#Shotty cervical lymph nodes skin

Fungal: histoplasmosis, coccidioidomycosis.Bacterial: syphilis, brucellosis, tuberculosis, typhoid fever, septicemia.Viral (most common): URTI, measles, varicella, rubella, hepatitis, HIV, EBV, CMV, adenovirus.Differential diagnosisĮnlargement of more than 2 noncontiguous lymph node groups Worrisome findings which increase risk of malignancyīe sure to examine all the lymph nodes: Pre-auricular, post-auricular, tonsillar, submental, submandibular, anterior cervical, posterior cervical, occipital, supraclavicular, axillary, epitrochlear (in the antecubital fossa), inguinal, popliteal and don’t forget the liver and spleen!!įigure 1: “Diagram (c)EMIS 2011, as distributed at, used with permission.”Ī careful history and physical exam will help determine whether further investigation is needed. When palpating a lymph node it is important to consider the following: – Hepatosplenomegaly (this is actually considered part of your lymph node exam!) – Oropharynx for pharyngitis, dental problems, HSV ginivostomatitis In an infant with occipital lymphadenopathy, one should examine the scalp for lesions such as seborrheic dermatitis. Ask if the patient has had a sore throat or ear pain.

For example, in a child with cervical adenopathy one should examine the orpharynx and consider the possibility of streptococcal pharyngitis or viral upper respiratory infection. Always pay special attention to the area of the enlarged node for a focus of infection. Are they febrile? Plot them on the appropriate growth chart have they lost weight? Then perform a complete systematic physical exam paying special attention to your head and neck, abdominal and dermatological examinations. Palpable nodes in the supraclavicular region are often associated with malignancy of the chest or abdomen and always require further investigation.Īlways perform a complete physical exam beginning with general appearance, vital signs and growth parameters. Nodes that are usually palpable include anterior cervical, inguinal, and axillary regions until about age 12. Ingestion of unpasteurized animal milk (brucellosis), or undercooked meats (toxoplasmosis, tularemia)Ĭhildren often have easily palpable nodes enlarged in response to infection.

In adolescents, it is also important to ask about IV drug use and obtain a sexual history.

Carbemazepine or phenytoin? There are a wide variety of medications which can cause lymphadenopathy. Could the child have picked up an infection while traveling? Has the child been in contact with infected individuals? Viral respiratory exposures such as EBV/CMV? TB exposure? Has this child been hospitalized in the past? Any ongoing medical conditions? Any surgeries? Any visits to the Emergency department?

#Shotty cervical lymph nodes skin

Skin lesions or trauma? Cat scratch? Animal/insect bites? Other open wounds? Dental abscesses?.Constitutional symptoms? Fever, night sweats, weight loss?.Has this child had a recent infection that may explain a lymphadenopathy? Upper respiratory tract symptoms? Any respiratory symptoms? Rashes? Changes in bowel movements or voiding patterns? Any bone or joint pain? Changes in vision? Headaches? Onset, size, duration? Is it painful or erythematous? Generalized or local? Associated symptoms? Some questions that will help narrow the differential include: It is especially important to rule out possible neoplasms. There are many different causes of lymphadenopathy, and thus, a thorough history and physical are critical in establishing a diagnosis. Lymphadenopathy is most common in young children whose naïve immune systems respond more frequently to newly encountered infections. Normal lymph nodes are most prominent in children ages 4 to 8 years old. Normally, lymphoid tissue enlarges until puberty and then undergoes gradual atrophy throughout the rest of life. Finally, it is crucial to rule out rarer, more serious causes such as lymphomas or leukemias, which are due to proliferation of neoplastic lymphocytes or macrophages. There may also be localized infiltration by inflammatory cells in response to an infection of the nodes themselves. Viral or bacterial infections lead to localized responses from lymphocytes and macrophages, leading to enlargement of nodes. This process is often secondary to infection and is frequently benign and self-limited. Lymphadenopathy is defined as enlargement of lymph nodes. Click for pdf: Approach to Lymphadenopathy Definition