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Abstract
Objectives: The aim of this study was to evaluate the etiological factors for cervical lymphadenopathy in children and the role of ultrasonography (USG) in diagnosis. Methods: A total of 200 children of significant cervical lymphadenopathy between 3 months to18 years were pro-spectively included in a tertiary referral hospital. All subjects were evaluated by history, examination, hemogram, chest X-ray, mantoux test, fine needle aspiration cytology (FNAC), acid-fast bacillus (AFB) staining, ultrasonography (USG) of lymph node. Open lymph node biopsy, bone marrow examination, serological tests were optional. Results: A total of 84 subjects (42%) identified as benign reactive, 80 (40%) as tuberculosis, 20 (10%) chronic lym-phadenitis, 12 (6%) non-Hodgkin and 4 (2%) Hodgkin’s lymphoma by USG. However, on USG among 84 subjects of benign reactive lymphadenopathy, 60 (71.4%) were having features of benign reactive lymph node, remaining 24 (28.6%) have normal sonogram; out of 80 subjects of tuberculosis lymphadenitis 66 (82.5%) have features of tuber-culosis and rest14 (17.5%) have nonspecific ultrasound changes; among 16 subjects of lymphoma, 10 (62.5%) have features of malignancy, rest 6 (37.5%) have nonspecific changes in USG examination. Male to Female ratio was1.68:1. Cervical lymphadenopathy was most prevalent in 6 to 10 years age group. Conclusion: Reactive lymphadenitis due to underlying acute bacterial or viral infection was the commonest cause of significant cervical lymphadenopathy in children and ultrasonography is a good noninvasive diagnostic modality, but requires other tests for definitive diagnosis.
Highlights
Cervical lymph node enlargement is common clinical finding in pediatric practice[1]
Etiological profile varies from region to region, in developing country like India, acute respiratory infection; supportive skin infections and tuberculosis are the major causes for regional lymphadenopathy[1]
There was a male preponderance accounting for 128 cases (64%) with M:F ratio 1.68 : 1. The common symptom noted was swelling in neck region in 200 cases (100%) followed by loss of appetite in 120 cases (60%) followed by fever in 102 cases (51%), cough in 86 cases (43%), sore throat in 78 (39%) and ear discharge in 16 cases (8%) majority of the cases had bilateral cervical lymphadenopathy in 118 cases (59%)
Summary
Cervical lymph node enlargement is common clinical finding in pediatric practice[1]. Enlargement of lymph node may result from proliferation of lymphocytes intrinsic to the lymph node either due to infection or due to lymphoproliferative disorder or from the migration & infiltration of nodal tissue by either extrinsic inflammatory cells or metastatic malignant cells[1 ]. Any failure to decrease in size of lymph node within 10-14 days of treatment, a need for further evaluation is indicated[1,5,6]. It may represent normal age related physiological changes[1,7] or chronic lymphadenopathy like tuberculosis, brucellosis, systemic lupus erytematosus, histiocytosis etc[1,8]. The difference in flow pattern in lymph node affected by metastasis and nodes affected by benign processes might permit distinction by means of colour Doppler imaging[2,3,4]
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