The anamnesis must include any reference to a focus, including in the past, such as a sore throat, earache or toothache, insect bites or injuries. Subacute lymph node enlargement has various possible causes, and additional criteria therefore need to be drawn on before determining the subsequent diagnostic and therapeutic steps (Figure 5 ). The course of the illness is one of the first aspects to be considered in diagnosis: the majority of cases of acute lymphadenitis, which subside after 2 weeks, are of infectious origin this contrasts with chronic lymph node enlargement, which is more likely to originate from neoplastic or metabolic disorders or opportunistic infections. The more varied the possible differential diagnoses are, the greater the importance of the primary diagnostic instruments, namely anamnesis and clinical examination, available to the physician. For this reason, anamnesis and thorough clinical examination are crucial steps towards securing a diagnosis. hemangioma), paraganglioma/neurinoma, lesions of the salivary or thyroid glands, lymphangioma, teratoma, (epi-)dermoid cysts, and ectopic thyroid tissue (see Figure 1, Figure 2, Figure 3, Figure 4 ).Īs Table 1 shows, there are many possible causes of lymph node enlargement.
Enlarged lymph nodes must also be differentiated from other possible causes of neck masses, such as midline thyroglossal cysts and branchial cysts, lipoma, vascular malformations (e.g. A distinction is made between an acute (6 weeks) course of the lymphadenopathy. If the mass originates from the lymph nodes, the first step should be to establish whether the lymph node itself is enlarged: this is the case above a diameter of >1 cm (in the angle of the mandible >1.5 cm) and is defined as lymphadenopathy. Neck masses are a symptom ENT physicians in hospitals and surgeries are frequently confronted with among children. Such an approach is described in the following paper. The spectrum of differential diagnoses and the varying degrees of clinical relevance – from banal infections to malignant diseases – demand a clear and considered approach to the child’s individual clinical presentation.
#Posterior cervical lymph nodes full
Sonography also plays an important role in differential diagnosis of lymph node swelling in children and is useful in answering one of the critical diagnostic questions: is there a suspicion of malignancy? If so, full dissection of the most conspicuous lymph node may be necessary to obtain histological confirmation.ĭiagnosis and treatment of childhood cervical lymph node disorders present the attending pediatric and ENT physicians with some particular challenges. The basis of diagnostic decisions is a detailed anamnesis and clinical examination. In the interests of time, patient wellbeing and cost, a careful choice of these must be made to permit appropriate treatment. Involvement of the lymph nodes in multiple conditions is accompanied by a correspondingly large number of available diagnostic procedures. The cervical lymph nodes are particularly important because they are the first drainage stations for key points of contact with the outside world (mouth/throat/nose/eyes/ears/respiratory system) – a critical aspect especially among children – and can represent an early clinical sign in their exposed position on a child’s slim neck. The lymph nodes are an essential part of the body’s immune system and as such are affected in many infectious, autoimmune, metabolic and malignant diseases.
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