RIGHT LATERAL CERVICAL MASS Presenting Manifestation

Approach to Diagnosis Symptom with the least number of diseases

Cervical Lymphadenopathy in children Dental Caries Upper Respiratory Tract infection Mumps Tuberculosis Lymphoma

Approach to Diagnosis History – Duration and laterality of adenopathy and change in size over time – Associated symptoms – Ill contacts – Ingestion of unpasteurized animal milk or undercooked meats – Dental problems or mouth sores – Skin lesions or trauma – Animal exposures – Immunization status – Medications – Geographic location and travel

Approach to Diagnosis Physical examination – Examination of the lymphatic system, including assessment of the liver, spleen, cervical lymph nodes, and noncervical lymph nodes should be performed. Hepatosplenomegaly with generalized adenitis indicates a possible infection with EBV, CMV, HIV, histoplasmosis, TB, or syphilis. These findings also may be signs of neoplastic disease, collagen vascular disease, or other noninfectious etiology

Approach to Diagnosis Physical examination – The lymph node number, location, size, shape, consistency, tenderness, mobility, and color should be recorded. "Reactive" lymph nodes are usually discrete, mobile, feel rubbery, and are minimally tender. Infected lymph nodes are usually isolated, asymmetric, tender, warm, and erythematous; they may be fluctuant; they are less mobile and discrete than reactive lymph nodes. Malignant lymph nodes often are hard, fixed or matted to the underlying structures; they are usually nontender. – Oral cavity —periodontal disease, herpangina, gingivostomatitis, or pharyngitis – Eyes — Conjunctival injection – Skin — generalized rash, pustular or papular lesions

Differentials Patient: 6y.o./ FemaleDental CariesLymphoma ((+) 5x3cm – progressive in size, unilateral, semi-solid, tender (initially non-tender), fixed, mass on the left retroauricular area, extending to the submandibular area painless lymphadenopathy, usually cervical, supraclavicular, axillary, or, less often, inguinal -rubbery and more firm than inflammatory adenopathy -may be sensitive to palpation if they have grown rapidly (+) non-productive cough for 2 weeks (+) undocumented fever for 2 weeks (+) weight loss (-) colds presence of pits and fissures on the affected tooth surface Fever, weight loss, hepatosplenomegaly, night sweats (+) mediastinal mass on CXR

Differentials Patient: 6y.o./ Female URTIMumpsTB Infection (+) 5x3cm – progressive in size, unilateral, semi- solid, tender (initially non- tender), fixed, mass on the left retroauricular area, extending to the submandibular area Most often unilateral; but can be bilateral; usually is 3 to 6 cm in diameter, tender, warm, nondiscrete, and poorly mobile local tenderness of the area of the parotid, with ear pain followed by swelling of the parotid gland Bilateral (90%) Parotid swelling can last up to 10 days unilateral nontender firm discrete mass or matted nodes, fixed sometimes accompanied by overlying skin induration; submandibular and supraclavicular lymph node involvement also occurs

Differentials Infectious Causes Patient: 6y.o./ Female URTIMumpsTB Infection (+) non-productive cough for 2 weeks (+) undocumented fever for 2 weeks (+) weight loss (-) colds Nasal congestion, (+/-) fever, sore throat, cough, irritability, difficulty sleeping, and decreased appetite, may include erythema and swelling of the nasal mucosa, as well as moderate anterior cervical lymphadenopathy. low-grade fever, malaise, headache, myalgias, and anorexia within 48 hours after parotitis Cough/ wheezing of 2 or more weeks Unexplained fever of 2 or more weeks; loss of appetite, loss of weight, failure to gain weight; failure to regain previous state of health after infection; fatigue, reduced playfulness or activity

T/C KOCH’S INFECTION Clinical Impression

Approach to Diagnosing a TB symptomatic child who has no/unknown exposure (+) signs/ symptoms of TB TB Close contact of a source case No/Unknown0-4 years old5-9 years oldYes… Tuberculosis in Infency and Childhood 3rd ed PPS, Inc. p.123

5-9 years old Can produce sputum? NOTSTNegative Evaluate further and refer PositiveTB DiseaseDSSMNegativePositive Tuberculosis in Infency and Childhood 3rd ed PPS, Inc. p.123