Section: Head and neck Curriculum: Curriculum, page 43
Definition
Enlarged lymph nodes of the neck
- Infectious or non-infectious causes
- Including preauricular, parotid, jugulodigastric, submental, submandibular, posterior cervical, superficial cervical, deep cervical, occipital, and posterior auricular (mastoid); lymphadenopathy
Children
Infectious causes
| Presentation | Common | Uncommon | Rare |
|---|---|---|---|
| Acute bilateral | - Rhinovirus - Epstein-Barr virus*¶ - Cytomegalovirus*¶ - Herpes simplex virus - Adenovirus - Enterovirus - Mycoplasma pneumoniae - Group A Streptococcus - Arcanobacterium haemolyticum - Influenza | - Roseola¶ - Parvovirus B19¶ | - Corynebacterium diphtheriae - Rubella¶ - Measles - Mumps¶ |
| Acute unilateral | - Staphylococcus aureus - Group A Streptococcus - Anaerobic bacteria | - Group B Streptococcus - Tularemia* - Alpha Streptococcus - Pasteurella multocida - Yersinia pestis¶ - Gram-negative bacilli | - Yersinia enterocolitica* - Anthrax |
| Subacute/chronic bilateral | - Epstein-Barr virus¶ - Cytomegalovirus¶ | - HIV¶ - Toxoplasmosis¶ - Tuberculosis¶ - Syphilis¶ | - Brucellosis¶ - Histoplasmosis¶ |
| Subacute/chronic unilateral | - Nontuberculous mycobacteria - Cat scratch disease | - Toxoplasmosis¶ - Tuberculosis¶ - Actinomycosis¶ | - Nocardia brasiliensis - Aspergillosis - Sporotrichosis |
Non-infectious causes
| Malignancy | |
|---|---|
| Lymphoma or leukemia | Persistent, or progressive, nontender cervical or generalized lymphadenopathy; constitutional symptoms (eg, fever, weight loss, fatigue) |
| Neuroblastoma | Constitutional symptoms (fever, weight loss); abdominal mass; GI symptoms; proptosis; periorbital ecchymoses; Horner syndrome; opsoclonus myoclonus ataxia; palpable subcutaneous nodules; bone pain; hypertension; unilateral nasal obstruction |
| Rhabdomyosarcoma | Localized, painless, enlarging mass; proptosis; ophthalmoplegia; nasal, aural, or sinus obstruction (without drainage) |
| Thyroid cancer | History of external radiation to the head and neck; hoarseness; dysphagia; medullary thyroid cancer may be associated with multiple endocrine neoplasias |
| Collagen vascular disease | |
| Juvenile idiopathic arthritis | Arthritis/arthralgia; fever; rash; other systemic involvement (eg, hepatosplenomegaly, pericarditis, etc) |
| Systemic lupus erythematosus | Arthritis/arthralgia; hematologic abnormalities (anemia, leukopenia, lymphopenia, thrombocytopenia); malar rash; oral ulcers; fever; kidney disease |
| Drugs | |
| Phenytoin | Seizure disorder |
| Carbamazepine | Seizure disorder |
| Miscellaneous | |
| Kawasaki disease | Fever; rash; nonexudative conjunctivitis; enanthem; swelling of hands and feet |
| MIS-C (postinfectious) | Presentation may be similar to incomplete Kawasaki disease or toxic shock syndrome |
| PFAPA | Recurrent fevers; aphthous stomatitis; pharyngitis; and adenitis |
| Kikuchi disease | Fever; rash; systemic symptoms (fatigue, weight loss); leukopenia; anemia; usually occurs in young adult females |
| Langerhans cell histiocytosis | Lytic bone lesions; rash (papular or eczematous); oral lesions (mass, gingivitis, ulcers, loose teeth); diabetes insipidus |
| Hemophagocytic lymphohistiocytosis | Hepatomegaly; rash; neurologic findings (seizures, mental status changes); anemia; thrombocytopenia; most frequent at age <10 months, but may occur in older children |
| Castleman disease | Lymph nodes may be >4 cm (1.6 inches); may have systemic symptoms (fever, night sweats, malaise); hepatosplenomegaly; anemia, thrombocytosis |
| Kimura disease | Painless subcutaneous masses in head and neck; eosinophilia; increased IgE |
| Postvaccination | Recent history of immunization (particularly diphtheria-tetanus-pertussis, polio, or typhoid fever vaccine) |
| Sarcoidosis | Extensive enlargement of cervical nodes; facial eruption (flat-topped papules); weight loss; lethargy; fatigue, cough; bone lesions (eg, cystic or sclerotic focal lesions, osteopenia, osteoporosis) |