Cervical Lymphadenopathy and Adenitis

Abstract

Listen

Translate article

1. Timothy R. Peters, MD* 2. Kathryn M. Edwards, MD† 1. 2. *Clinical Fellow, Division of Pediatric Infectious Diseases. 3. 4. †Professor of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee. After completing this article, readers should be able to: 1. Describe the management of cervical lymphadenopathy in children. 2. Identify the cause of most cases of childhood cervical lymphadenopathy and adenitis. 3. Identify the etiology of most cases of acute suppurative cervical lymphadenitis in children between the ages of 1 and 5 years. 4. Describe the treatment of suppurative cervical lymphadenitis caused by nontuberculous mycobacteria. 5. List the causes of chronic cervical lymphadenitis in children. Cervical lymphadenopathy may be either an important clue to an underlying disease process or a specific clinical syndrome. Appropriate management of children who have enlarged cervical lymph nodes ranges from observation and reassurance to extensive diagnostic evaluation and aggressive medical and surgical intervention. Decisions regarding diagnostic tests and therapy are based entirely on clinical judgment, informed by a thoughtful patient history and careful physical examination. We review the extensive differential diagnosis of cervical lymphadenopathy and lymphadenitis in the context of information gathered in the patient history and examination and suggest the management of children who have common clinical presentations. Enlargement of lymph nodes (lymphadenopathy) may be caused by proliferation or invasion of inflammatory cells (lymphadenitis) or by infiltration of neoplastic cells. The complex array of lymph nodes of the head and neck efficiently defend against infection and often are considered in anatomic groupings based on lymph drainage patterns. Cervicofacial lymph nodes may reside in the anterior triangle forward of the sternocleidomastoid muscle, the posterior triangle behind the sternocleidomastoid, the submandibular region below the jaw line, the supraclavicular region in the lower neck, and the preauricular and occipital regions. The distribution of enlarged nodes is important in that almost all healthy children have small, palpable lymph nodes in the anterior cervical triangle, but palpable, nontender lymph nodes in the supraclavicular region can suggest malignancy. Before considering the extensive differential diagnosis of …