Page created on February 14, 2022. Not updated since.
Evaluation of lymphadenopathy
It is generalised if it occurs in more than one lymph node region, and local if it’s confined to only one region. It’s important to examine the whole patient for signs of infection, like infection of the scalp, conjunctiva, pharynx, and skin. In the evaluation of lymphadenopathy, it’s important to evaluate its consistency, whether it’s tender, and whether it’s fixed:
- Tender, rubbery, non-fixed -> infectious etiology
- Non-tender, hard, fixed, supraclavicular -> malignant etiology
Lymphadenopathy is usually benign and self-limited, but it’s important to pick up on those who have it due to severe disease. If the child is not ill and has no worrisome features, it’s not always necessary to identify the underlying etiology, as it’s spontaneously resolve often anyway.
Worrisome features that are indication for urgent determination of the etiology include typical clinical features of malignancy, abnormal laboratory results, absence of infectious symptoms, generalised lymphadenopathy, etc. If etiology cannot be determined, a trial of empiric antibiotics can be tried. If unsuccessful, lymph node biopsy should be performed.
Differential diagnosis
| Etiology | Typical features/lymph nodes affected |
| URTI | Cervical, cold symptoms |
| Pharyngitis | Cervical, exudate on tonsils |
| Infectious mononucleosis | Bilateral cervical, exudate on tonsils |
| Cat scratch disease | Papule or lesion at site of scratch, enlarged lymph nodes of the draining region |
| Other infections (CMV, HSV, tularaemia, etc.) | Generalised or local |
| Kawasaki disease | Unilateral cervical, conjunctivitis, red cracked lips, polymorphic lips, erythema and oedema on hands |
| Acute leukaemia | Generalised, malaise, infections, skin bleeding, lymphadenopathy |
| Lymphoma | Cervical or abdominal, B symptoms |
| STD | Inguinal, STD symptoms |
| HIV | Persistent, generalised |
| SLE | Generalised, butterfly rash, photosensitivity |