Pediatric Lymphadenopathy; Causes according to the location, clinical approach and when to take biopsy

Pediatric Lymphadenopathy

Causes of lymphadenopathy according to location

•• Cervical

–– Oropharyngeal infections, for example, EBV

–– Mycobacterial lymphadenitis

–– Cat scratch disease

–– Kawasaki disease

•• Supraclavicular

–– Right side—Malignancy or infection in the mediastinum

–– Left side—Malignancy or infection from the abdomen

–– Lymphoma

–– Tuberculosis

•• Hilar

–– Tuberculosis

–– Leukemia

–– Lymphoma

–– Sarcoidosis

–– Histoplasmosis

•• Axillary

–– Cat scratch disease

–– Arm or chest infection

–– Leukemia

–– Lymphoma

•• Abdominal

–– Malignancy

–– Mesenteric adenitis

Clinical approach to lymphadenopathy

•• History

–– Associated other systemic symptoms

•• Age

–– Lymph node enlargement in children less than 5 years most likely infectious

–– Histiocytosis can cause lymphadenopathy in children < 3 years

–– Large lymph node in neonate most likely related to congenital infection

–– Likelihood of malignant lymphoma increases in adolescents

•• Location

–– Supraclavicular lymphadenopathy is always abnormal and the chances of malignancy are high

•• Size

–– Size of the enlarged lymph node aids in determining the need for further evaluation

–– Axillary and cervical > 1 cm

–– Inguinal > 1.5 cm

–– Epitrochlear > 0.5 cm

–– Anywhere > 2 cm

•• Characteristics

–– Usually develops over weeks or months.

–– Nontender, discrete, firm, rubbery, often immobile

Biopsy criteria

•• Size

–– > 2 cm

–– Increasing over 2 weeks

–– No decrease in size after 4 weeks

•• Location

–– Supraclavicular

•• Consistency

–– Hard

–– Matted

–– Rubbery

•• Associated features

–– Abnormal CXR

–– Fever

–– Weight loss

–– Hepatosplenomegaly