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American Academy of Pediatrics
Article

Pediatric Cervical Lymphadenopathy

Michael S. Weinstock, Neha A. Patel and Lee P. Smith
Pediatrics in Review September 2018, 39 (9) 433-443; DOI: https://doi.org/10.1542/pir.2017-0249
Michael S. Weinstock
*Cohen Children’s Medical Center, Hofstra Northwell School of Medicine, New Hyde Park, NY
†Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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Neha A. Patel
*Cohen Children’s Medical Center, Hofstra Northwell School of Medicine, New Hyde Park, NY
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Lee P. Smith
*Cohen Children’s Medical Center, Hofstra Northwell School of Medicine, New Hyde Park, NY
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  1. Michael S. Weinstock, MD*,†
  2. Neha A. Patel, MD*
  3. Lee P. Smith, MD*
  1. *Cohen Children’s Medical Center, Hofstra Northwell School of Medicine, New Hyde Park, NY
  2. †Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
  • AUTHOR DISCLOSURE

    Drs Weinstock, Patel, and Smith have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abstract

Cervical lymphadenopathy affects as many as 90% of children aged 4 to 8 years. With so many children presenting to doctors' offices and emergency departments, a systematic approach to diagnosis and evaluation must be considered. In the following review, we aim to provide the pediatric clinician with a general framework for an appropriate history and physical examination, while giving guidance on initial diagnostic laboratory testing, imaging, and potential need for biopsy. The most common cause of cervical lymphadenopathy in the pediatric population is reactivity to known and unknown viral agents. The second most common cause includes bacterial infections ranging from aerobic to anaerobic to mycobacterial infections. Malignancies are the most concerning cause of cervical lymphadenopathy.

The explosion in the use of ultrasonography as a nonradiating imaging modality in the pediatric population has changed the diagnostic algorithm for many clinicians. We aim to provide some clarity on the utility and shortcomings of the imaging modalities available, including ultrasonography, computed tomography, and magnetic resonance imaging.

  • © American Academy of Pediatrics, 2018. All rights reserved.

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Pediatrics in Review: 39 (9)
Pediatrics in Review
Vol. 39, Issue 9
1 Sep 2018
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Pediatric Cervical Lymphadenopathy
Michael S. Weinstock, Neha A. Patel, Lee P. Smith
Pediatrics in Review Sep 2018, 39 (9) 433-443; DOI: 10.1542/pir.2017-0249

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Pediatric Cervical Lymphadenopathy
Michael S. Weinstock, Neha A. Patel, Lee P. Smith
Pediatrics in Review Sep 2018, 39 (9) 433-443; DOI: 10.1542/pir.2017-0249
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  • Article
    • Abstract
    • Practice Gaps
    • Objectives
    • Introduction
    • History and Physical Examination
    • Differential Diagnosis
    • Reactive Cervical Lymphadenopathy Secondary to Viral Infection
    • Acute Bacterial Lymphadenitis/Suppurative Lymphadenitis
    • Subacute or Chronic Lymphadenopathy
    • Noninfectious Causes of Cervical Lymphadenopathy in Children
    • Malignancy
    • Congenital Neck Masses
    • Noninfectious Causes
    • Parotid, Submandibular, and Sublingual Gland Pathology
    • Imaging
    • Biopsy versus FNA?
    • References
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