Lymphadenopathy Treatment & Management

Updated: Feb 14, 2017
  • Author: Vikramjit S Kanwar, MBBS, MBA, MRCP(UK), FAAP; Chief Editor: Russell W Steele, MD  more...
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Treatment

Medical Care

Treatment is determined by the specific underlying etiology of lymphadenopathy.

  • Most clinicians treat children with cervical lymphadenopathy conservatively. Antibiotics should be given only if a bacterial infection is suspected. This treatment is often given before biopsy or aspiration is performed. This practice may result in unnecessary prescription of antimicrobials. However, the risks of surgery often outweigh the potential benefits of a brief course of antibiotics. Most enlarged lymph nodes are caused by an infectious process. If aspects of the clinical picture suggest malignancy, such as persistent fevers or weight loss, biopsy should be pursued sooner.
  • Management of superior vena cava syndrome requires emergency care, including chemotherapy and possibly radiation therapy.
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Surgical Care

Surgical care usually involves a biopsy. If lymphadenitis is present, aspirate may be needed for culture, and removal of the affected node may be indicated.

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Consultations

Consultation with a pediatric hematologist, pediatric oncologist, or both is often useful, especially if the adenopathy seems to be more than reactive. Often, the most important decision for these children is whether further evaluation is necessary at all; experience in evaluating these children is frequently very helpful. The ability to provide a careful assessment of the peripheral blood smear may be particularly important.

Surgical consultation is usually helpful for lymph node biopsy, needle aspiration for culture, and for incision and drainage of obviously infected fluctuant nodes.

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Diet

Diet plays little role in the pathophysiology of lymphadenopathy.

Internationally, many of the infectious etiologies may be associated with a higher risk of malnutrition.

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Activity

Limitations on activity usually involve associated acute-onset splenomegaly. Any patient with an acutely enlarged spleen may need to be restricted from contact sports.

In infectious mononucleosis, rupture of the spleen can occur with relatively little trauma and can be fatal.

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