Excerpt from Lymphadenitis

Synonyms, Key Words, and Related Terms: lymphadenitis, adenopathy, lymphadenopathy, lymph node enlargement, lymph node inflammation, lymph node infection, postauricular node, supraclavicular node, epitrochlear node, popliteal node, tuberculous lymphadenitis, regional adenopathy, cervical adenopathy, splenomegaly, human immunodeficiency virus infection, HIV infection, torticollis, dysphagia, dyspnea, stridor, pleural effusion, upper respiratory symptoms, sore throat, earache, coryza, conjunctivitis

impetigo, dental caries, dental abscess, stomatitis, pharyngitis, scalp infections, seborrheic dermatitis, scalp pediculosis, periodic fever, PFAPA syndrome, Yersinia pestis, bubonic plague, atypical mycobacteria, tularemia, Yersinia enterocolitica, Salmonella infection, rubella, parvovirus infection, tuberculosis, chronic sinusitis, histoplasmosis, candidiasis, coccidioidomycosis, bronchiectasis, Hodgkin disease, atopic eczema, group B streptococcal cellulitis, adenitis, hepatosplenomegaly, preauricular adenopathy

Parinaud oculoglandular syndrome, catscratch disease, chlamydial conjunctivitis, listeriosis, brucellosis, adenovirus type 3, epidemic keratoconjunctivitis, Bartonella henselae, cytomegalovirus, toxoplasmosis, Gianotti-Crosti syndrome, juvenile rheumatoid arthritis, serum sickness, graft versus host disease, acute leukemia, lymphosarcoma, reticulum cell sarcoma, non-Hodgkin lymphoma, malignant histocytosis, histocytic lymphoma, nonendemic Burkitt tumor, nasopharyngeal rhabdomyosarcoma, neuroblastoma, thyroid carcinoma, chronic lymphocytic thyroiditis, histiocytosis X, Kikuchi disease, benign sinus histiocytosis

angioimmunoblastic lymphadenopathy, immunoblastic lymphadenopathy, chronic granulomatous disease of childhood, acquired immunodeficiency syndrome, AIDS, hyperimmunoglobulin E (Job) syndrome, Gaucher disease, Niemann-Pick disease, cystinosis, sickle cell anemia, thalassemia, congenital hemolytic anemia, autoimmune hemolytic anemia, Kawasaki disease, Castleman disease, benign giant lymph node hyperplasia

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Background

Lymphadenitis is the inflammation and/or enlargement of a lymph node. Lymph node enlargement is common in children. Most cases represent a response to benign, local, or generalized infections (usually viral). Lymphadenitis may affect a single node or a localized group of nodes (regional adenopathy) and may be unilateral or bilateral. The onset and course of lymphadenitis may be acute, subacute, or chronic.¹

Most children with lymphadenitis exhibit small palpable cervical, axillary, and inguinal nodes. Approximately 5% of these children have palpable suboccipital or postauricular nodes. Palpable supraclavicular, epitrochlear, and popliteal nodes are uncommon, as are mediastinal or abdominal nodes that are detected with radiographic studies.

Pathophysiology

Increased node size may be caused by the following:

Multiplication of cells within the node, including lymphocytes, plasma cells, monocytes, or histiocytes
Infiltration of cells from outside the node, such as malignant cells or neutrophils
Draining of a source of infection by lymph nodes

If the cause of adenopathy is not evident, consider congenital or neoplastic causes.

Frequency

United States

Lymph nodes are usually small and firm. They are palpable in the cervical, axillary, inguinal, and occipital regions of healthy infants and children. Multiple nodes, especially if present with splenomegaly, may be associated with human immunodeficiency virus (HIV) infection.

International

Tuberculous lymphadenitis can be seen in developing countries.

Mortality/Morbidity

Nodes may be large and may cause local pain and tenderness. Overlying skin may be erythematous. Neck stiffness and torticollis may occur because of cervical lymphadenopathy. Inflammation of retropharyngeal nodes (retropharyngeal abscess) may lead to dysphagia or dyspnea.

Mediastinal lymphadenitis may cause cough, dyspnea, stridor, dysphagia, pleural effusion, and venous congestion in the upper body. Intra-abdominal (mesenteric and retroperitoneal) adenopathy may manifest as abdominal pain. Iliac lymph node involvement may cause abdominal pain and limping.

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