant cells. In most instances, lymphadenopathy represents transient proliferative responses to local or generalized infections. Reactive hyper-plasia, defined as a polyclonal proliferation of one or more cell types, is the most frequent diagnosis in pediatric lymph node biopsies.

Lymphadenopathy is also a presenting sign of malignancies such as leukemia, lymphoma, or neuroblastoma, and it is important to be able to differentiate benign from malignant lymphadenopathy.

Lymphadenopathy in the head and neck region must be differentiated from several congenital malformations (Table 12-1).

Systematic palpation of the lymph nodes is important and should include examination of the occipital, posterior auricular, preauricular, tonsillar, submandibular, submental, upper anterior cervical, lower anterior cervical, posterior upper and lower cervical, supraclavicular, infraclavicular, axillary, epitrochlear, and popliteal lymph nodes. Many children have small palpable nodes in the cervical, axillary, and inguinal regions that are usually benign in nature. However, adenopathy in the su-praclavicular regions is usually pathologic.

When nodes of significant size are palpated, radiography of the chest should be carried out to determine whether there is an associated mediastinal or hilar lym-phadenopathy. The latter may require computed tomography (CT) of the chest. When a malignant disease is suspected, abdominal sonography and CT are required to determine whether retroperitoneal lymph nodes are present. When a child presents with lymphadenopathy, management is based on the following factors.

Table 12-1. Differential Diagnosis of Cervical Lymphadenopathy

Cystic hygroma

Branchial cleft anomalies, branchial cysts Thyroglossal duct cysts Epidermoid cysts Neonatal torticollis

Lateral process of lower cervical vertebra may be misdiagnosed as supraclavicular node.

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