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Cervical Lymphadenopathy
In PediatricsPresented by:
Mahmoud MotaweaAssistant Lecturer of Pediatric Surgery
History
Female patient aged 1 8/12.
FT – NVD – Not intubated.
Medical : Repeated history of tonsillitis.
No surgical history of importance.
History
Complaint:• Multiple painless neck swellings noticed
two months ago.• Increasing in size.
History of similar condition; Small bilateral post auricular swellings appeared 4 months and resolved with medical treatment.
Examination
•Multiple painless amalgamated cervical lymph nodes mainly level I, II, III.•Not fluctuant.•No other lymph nodes enlargement.• Bilaterally enlarged tonsils•No abdominal organomegaly.
Investigations
Lab investigations:
• CBC: Hb: 9.1 gm/dL , TLC 5.1, Plt 425.000Leukocyte differential : 71% lymphcytes, Neutrophils 22%• ESR: 1st hour : 35mm 2nd hour 60mm• CRP : negative
Investigations
Lab investigations:
• EBV IgG, HSV IgM & IgG, Toxoplasma IgM & IgG All negative• CMV IgG Positive• Rubella IgG Positive• LDH 527 IU/L (child n < 300)• Paratyphoid B +ve (1/80)
Investigations
Ultrasound:
• Multiple innumerable, variable sized, rounded enlarged upper and lower deep cervical lymph nodes with no fatty hilum likely malignant for further histopathological correlation
Investigations
Ultrasound:
Investigations
Chest X-Ray :
Home Message
• Many lymph nodes are palpable in children, and generally, cervical nodes aer less than 2 cm (suspicious if > 3cm).• Persistent or progressive new-onset
lymphadenopathy of greater than 4 to 6 weeks duration and/or palpable epitrochlear and supraclavicular nodes should trigger investigations.
Home Message
• Associated symptoms of night sweats, weight loss, and hepatosplenomegaly also increase the chance of malignancy. • In addition, an abnormal chest radiograph,
and fixed nodes are all significantly associated with malignancy.
Home Message
• A chest radiograph should be performed prior to any operative intervention.• The lymph node should be sent as a fresh
specimen. The nodes should not be fixed in formalin.
Home Message
