Cervical lymphadenopathy in children—Incidence and diagnostic management

doi:10.1016/j.ijporl.2006.08.024

International Journal of Pediatric Otorhinolaryngology

Volume 71, Issue 1, January 2007, Pages 51-56

https://doi.org/10.1016/j.ijporl.2006.08.024 Get rights and content

Summary

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.

Introduction

Enlarged, palpable lymph nodes are common due to the reactive hyperplasia of lymphatic tissue mainly connected with local inflammatory process. Park states that up to 90% of children aged 4–8 have palpable cervical lymph nodes [1]. According to Larsson et al. approximately 38–45% of otherwise healthy children have palpable lymph nodes [2]. Lymphadenopathy may be a part of clinical manifestation of neoplasmatic process therefore precise diagnostics is crucial. Differential diagnosis of persistent nodular change on the neck is different in chidren, due to higher incidence of congenital abnormalities and infectious diseases and relative rarity of malignancies in that age group. The main causes of lymphadenopathy in children are: bacterial, viral, protozoal and fungal infections, malignancies including Hodgkin's lymphoma, leukaemia, metastases. Enlarged lymph nodes may accompany systemic lupus erythematosus, juvenile rheumatoid arthritis, histiocytosis, sarcoidosis, Kawasaki disease (KD) and may follow immunization or some drugs intake (e.g. phenytoin). Discussions on most of these causes have been published [3], [4], [5], [6], nevertheless the issue of management in pediatric population remains unclear.

The aim of our study was to analyse the most common causes of childhood cervical lymphadenopathy and to determine the management guidelines on the basis of clinical examination and sonographic evaluation.

Section snippets

Material and methods

The research covered 87 children with cervical lymphadenopathy treated at the Department of Pediatric Otolaryngology, Phoniatrics and Audiology of Medical University of Lublin, Poland in the years 2000–2004. Age, gender and accompanying diseases of the patients were assessed. All the patients were diagnosed radiologically on the basis of ultrasonographic evaluation (US) including Power Doppler (PD) using 7.5 MHz tranducer, on a Siemens Sonoline Elegra unit. Assessment of node morphology

Results

Reactive inflammatory changes of bacterial origin were observed in 50 children (57.5%). Among them unilateral lymphadenopathy concerned 35 patients (70%) whereas 15 children presented bilateral pathology. Unilateral lesions were localized along sternocleidomastoid muscle in 18 patients and in submandibular region medially to the angle of mandible in 17 cases. Reactive changes in lymph nodes accompanied pharyngitis and palatine tonsils. Lymphadenopathy accompanied inflammatory infiltrations,

Discussion

Management algorithms in case of generalized lymphadenopathy have been established [6], but there is still the lack of formal guidelines for persistent cervical lymphadenopathy in the paediatric population. The researches indicate that bilateral lymphadenopathy is more likely to be reactive in nature than unilateral cervical enlargement. Our study do not confirm such a relation because unilateral lymphadenopathy was observed in 70% of patients with reactive nodal changes. According to Srouji et

Conclusions

1.
Enlargement of cervical lymph nodes is a common childhood pathology.
2.
Bacterial and viral infections are the most common causes of lymphadenopathy.
3.
Ultrasonographic imaging is extremely helpful in diagnostics, differentiation and following the treatment of childhood lymphadenopathy.
4.
The ease of performance, cost-effectiveness and lack of irradiation makes ultrasonography an ideal imaging tool for the routine assessment of cervical lymphadenopathy in children.

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View full text

Cervical lymphadenopathy in children—Incidence and diagnostic management

Summary

Objective

Material and methods

Results

Conclusions

Introduction

Section snippets

Material and methods

Results

Discussion

Conclusions

Pediatr. Clin. N. Am.

Int. J. Paediatr. Otolaryngol.

J. Paediatr. Surg.

Evaluation of neck masses in children

Am. Family Physician

Palpable lymph nodes of the neck in Swedish schoolchildren

Acta Paediatra

Peripheral lymphadenopathy in childhood: recommendations for diagnostic evaluation

Klin. Pediatr.

Adenites cervicales unilaterales de l’enfant: approche diagnostique et therapeutique

Revue Medicale dela Suisse Romande

Cervical lymphadenopathy in children

Hospital Med.

High-resolution and color Doppler ultrasonography of cervical lymphadenopathy in children

Acta Radiol.

In-vitro high resolution ultrasonography of benign and malignant lymph nodes

Invest. Radiol.