Cervical lymphadenopathy in children--incidence and
diagnostic management.
Int J Pediatr Otorhinolaryngol. 2007 Jan;71(1):51-6.
OBJECTIVE:
Palpable lymph nodes are common due to the reactive hyperplasia of
lymphatic tissue mainly connected with local inflammatory process.
Differential diagnosis of persistent nodular change on the neck is
different in children, due to higher incidence of congenital
abnormalities and infectious diseases and relative rarity of
malignancies in that age group. The aim of our study was to analyse
the most common causes of childhood cervical lymphadenopathy and
determine of management guidelines on the basis of clinical
examination and ultrasonographic evaluation. MATERIAL AND METHODS:
The research covered 87 children with cervical lymphadenopathy. Age,
gender and accompanying diseases of the patients were assessed. All
the patients were diagnosed radiologically on the basis of
ultrasonographic evaluation. RESULTS: Reactive inflammatory changes
of bacterial origin were observed in 50 children (57.5%). Fever was
the most common general symptom accompanying lymphadenopathy and was
observed in 21 cases (24.1%). The ultrasonographic evaluation
revealed oval-shaped lymph nodes with the domination of long axis in
78 patients (89.66%). The proper width of hilus and their proper
vascularization were observed in 75 children (86.2%). Some
additional clinical and laboratory tests were needed in the patients
with abnormal sonographic image. CONCLUSIONS: Ultrasonographic
imaging is extremely helpful in diagnostics, differentiation and
following the treatment of childhood lymphadenopathy. Failure of
regression after 4-6 weeks might be an indication for a diagnostic
biopsy.
Childhood cervical lymphadenopathy.J
Pediatr Health Care. 2004
Jan-Feb;18(1):3-7.
Cervical
lymphadenopathy is a common problem in children. The condition most
commonly represents a transient response to a benign local or
generalized infection, but occasionally it might herald the presence
of a more serious disorder. Acute bilateral cervical lymphadenopathy
usually is caused by a viral upper respiratory tract infection or
streptococcal pharyngitis. Acute unilateral cervical lymphadenitis
is caused by streptococcal or staphylococcal infection in 40% to 80%
of cases. The most common causes of subacute or chronic
lymphadenitis are cat scratch disease, mycobacterial infection, and
toxoplasmosis. Supraclavicular or posterior cervical lymphadenopathy
carries a much higher risk for malignancies than does anterior
cervical lymphadenopathy. Generalized lymphadenopathy is often
caused by a viral infection, and less frequently by malignancies,
collagen vascular diseases, and medications. Laboratory tests are
not necessary in the majority of children with cervical
lymphadenopathy. Most cases of lymphadenopathy are self-limited and
require no treatment. The treatment of acute bacterial cervical
lymphadenitis without a known primary source should provide adequate
coverage for both Staphylococcus aureus and group A beta hemolytic
streptococci.
Suppurative
cervical lymphadenitis in children. Review of 45 patients.Ann
Otolaryngol Chir Cervicofac. 2004
Apr;121(2):110-4.
OBJECTIVE:
To review the bacteriological features and treatment of suppurative
cervical lymphadenitis in children in order to achieve optimal
treatment. PATIENTS AND METHODS: Forty-five children were
hospitalized. Time of hospitalization was evenly distributed over
Year and between Years. Age ranged from 2.5 Months to 13.5 Years
(median 1 Year 10 Months). Twenty-nine patients had received prior
antibiotic treatment. Bacteriological samples were sterile in 15 out
of 45 children and were positive for Staphylococcus (all meti-S) in
20. Cefotoxim and fosfomycin were prescribed and was sufficient in
14 children (with needle aspiration). Surgical drainage was
performed in the other cases. CONCLUSION: Staphylococcus aureus is
the predominant causal agent for acute suppurative lymphadenitis in
children. Antibiotic therapy in the outpatient setting does not
always prevent abscess formation and surgical drainage may be
required.
Diagnosis, management and surgical treatment of non-tuberculous
mycobacterial head and neck infection in children.ORL
J Otorhinolaryngol Relat Spec. 2002
;64(4):284-9.
The aim of
this study was to present our experience with the clinical
characteristics of non-tuberculous mycobacterial (NTM) head and neck
lymph node infections, the use of modern diagnostic tools and the
appropriate therapeutic measures. We have reviewed the cases of 14
Caucasian children with NTM head and neck lymphadenitis who were
treated in our clinic in the last 5 years. Three of the patients
were male and 11 were female. Their age ranged from 15 to 98 months
(mean age 45.7 +/- 21.76 months). Cervical lymph nodes were involved
in all of our cases, while the submandibular region was found to be
the area mostly affected. Overlying skin was involved in 7 cases.
Diagnosis was based on intradermal skin testing with specific
antigens for atypical mycobacteria, histological examination and
specimen culture. Skin tests were positive for NTM in all of the
patients with a predilection for Mycobacterium avium complex. The
diagnosis was confirmed by histological examination in 13 cases.
Specimen culture was positive in 9 cases, most of them growing M.
avium-intracellulare complex. Treatment included complete surgical
excision of the affected lymph nodes and the overlying skin, as well
as functional neck dissection when required. A second procedure was
performed in 2 patients. Successful evaluation of NTM infections of
the head and neck lymph nodes should include a detailed history,
thorough physical examination and specific laboratory
investigations. The treatment of choice is complete surgical
excision of all affected tissue.
Peripheral
lymphadenopathy in childhood--recommendations for diagnostic
evaluation.
Klin Padiatr. 2000
Sep-Oct;212(5):277-82.
BACKGROUND:
Enlargement of peripheral lymph nodes most commonly caused by a
local inflammatory process is frequently seen in childhood. The aim
of the present study was to analyze the most common causes of
peripheral lymphadenopathy and to develop a simple algorithm for the
primary diagnostic evaluation of peripheral lymph node enlargement
in this age group. PATIENTS: Between April and September 1999 87
unselected children (median age: 5 1/2 years) with peripheral
lymphadenopathy were referred to the Department of Pediatrics,
University of Graz, for further investigation. RESULTS: EBV
infection was diagnosed in 20 (23.0%) children. 19 (21.8%) patients
had acute bacterial lymphadenitis. In 21 (24.1%) patients lymph node
enlargement was classified as "post/parainfectious (viral)". Four
patients each had toxoplasmosis and cat scratch disease. In 11
(12.6%) patients neither physical nor laboratory examinations
revealed pathologic results. Among the remaining 8 children
sarcoidosis and Hodgkin disease was diagnosed in one patient each.
Small, soft, mobile, nontender, cervical, axillary or inguinal lymph
nodes do not require further investigations. In case of enlarged,
tender lymph nodes with overlying skin erythema and fever diagnostic
evaluation should include complete blood count, erythrocyte
sedimentation rate and/or c-reactive protein level, supplemented by
appropriate antibody testing (EBV, CMV, Toxoplasma gondii,
Bartonella henselae). Firm, enlarged, painless lymph nodes which are
matted together and fixed to the skin or underlying tissues
necessitate a more detailed diagnostic evaluation in order to
exclude malignant or granulomatous diseases. CONCLUSIONS: Our study
demonstrated that primary diagnostic evaluation of childhood
peripheral lymphadenopathy is mainly based on clinical grounds. In
most cases a small number of additionally performed laboratory tests
allow to correctly identify the cause of the peripheral lymph node
enlargement.
The ratio of
cervical subacute necrotizing lymphadenitis occupying superficial
lymphadenopathy and its clinical findings.Nippon
Jibiinkoka Gakkai Kaiho. 1999
May;102(5):635-42.
INTRODUCTION: Diseases in which cervical lymphadenopathy is a chief
complaint are commonly observed. These cases are associated with a
good prognosis, high fever and pain which usually recovers without
medication. This condition is referred to as subacute necrotizing
lymphadenitis (SNL). We investigated cases of SNL that were
correctly diagnosed by biopsy. OBJECT AND METHODS: We examined cases
of SNL that were correctly diagnosed by biopsy in the Naha
Prefectural hospital between April 1987 and March 1997. We
statistically analyzed the ratio of occurrence and clinical findings
(age, sex, season of occurrence, physical characteristics, clinical
progress, blood findings, therapy, and prognosis). RESULTS: In a
total of 629 cases, a biopsy specimen from the body surface of the
area affected by lymphadenopathy was obtained. Among these cases,
SNL was diagnosed in 54 accounting for 9% of the total body surface
biopsies and 13% of the cervical lymphadenopathic biopsies. Sex: Of
the 54 subjects, 18 were males and 36 females. AGE: Most of the
subjects (87%) ranged from 10 to 30 years of age. Season of
occurrence: The number SNL cases decreased from 1993. Many cases
occurred in the cold season, from October to March. Clinical
findings: Forty cases were investigated as fever, swelling, pain and
complications. FEVER: Six cases (15%) were not associated with fever
and 34 cases (85%) exhibited fever. Swelling: All subjects
demonstrated swelling for at least one week and the longest duration
of swelling was six months. Swelling continued for two to three
months on average. Thirty-five cases (88%) showed swelling on one
side only, left or right, and five cases (12%) showed swelling on
both sides. PAIN: Ten cases (25%) were without pain and 30 cases
(75%) with some pain. Complications: Twelve cases (30%) had
complications including six of drug allergy, four of dermatitis, and
some cases of diabetes mellitus and hyperthyroidism. Eleven of 54
cases (20%) were admitted to the hospital. Blood findings: The white
blood cell level decreased in 30 of 37 cases (82%). As shown below,
increased levels of CRP (6/34), ESR (4/31) and LDH (17/31) were
observed. THERAPY: Steroids were administered in 24 of 36 cases and
were effective in all cases. Antibiotics were administered in 25 of
31 cases and were effective in six cases (19%)) and ineffective in
10 cases (32%). The condition in nine cases (29%) worsened. Pain
killers were employed in 26 of 32 cases. They were effective 18
cases (56%) and ineffective in eight cases (25%). No subjects died.
The prognoses were good and all patients recovered without sequela.
CONCLUSION: SNL was detected in a large number of patients with
cervical lymphadenopathy who visited our hospital, if patients who
were not diagnosed correctly by biopsy were included. Many patients
exhibited lymphadenopathy on one side (88%). This result was
slightly higher than that previously reported. SNL is considered to
be related to allergy or upper respiratory infections. This disease
often occurs in cold seasons and patients often exhibit
complications such as drug allergies or antoimmune diseases.
Kikuchi
lymphadenitis. A contribution to the differential diagnosis of
cervical lymph node swelling of unknown origin.HNO.
1995 Apr;43(4):253-6.
According to
its morphological appearance, Kikuchi's disease is also called "histiocytic
necrotizing lymphadenitis". This disorder was first described in
Japan in 1972 as a benign lymphadenopathy of the neck. In Germany
only a few cases have been reported by pathologists, whereas most
clinicians are unaware of the existence of this rare disease, which
can easily be mistaken for malignant lymphoma. In 1993 three cases
of Kikuchi's lymphadenitis were treated at the ENT Department of the
University of Lübeck. Patients' ages ranged from 15 to 30 years old.
Except for cervical adenopathy, findings in blood tests, viral
serology and radiological imaging were unremarkable. While fine
needle aspirations were suspicious for malignant lymphoma, a final
diagnosis of self-limiting "Kikuchi's lymphadenitis" was established
histologically from excised lymph nodes. In our opinion early
extirpation of lymph nodes and consultation of a pathologist are
necessary to make a correct diagnosis without delay. Thus, in
patients with Kikuchi's lymphadenitis unnecessary staging procedures
and treatment can be avoided.
Infectious
cervical adenopathy.Schweiz
Rundsch Med Prax. 1993 Dec
14;82(50):1441-3.
Cervical
adenopathy is often found on examination, but rarely causes clinical
problems. If the adenopathy persists for a longer period then three
to four weeks and no infectious causes are found, further
investigations are needed, especially to exclude a malignancy. The
chronic infectious adenopathies are discussed: mycobacterial (tuberculous
and atypical), toxoplasmosis, cat-scratch disease and actinomycosis.
Diagnostic
evaluation of cervical adenopathies in childhood.An
Esp Pediatr. 1992 Sep;37(3):233-7.
Between 1985
and 1990, 45 children were studied in an inpatient basis hospital
because of cervical lymphadenopathy. This was the most important
clinical sign in these patients. Forty-three had true adenitis. In
the others, one was submaxillitis and one a sarcoma. The age range
was from 2.1 to 13.3 years. Seven children (16%) had neoplastic
adenitis (2 papillary carcinoma of the thyroid, 4 Hodgkin's lymphoma
and one non-Hodgkin's lymphoma). Thirty-six patients had benign
disorders (18 mononucleosis infections, 7 nonspecific adenitis, 5
infections of mycobacteria, 2 of toxoplasma and 2 of rickettsia, one
cervical Whipple and one desmopathic adenitis). We did no find any
differences related to age or morphological characteristics of the
lymph nodes. The evolution time in patients with malignant tumors
was 16.4 weeks and 9.6 weeks in the benign group. All of the cases
with supraclavicular location had a lymphoma. The mean LDH in
patients with malignant tumors was 214 U/L and 614 U/L in those with
non-malignant tumors (p < 0.01).
Neck masses
in childhood. Surgical experience in 154 cases.
Minerva Pediatr.
1990 May;42(5):169-72.
Neck masses
of children often constitute a complex problem of diagnosis and
treatment. Despite the currently available diagnostic techniques,
excisional biopsy still remains the procedure of first choice in a
high percentage of cases to obtain a definitive diagnosis. In the
present research, we analyze the problems of differential diagnosis
and surgical treatment of neck masses in children, on the basis of
154 cases recruited in 20 years (at the Dept. of Surgery of the
University of Pisa). Specific and unspecific lymphadenitis were
observed in 26 (16.9%: and 18 cases 18 cases (11.7%), respectively.
Hodgkins' lymphoma was present in 12 patients (7.8%). Thyroid
disorders were diagnosed in 48 cases; 31 (20.1%) of these were
benign, and 17 (11.1%) were malignant. Thirty-nine children showed
congenital anomalies: 26 (16.9%) suffered from cysts of the
thyroglossal duct, 10 (6.5%) from branchial abnormalities, and 3
(1.9%) from cystic lymphangioma. Two dermoid cysts (1.3%) and 2
parotid gland mixed tumours (1.3%) were also observed. The deep
knowledge of embryology and anatomy of the neck, a careful clinic
examination, an echography, as well as a fine needle-aspiration,
seem thus essential to achieve the correct diagnosis and treatment.
|
