Presentation on theme: "Lymphadenopathy in Children"— Presentation transcript:
1 Lymphadenopathy in Children FAHAD AL ZAMILProfessor & ConsultantPaediatric Infectious DiseasesKing Khalid University Hospital
2 DefinitionPalpable lymph nodes are normal in anterior cervical, axillary and inguinal regions in healthy children.Lymphadenopathy is enlargement of the lymph nodes beyond this normal state. Practically this is any node >1.0 cm in greatest diameterCertain nodes should be considered enlarged at different sizes (i.e. epitrochlear nodes > 0.5 cm, inguinal nodes > 1.5 cm, submandibular nodes > 1.5 cm)
3 History & Physical Exam The history and physical examination are particularly important in determining the differential diagnosis and ultimately the timing, workup and treatment of lymphadenopathy.
4 History Duration Short (< 2 weeks) - likely to be infectious Long (> 2 weeks but < 1 year) - likely to be infectious, malignancy, autoimmune, drug reactionVery long (> 1 year) likely to be pathologic but not malignancy
5 Cont. History Location Localized - likely to be infectious Regional - likely to be infectiousGeneralized - more likely pathologic (e.g. malignancy, autoimmune, etc.)Head and Neck - likely infectiousMediastinal - likely pathologicAbdominal - likely pathologicInguinal - likely infectious
6 Cont. HistoryAssociated symptoms - each may be associated with infectious, malignant, autoimmune, or immunodeficiency diseases:PainFeverWeight loss (> 10% over 6 months)Night sweatsPruritisMyalgia/arthralgiaRashesMalaise
7 Other history Pets - especially cats for Cat Scratch Disease Travel - including Tuberculosis exposurePossible immunodeficiency risk such as HIVFamily history of similar problemsPrevious treatments (such as antibiotics and how patient responded)What do parents think might be going on? What are parents most worried about?
8 Physical Examination Nodes Location - local, regional, generalized SizeCharacter - e.g. firm, rubbery, etc. (may be subjective)Fixed or non-fixedErythema and tendernessLAP
9 Note:Generalized, firm, discrete, non-tender, fixed tend to be more ominous causes such as malignancyLocalized, warm, tender, matted, erythematous - tend to be associated with infections
10 Other SignsSigns of anemia - tachycardia, pale conjunctiva - may be associated with malignancy, autoimmune diseasesDermatological changes - petechiae, bruising, bleeding - may be associated with malignancyWeight/growth - poor growth may be associated with malignancy
14 Approach to Lymphadenopathy Reassure FamilyLymphadenopathyYesSignificant Physical Signs or Symptoms?e.g. Weight loss, Hepatosplenomegaly …YesNoObserve :2-3 WeeksNode(s) :Increase in sizeNot ResolvingNode(s) ResolvingInvestigate :(CBC, ESR …)Observe & Follow
15 When to Investigate ?Patients generally should be considered for investigation and/or referral if:Unexplained generalized lymphadenopathyAny palpable supraclavicular or popliteal nodeSignificant constitutional symptomsHepatic or splenic enlargementAnemia or bleeding? Unresponsiveness to antibiotic treatmentNot decreasing in size after appropriate period of observation
16 Investigations These may include: Laboratory CBC with differential ESR or C-reactive proteinlactate dehydrogenaseuric acidliver function tests
17 Cont. Investigations Purified Protein Derivative skin test Viral titersOther titers - Toxoplasmosis, Bartonella henselaeImaging studies: e.g. Chest radiographBiopsyConsultation with Oncology, Infectious Disease, Rheumatology, Surgery, Radiology