eMedicine Specialties > Pediatrics: General Medicine > Hematology

Lymphadenopathy: Follow-up

Author: Vikramjit S Kanwar, MD, MBA, MRCP(UK), FAAP, Associate Professor of Pediatric Hematology and Oncology, Department of Pediatrics, Albany Medical Center; Faculty, Alden March Bioethics Institute
Coauthor(s): Richard H Sills, MD, Professor of Pediatrics, Upstate Medical University
Contributor Information and Disclosures

Updated: May 12, 2009

Follow-up

Further Inpatient Care

  • Additional inpatient treatment depends on establishing the diagnosis and determining management based on that diagnosis.

Further Outpatient Care

  • Further outpatient treatment depends on establishing a diagnosis and determining management of that diagnosis.

Inpatient & Outpatient Medications

  • Inpatient and ambulatory medications depend on the specific underlying etiology of the lymphadenopathy.

Transfer

  • Transfer of the patient usually depends on the specific diagnosis. Patients who develop superior vena cava syndrome with either respiratory symptoms or obstruction to blood flow require emergency medical care and may require transfer to a tertiary care center.

Complications

  • Complications are usually related to the specific underlying disorder causing the lymphadenopathy; however, the lymphadenopathy itself can cause potentially serious complications.
  • Mediastinal adenopathy can result in several potentially life-threatening complications. Recognition of these complications is important because mediastinal adenopathy cannot be directly assessed clinically and therefore may be easily missed.
  • Mediastinal adenopathy can cause superior vena cava syndrome with obstruction of blood flow; bronchial or tracheal obstruction with cough, wheezing, and ultimately respiratory tract obstruction (which can be life threatening); and dysphagia from esophageal compression. Occasionally, erosion of a node into a bronchus or trachea can result in hemoptysis.
  • When the diagnosis of an underlying malignancy is missed, serious metabolic complications can occur. These include uric acid nephropathy, hyperkalemia, hypercalcemia, hypocalcemia, hyperphosphatemia, and acid renal failure.
  • Abdominal adenopathy can cause abdominal or back pain, constipation, and urinary frequency. Intestinal obstruction caused by intussusception can be life threatening.

Prognosis

  • The prognosis of lymphadenopathy almost entirely depends on the underlying etiology. Patients with specific complications, such as superior vena cava syndrome, are at risk unless this specific complication is managed. Their prognosis is dependent on the management of the neoplastic process resulting in superior vena cava syndrome.

Patient Education

  • Patient and family education depends on the specific etiology of the lymphadenopathy.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose an underlying malignancy is a major medical/legal issue. As with any decision about providing medical care, the risks of not making a timely diagnosis must be weighed against the potential benefits of treating an illness appropriately.
  • Routine laboratory studies, CT scans, and lymph node biopsies should not be obtained in most children who present with lymphadenopathy. Most of these children have self-limited illnesses that require no further treatment and no intervention. Otherwise, many children undergo unnecessary biopsy, with its cost, psychologic trauma, morbidity, and rare mortality.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Stephanie Jorgensen, MD, to the original writing and development of this article.



More on Lymphadenopathy

Overview: Lymphadenopathy
Differential Diagnoses & Workup: Lymphadenopathy
Treatment & Medication: Lymphadenopathy
Follow-up: Lymphadenopathy
Multimedia: Lymphadenopathy
References
Further Reading
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References

  1. Larsson LO, Bentzon MW, Berg Kelly K, et al. Palpable lymph nodes of the neck in Swedish schoolchildren. Acta Paediatr. Oct 1994;83(10):1091-4. [Medline].

  2. Moore SW, Schneider JW, Schaaf HS. Diagnostic aspects of cervical lymphadenopathy in children in the developing world: a study of 1,877 surgical specimens. Pediatr Surg Int. Jun 2003;19(4):240-4. [Medline].

  3. Oguz A, Karadeniz C, Temel EA, Citak EC, Okur FV. Evaluation of peripheral lymphadenopathy in children. Pediatr Hematol Oncol. Oct-Nov 2006;23(7):549-61. [Medline].

  4. Yaris N, Cakir M, Sozen E, Cobanoglu U. Analysis of children with peripheral lymphadenopathy. Clin Pediatr (Phila). Jul 2006;45(6):544-9. [Medline].

  5. [Best Evidence] Gray DM, Zar H, Cotton M. Impact of tuberculosis preventive therapy on tuberculosis and mortality in HIV-infected children. Cochrane Database Syst Rev. Jan 21 2009;CD006418. [Medline].

  6. Leung AK, Davies HD. Cervical lymphadenitis: etiology, diagnosis, and management. Curr Infect Dis Rep. May 2009;11(3):183-9. [Medline].

  7. Lindeboom JA, Kuijper EJ, Bruijnesteijn van Coppenraet ES, Lindeboom R, Prins JM. Surgical excision versus antibiotic treatment for nontuberculous mycobacterial cervicofacial lymphadenitis in children: a multicenter, randomized, controlled trial. Clin Infect Dis. Apr 15 2007;44(8):1057-64. [Medline].

  8. Niedzielska G, Kotowski M, Niedzielski A, Dybiec E, Wieczorek P. Cervical lymphadenopathy in children--incidence and diagnostic management. Int J Pediatr Otorhinolaryngol. Jan 2007;71(1):51-6. [Medline].

  9. Grossman M, Shiramizu B. Evaluation of lymphadenopathy in children. Curr Opin Pediatr. 1994;6(1):68-76. [Medline].

  10. Kliegman RM, Nieder ML, Super DM. Lymphadenopathy. In: Fletcher J, Bralow L, eds. Practical Strategies in Pediatric Diagnosis and Therapy. WB Saunders Co; 1996:791-803.

  11. Miller DR. Hematologic malignancies: leukemia and lymphoma (Differential diagnosis of lymphadenopathy). In: Miller DR, Baehner RL, eds. Blood Diseases of Infancy and Childhood. Mosby Inc; 1995:745-9.

  12. Nield LS, Kamat D. Lymphadenopathy in children: when and how to evaluate. Clin Pediatr (Phila). Jan-Feb 2004;43(1):25-33. [Medline].

  13. Roberts KB, Tunnessen WW. Lymphadenopathy. In: Signs and Symptoms in Pediatrics. 3rd ed. Lippincott, Williams, and Wilkins; 1999:63-72.

  14. Twist CJ, Link MP. Assessment of lymphadenopathy in children. Pediatr Clin North Am. Oct 2002;49(5):1009-25. [Medline].

  15. Vayner N, Coret A, Polliack G, et al. Mesenteric lymphadenopathy in children examined by US for chronic and/or recurrent abdominal pain. Pediatr Radiol. Dec 2003;33(12):864-7. [Medline].

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Keywords

lymphadenopathy, adenopathy, lymph node enlargement, lymph node disease, lymph nodes, viral illness, lymphadenitis, lymphoma, Gaucher disease, viral infections, bacterial infections, infectious mononucleosis, cytomegalovirus, CMV, viral upper respiratory infections
 
staphylococci, beta-hemolytic streptococci, HIV infection, malignancies, autoimmune diseases, tuberculosis, typhoid fever, catscratch disease, leishmaniasis, trypanosomiasis, schistosomiasis, filariasis, fungal infections, leukemia, neuroblastoma, autoimmune disorders, juvenile rheumatoid arthritis

systemic lupus erythematosus, histiocytoses, storage diseases, Hodgkin disease, cervical adenopathy, group A streptococcal pharyngitis, otitis media, impetigo, cellulitis, shotty supraclavicular nodes, matting together of nodes, abdominal adenopathy, systemic viral infections, roseola infantum, human herpes virus 6, varicella, adenovirus, syphilis, plague, endocarditis, acute lymphoblastic leukemia, ALL, acute myeloblastic leukemia, AML, non-Hodgkin lymphoma, lipid storage diseases

Niemann-Pick disease, Langerhans cell histiocytosis, Epstein-Barr virus-associated lymphoproliferative disease, sarcoidosis, cervical lymphadenopathy, herpesvirus, coxsackievirus, herpes gingivostomatitis, Mycobacterium tuberculosis, Bartonella henselae, rhabdomyosarcoma
 
Kawasaki disease, submaxillary lymphadenopathy, submental lymphadenopathy, pharyngitis, dental abscess, occipital lymphadenopathy, tinea capitis, seborrheic dermatitis, insect bites, orbital cellulitis, pediculosis, rubella, enucleation of eye, preauricular lymphadenopathy, oculoglandular syndrome, severe conjunctivitis, corneal ulceration, eyelidedema, Chlamydia trachomatis, mediastinal lymphadenopathy, supraclavicular adenopathy, superior vena cava syndrome, histoplasmosis, coccidioidomycosis

nonlymphoid mediastinal tumors, neurogenic tumors, germ cell tumors, teratomas, bacille Calmette-Guerin vaccine, brucellosis, hydradenitis suppurativa, abdominal lymphadenopathy, mesenteric adenitis, ulcerative colitis, iliac lymphadenopathy, inguinal lymphadenopathy, diaper dermatitis

measles, septicemia, toxoplasmosis, serum sickness, acute bacterial lymphadenitis, pediculosis capitis, lymphogranuloma venereum

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Contributor Information and Disclosures

Author

Vikramjit S Kanwar, MD, MBA, MRCP(UK), FAAP, Associate Professor of Pediatric Hematology and Oncology, Department of Pediatrics, Albany Medical Center; Faculty, Alden March Bioethics Institute
Vikramjit S Kanwar, MD, MBA, MRCP(UK), FAAP is a member of the following medical societies: American Academy of Pediatrics, American Society of Pediatric Hematology/Oncology, Children's Oncology Group, and Royal College of Physicians of the United Kingdom
Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sills, MD, Professor of Pediatrics, Upstate Medical University
Richard H Sills, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society of Hematology, and American Society of Pediatric Hematology/Oncology
Disclosure: Nothing to disclose.

Medical Editor

Gary J Noel, MD, Department of Pediatrics, Clinical Associate Professor, Weill Medical College of Cornell University
Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Helen SL Chan, MBBS, FRCP(C), FAAP, Senior Scientist, Research Institute; Professor, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Canada
Helen SL Chan, MBBS, FRCP(C), FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Society of Hematology, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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