Lymphadenitis 

  • Author: Ulfat Shaikh, MD, MPH; Chief Editor: Russell W Steele, MD   more...
 
Updated: Apr 23, 2010
 

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).[1] 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.[2]

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.

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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.

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Epidemiology

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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Contributor Information and Disclosures
Author

Ulfat Shaikh, MD, MPH  Assistant Professor of Pediatrics, Department of Pediatrics, University of California Davis Medical Center

Ulfat Shaikh, MD, MPH is a member of the following medical societies: American Academy of Pediatrics and American Public Health Association

Disclosure: Nothing to disclose.

Coauthor(s)

Dean A Blumberg MD  Associate Professor of Pediatrics, Section of Pediatric Infectious Disease, University of California Davis School of Medicine; Acting Chief, Section of Pediatric Infectious Disease, UC Davis Medical Center

Dean A Blumberg MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, California Medical Association, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Sierra Sacramento Valley Medical Society

Disclosure: Novartis Grant/research funds clinical research investigator; Merck speaking fees paid to university, not self Speaking and teaching; sanofi pasteur speaking fees paid to university, not self Speaking and teaching

Specialty Editor Board

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.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

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.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

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: Nothing to disclose.

References

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

  2. Friedmann AM. Evaluation and management of lymphadenopathy in children. Pediatr Rev. Feb 2008;29(2):53-60. [Medline].

  3. Fraser L, Moore P, Kubba H. Atypical mycobacterial infection of the head and neck in children: a 5-year retrospective review. Otolaryngol Head Neck Surg. Mar 2008;138(3):311-4. [Medline].

  4. Guss J, Kazahaya K. Antibiotic-resistant Staphylococcus aureus in community-acquired pediatric neck abscesses. Int J Pediatr Otorhinolaryngol. Jun 2007;71(6):943-8. [Medline].

  5. Guffey MB, Dalzell A, Kelly DR, Cassady KA. Ulceroglandular tularemia in a nonendemic area. South Med J. Mar 2007;100(3):304-8. [Medline].

  6. Carvalho AC, Codecasa L, Pinsi G, et al. Differential Diagnosis of Cervical Mycobacterial Lymphadenitis in Children. Pediatr Infect Dis J. Feb 12 2010;[Medline].

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  8. Chuang CH, Yan DC, Chiu CH, et al. Clinical and laboratory manifestations of Kikuchi's disease in children and differences between patients with and without prolonged fever. Pediatr Infect Dis J. Jun 2005;24(6):551-4. [Medline].

  9. [Guideline] Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. Oct 26 2004;110(17):2747-71. [Medline].

  10. Rigante D, La Torraca I, Rossodivita A, et al. Unilateral cervical mass as a main clue raising the diagnostic suspicion of Kawasaki syndrome. Rheumatol Int. Nov 2007;28(1):73-6. [Medline].

  11. Gattorno M, Caorsi R, Meini A, et al. Differentiating PFAPA syndrome from monogenic periodic fevers. Pediatrics. Oct 2009;124(4):e721-8. [Medline].

  12. Simanovsky N, Hiller N. Importance of sonographic detection of enlarged abdominal lymph nodes in children. J Ultrasound Med. May 2007;26(5):581-4. [Medline].

  13. Balaji J, Sundaram SS, Rathinam SN, Rajeswari PA, Kumari ML. Fine needle aspiration cytology in childhood TB lymphadenitis. Indian J Pediatr. Dec 2009;76(12):1241-6. [Medline].

  14. Ahuja A, Ying M, Yuen YH, Metreweli C. Power Doppler sonography of cervical lymphadenopathy. Clin Radiol. Dec 2001;56(12):965-9. [Medline].

  15. Chao SS, Loh KS, Tan KK, Chong SM. Tuberculous and nontuberculous cervical lymphadenitis: A clinical review. Otolaryngol Head Neck Surg. Feb 2002;126(2):176-9. [Medline].

  16. Elden LM, Grundfast KM, Vezina G. Accuracy and usefulness of radiographic assessment of cervical neck infections in children. J Otolaryngol. Apr 2001;30(2):82-9. [Medline].

  17. Eriksson M, Bennet R, Danielsson N. Non-tuberculous mycobacterial lymphadenitis in healthy children: another "lifestyle disease"?. Acta Paediatr. Nov 2001;90(11):1340-2. [Medline].

  18. Green M. Lymphadenopathy. In: Pediatric Diagnosis. 5th ed. WB Saunders Co; 1992:393-7.

  19. Hazra R, Robson CD, Perez-Atayde AR, Husson RN. Lymphadenitis due to nontuberculous mycobacteria in children: presentation and response to therapy. Clin Infect Dis. Jan 1999;28(1):123-9. [Medline].

  20. Koybasi S, Saydam L, Gungen Y. Histiocytic necrotizing lymphadenitis of the neck. Am J Otolaryngol. Sep-Oct 2003;24(5):344-7. [Medline].

  21. Loeffler AM. Treatment options for nontuberculous mycobacterial adenitis in children. Pediatr Infect Dis J. Oct 2004;23(10):957-8. [Medline].

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  23. Thomas KT, Edwards KM. Periodic fever syndrome. Pediatr Infect Dis J. Jan 1999;18(1):68-9. [Medline].

 
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A lymph node biopsy is performed. Note that a marking pen has been used to outline the node before removal and that a silk suture has been used to provide traction to assist the removal.
 
 
 
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