![]() ![]() Associated symptoms, particularly fever constitutional symptoms (weight loss, fatigue, malaise) conjunctivitis pharyngitis nasal, aural, or sinus obstruction without discharge dental problems or mouth sores cough gastrointestinal symptoms arthralgia skin lesions or trauma.Duration and laterality of enlargement and change in size over time.History - Important aspects of the history in a child with cervical lymphadenitis include : (See 'Suspected malignancy' below and 'Suspected NTM' below and 'Additional evaluation for persistence or uncertain etiology' below.) As an example, early excisional biopsy is indicated for children with features suggestive of malignancy or nontuberculous mycobacterial infection. The pace of the diagnostic evaluation is dictated by how ill the patient appears. (See 'Additional evaluation for persistence or uncertain etiology' below.) (See 'Initial laboratory evaluation and management' below.)Īdditional testing depends upon the results of the initial evaluation and the clinical course, including the response to antimicrobial therapy if it is initiated. We use this categorization in conjunction with the findings from the history and examination to guide the initial laboratory evaluation and management. The infectious causes of cervical lymphadenitis in children vary depending upon whether the adenitis is acute or subacute/chronic and bilateral or unilateral, although there is some overlap ( table 1). Unless there are compelling associated symptoms suggestive of noninfectious causes ( table 2), we generally focus the initial evaluation on infectious causes of cervical lymphadenitis because infectious causes are more common and more frequently associated with tenderness and inflammation than noninfectious causes. In difficult cases, consultation with a specialist in pediatric infectious diseases can help to direct the evaluation and management. The initial laboratory evaluation and management depend upon the findings from the history and examination, and may range from observation and reassurance (for well-appearing children with acute bilateral cervical lymphadenitis that is only slightly enlarged and minimally tender) to comprehensive diagnostic testing and aggressive medical and surgical therapy (for ill-appearing children or those with suspected malignancy or mycobacterial disease). The goal of the evaluation is to determine the underlying cause, which affects initial management. Overview - The evaluation of children with cervical lymphadenitis includes a thorough history and physical examination ( table 3). (See "Cervical lymphadenitis in children: Etiology and clinical manifestations".) (See "Peripheral lymphadenopathy in children: Etiology", section on 'Generalized lymphadenopathy'.)ĬAUSES - There are numerous infectious and noninfectious causes of enlarged cervical lymph nodes in children ( table 1 and table 2). ![]()
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