Lymphadenopathy in

Children
Anh Bui, MS3
Saba University School of Medicine
Definition

 Lymphadenopathy  Disease of the Lymph node  Enlargement of lymph

nodes
 Enlarged by hyperplasia (MC: Benign Reactive Hyperplasia, less common is
lymphoma)
 Anatomy of Lymph node drainage
Lymph Nodes Drainage

Cervical Head, Neck, Ears, nose throat

Submental & Buccal mucosa, teeth/gums,

Submandibular cheek, nose

Right Thorax
Supraclavicular
Left Abdomen, Stomach (Virchow’s
Supraclavicular Node)
Axillary Ipsilateral breast, arm, thorax

Inguinal Ipsilateral leg, buttock, lower half

abdominal wall
Cervical Node Drainage and Causes
Acute Cervical Adenitis
Differential Diagnosis
Practice Question
Specific
Features
History Questions
Node Description
• When was the node first noticed?
• Size, course of growth, overlying skin changes?
• Tenderness?

Is child systemically well?

• Regional infections (tooth infections, ear infections, etc.)
• TB or malignancy red flag signs (fever, chills, night sweats, weight loss, bleeding
bruising)

• Background
• Is child growing and developing normally?
• Immunodeficiency Failure to thrive
• Recurrent or frequent infections? Immunodeficiency

• Foreign Travel? TB exposure?

• Exposure to animals, especially kittens?
• Adolescents with inguinal LAD: sexually active?
• Recent Immunizations
History

 Medicines causing generalized LAD

 Carbamazepine, phenyltoin, isoniazid

 Family History
Non-Tuberculous Mycobacteria

NTM should be considered

for unilateral cervical or
submandibular LAD that
persists despite anti-biotic
treatment!
Atypical Mycobacterium Infection
Axillary LAD
Lymphoma

 Non- tender lymphadenopathy

 Progressively enlarges over time
 B symptoms: night sweats, fevers, weight-loss
 Onset in neonatal period
 Hepatosplenomegaly
 Does not respond to empiric antibiotic treatment for 3-6 weeks
Red Flags
Physical Exam
Algorithm for assessment
Investigating LAD

 Blood Tests
 CBC
 LDH, ESR, CRP
 +/- Bartonella serology
 U/S (+/- CT for deep nodes, malignancy concern or staging)
 Fine Needle Aspiration Cytology
 Culture of Aspirate
 CXR
 PPD Skin Testing

 Do a CBC and CXR for chronic LAD!

Algorithm for Investigating LAD
Non-Hodgkin’s Lymphoma CT
Indications for Biopsy
Biopsy: Pathology
Ann Arbor Staging for Hodgkin’s
Lymphoma
Imaging for Hodgkin’s Lymphoma
PET Scan to
Evaluate
Treatment
Practice Question
Practice Question

D. Do Full Blood Count/ Complete Blood Count + CXR for Chronic LAD
Practice Question
Practice Question

C. MCC is Benign Reactive Hyperplasia

Practice Question
Practice Question

D. < 2cm is less concerning

Summary

 Most common cause of LAD in children benign reactive hyperplasia, usually self-
limiting
 Thorough history and physical can assist investigation and diagnosis
 For non- supraclavicalar, localized LAD in well-appearing children observation for
3-6 weeks is appropriate management
 Reassurance and safety net of seeking medical attention if increases in size is also
appropriate
 Red flags: firm fixed nodes >2cm, B-symptoms, supraclavicular nodes,
hepatosplenomegaly, rapidly enlarging
 CBC and CXR can be done for Chronic LAD
 US guided FNAB of most suspicious node if malignancy suspected
 Excisional Biopsy still the preferred method for diagnosis
Thank You!
References

 Hambleton, L., Sussens, J., & Hewitt, M. (2016). Lymphadenopathy in

Children and Young People. Paediatrics and Child Health,26(2), 63-67.
doi:10.1016/j.paed.2015.10.005
 King, D., Ramachandra, J., & Yeomanson, D. (2014). Lymphadenopathy in
children: refer or reassure? Archives of disease in childhood - Education &
practice edition,99(3), 101-110. doi:10.1136/archdischild-2013-304443
 Stutchfield, C. J., & Tyrrell, J. (2012). Evaluation of lymphadenopathy in
children. Paediatrics and Child Health,22(3), 98-102.
doi:10.1016/j.paed.2011.09.003