#paeds see: [RCH - cervical lymphadenopathy](https://www.rch.org.au/clinicalguide/guideline_index/cervical_lymphadenopathy/) - ( [Devonthink link](x-devonthink-item://44062D19-CD29-42F8-ABA0-2E086144C989) ), [Dunn - lymphadenopathy](x-devonthink-item://BC8A8EFE-A841-40DC-9F54-AD5FB1CF5EE8) see also: [[Kawasaki Disease]], [[Leukemia]] > [!key points] > - cervical lymph nodes are often palpable in well children; may be found in more than 1/3 of otherwise healthy children. observation and reassurance without investigation is usually appropriate for the well-appearing child with cervical lymphadenopathy > - most cases of cervical lymphadenopathy will be self-limited and do not require treatment > - considered abnormal if > 1cm > - red flags: > - loss of weight > - night sweats > - bruising > - features of deep tissue head or neck infection (trismus, muffled voice) > - recent [[Fever in returned traveller|travel]] or exposure to animals esp cats > - unimmunised ![[Pasted image 20241022232933.png]] ![[Pasted image 20241022232914.png]] # DDx ## acute cervical lymphadenopathy - cervical lymphadeniitis 2/2 viral infection -- very common, usually wiht history of viral prodrome - acute bacterial cervical lymphadenitis - also common, usually unilateral and in the anterior part of the neck - a/w fever and neck swelling - may be firm and tender with overlying erythema, limiting neck ROM - staph aureus, group B strep, group a, anaerobs if a/w dental disease - [[Kawasaki Disease]] ## persistent cervical lymphadenopathy - subacute cervical lymphadenopathy 2-6 weeks commonest cause is viral infection - chronic > 6 weeks number of causes, can still be viral - some causes unexplained | persistent cervical lymphadenopathy | clinical features | | ------------------------------------------------------ | ------------------------------------------------------------------------------------------- | | viruses (EBV, CMV, Rubella) | may be a/w generalised lymphadenopathy and hepatosplenomegaly | | mycobacterium tuberculosis | non-tender nodes. h/o exposure. systemic sx of fever, malaise, weight loss | | atypical mycobacterial infections | indolent, chronic unilatearl cervical lymphadenopathy, violaceous hue, usually children < 5 | | bartonella henselae (cat scratch disease) | enlarged nodes usually tender and in axillary region | | toxoplasmosis gondii | non-suppurative generalised lymphadenopathy. fatigue or myalgia | | malignancy | eg [[Leukemia]] or lymphoma. often *painless* and prolonged, bruising, mediastinal mass | | eczema | persistent head and neck eczema may cause prominent posterior cervical LNs | | rheumatological conditions (SLE, JIA), [[Sarcoidosis]] | may have rash, joint pain, conjunctival changes | # investigations - acute cervical lymphadenopathy < 2 weeks - if well, no Ix needed - if unwell, workup as with [[Febrile child]] or [[Kawasaki Disease]] - consider neck USS if suspected abscess - persistent 2-6 weeks - FBE, blood film - CRP, ESR, LDH - LFT - serology -- EBC, CMV, HIV - toxoplasmosis, bartonella henselae - tuberculin skin test, quantiferon gold if TB suspected - CXR if malignancy suspected - neck USS - +/- CT or MRI - +/- biopsy # Treatment - usually no tx - if signs of bacterial lymphadenitis (unilateral, tender, fluctuant), consider: - cefalexin 33mg/kg (max 500mg) po TDS for 7 days with review in 48 hours - if unwell or failed oral treatment, fluclox 50mg/kg (max 2g) IV Q6H and admit