Cervical Lymphadenitis: Differential Diagnosis

00:00 In this lecture, we’ll discuss cervical lymphadenitis and all its various causes. So, cervical lymphadenitis is common in children. It’s an enlargement of lymph nodes in the anterior chain of the neck. Happens usually between kids, in kids usually between the age of 1 and 5 and it’s usually infectious but it can be caused by a number of other things. Sometimes it’s caused by drainage of active organisms from infected mucous membranes of the mouth and throat. So this bacteria are essentially carried to the lymph node where they then take over and infect and cause a bacterial cervical lymphadenitis. So, understanding cervical lymphadenitis is important but before we go there we need to think about what else could this be and understand the differential diagnosis. Identifying cervical lymphadenitis as bacterial is usually best done by taking a good history and doing a thorough exam. So let’s look at the key things to look for that are other causes of cervical lymphadenopathy. So one example would be cancers. Specifically lymphoma may present with multiple nodules, they tend to be firm and rubbery, they are matted and immobile and they are non-tender. The patient may have a history of weight loss or other signs of systemic disease. This is true for most of our cancerous causes of lymphadenopathy in children. They tend to be multiple, firm, rubbery, fixed in position and non-tender. What about viral disease? Viruses like Epstein-Barr virus and cytomegalovirus can cause profound lymphadenopathy of the anterior cervical chain but even simple common cold viruses can do it like RSV, adeno, influenza or parainfluenza. Usually, viral lymphadenopathy is bilateral, it’s not usually unilateral.

02:05 Usually there are multiple nodes, not just one predominant node. They usually have other symptoms of runny nose, congestion, cough, other symptoms of the upper respiratory infection and for mononucleosis they usually have a severe pharyngitis with purulent drainage, a spleen or a big liver and spleen and they may have had multiple nodes not only at the neck but also in the armpits and around the groin. So they are more of a disseminated disease that may well be EBV or mono. So what about strep throat that usually comes with significant lymphadenopathy? Again, this is usually a bilateral presentation, there are usually multiple nodes. This patient will also have palatal petechiae as you can see here. It may be purulent much like EBV but the palatal petechiae is classic. They will have a prominent sore throat and they will have a paucity of runny nose and congestion. Large tonsils are likely in strep throat. Also, patients with some systemic diseases can absolutely present with lymph nodes in the anterior cervical chain. For example, in Kawasaki disease that’s one of our criteria for the disease. Also patients with JIA or HIV may have it and then there’s this unusual condition which we see periodically in children called periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis. It’s called PFAPA for short. This is a recurrent fever syndrome but lymph nodes predominate in this disease.

03:46 Signs of these diseases are usually present other than lymphadenitis. So in Kawasaki they may have a non-purulent conjunctivitis, swollen hands and feet or rash. In JIA, they will have arthritis or in systemic disease they may have this salmon rash. In PFAPA, they have these other things you see here with periodic fevers, aphthous ulcers of the mouth, a sore throat.

04:11 In HIV, they may have weight loss and other sequelae from acute HIV.