Rabbits, or sheep or cattle wool, hair, or hides HIV-1/HIV-2 immunoassay, rapid plasma reagin, culture of lesions, nucleic acid amplification for chlamydia, migration inhibitory factor test Limited illnesses may not require any additional testing depending on clinical assessment, consider CBC, monospot test, liver function tests, cultures, and disease-specific serologies as neededĬhancroid, HIV infection, lymphogranuloma venereum, syphilis Leukemia, lymphoma, solid tumor metastasisĬBC, nodal biopsy or bone marrow biopsy imaging with ultrasonography or computed tomography may be considered but should not delay referral for biopsyįever, chills, malaise, sore throat, nausea, vomiting, diarrhea no other red flag symptomsīacterial or viral pharyngitis, hepatitis, influenza, mononucleosis, tuberculosis (if exposed), rubella Corticosteroids have limited usefulness in the management of unexplained lymphadenopathy and should not be used without an appropriate diagnosis.įever, night sweats, weight loss, or node located in supraclavicular, popliteal, or iliac region, bruising, splenomegaly Antibiotics may be used to treat acute unilateral cervical lymphadenitis, especially in children with systemic symptoms. ![]() Biopsy options include fine-needle aspiration, core needle biopsy, or open excisional biopsy. The workup may include blood tests, imaging, and biopsy depending on clinical presentation, location of the lymphadenopathy, and underlying risk factors. Palpable supraclavicular, popliteal, and iliac nodes are abnormal, as are epitrochlear nodes greater than 5 mm in diameter. Risk factors for malignancy include age older than 40 years, male sex, white race, supraclavicular location of the nodes, and presence of systemic symptoms such as fever, night sweats, and unexplained weight loss. Generalized lymphadenopathy, defined as two or more involved regions, often indicates underlying systemic disease. Patients with localized lymphadenopathy should be evaluated for etiologies typically associated with the region involved according to lymphatic drainage patterns. When the cause is unknown, lymphadenopathy should be classified as localized or generalized. The history and physical examination alone usually identify the cause of lymphadenopathy. Etiologies include malignancy, infection, and autoimmune disorders, as well as medications and iatrogenic causes. We aim to provide some clarity on the utility and shortcomings of the imaging modalities available, including ultrasonography, computed tomography, and magnetic resonance imaging.Lymphadenopathy is benign and self-limited in most patients. The explosion in the use of ultrasonography as a nonradiating imaging modality in the pediatric population has changed the diagnostic algorithm for many clinicians. ![]() Malignancies are the most concerning cause of cervical lymphadenopathy. ![]() The second most common cause includes bacterial infections ranging from aerobic to anaerobic to mycobacterial infections. The most common cause of cervical lymphadenopathy in the pediatric population is reactivity to known and unknown viral agents. In the following review, we aim to provide the pediatric clinician with a general framework for an appropriate history and physical examination, while giving guidance on initial diagnostic laboratory testing, imaging, and potential need for biopsy. With so many children presenting to doctors' offices and emergency departments, a systematic approach to diagnosis and evaluation must be considered. Cervical lymphadenopathy affects as many as 90% of children aged 4 to 8 years.
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