A case presentation and algorithm for cervical lymphadenopathy of pediatrics

2. Cervical Lymphadenopathy
In Pediatrics
Presented by:
Mahmoud Motawea
Assistant Lecturer of Pediatric Surgery

3. History
Female patient aged 1 8/12.
FT – NVD – Not intubated.
Medical : Repeated history of tonsillitis.
No surgical history of importance.

4. History
 Complaint:
• Multiple painless neck swellings noticed
two months ago.
• Increasing in size.
 History of similar condition; Small bilateral
post auricular swellings appeared 4 months
and resolved with medical treatment.

5. Examination
•Multiple painless amalgamated cervical
lymph nodes mainly level I, II, III.
•Not fluctuant.
•No other lymph nodes enlargement.
•Bilaterally enlarged tonsils
•No abdominal organomegaly.

6. Investigations
Lab investigations:
•CBC: Hb: 9.1 gm/dL , TLC 5.1, Plt 425.000
Leukocyte differential : 71% lymphcytes,
Neutrophils 22%
•ESR: 1st hour : 35mm 2nd hour 60mm
•CRP : negative

7. Investigations
Lab investigations:
•EBV IgG, HSV IgM & IgG, Toxoplasma IgM &
IgG  All negative
•CMV IgG Positive
•Rubella IgG Positive
•LDH  527 IU/L (child n < 300)
•Paratyphoid B +ve (1/80)

8. Investigations
Ultrasound:
• Multiple innumerable, variable sized,
rounded enlarged upper and lower deep
cervical lymph nodes with no fatty hilum
likely malignant for further
histopathological correlation

9. Investigations
Ultrasound:

10. Investigations
Chest X-Ray :

11. Home Message
• Many lymph nodes are palpable in children,
and generally, cervical nodes aer less than 2
cm (suspicious if > 3cm).
• Persistent or progressive new-onset
lymphadenopathy of greater than 4 to 6
weeks duration and/or palpable epitrochlear
and supraclavicular nodes should trigger
investigations.

12. Home Message
• Associated symptoms of night sweats,
weight loss, and hepatosplenomegaly also
increase the chance of malignancy.
• In addition, an abnormal chest radiograph,
and fixed nodes are all significantly associated
with malignancy.

13. Home Message
• A chest radiograph should be performed
prior to any operative intervention.
• The lymph node should be sent as a fresh
specimen. The nodes should not be fixed in
formalin.

14. Home Message