14. Diagnosis of enlarged lymph nodes. Differential diagnosis.

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

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