![]() ![]() We use this categorization in conjunction with the findings from the history and examination to guide the initial laboratory evaluation and management. The infectious causes of cervical lymphadenitis in children vary depending upon whether the adenitis is acute or subacute/chronic and bilateral or unilateral, although there is some overlap ( table 1). Unless there are compelling associated symptoms suggestive of noninfectious causes ( table 2), we generally focus the initial evaluation on infectious causes of cervical lymphadenitis because infectious causes are more common and more frequently associated with tenderness and inflammation than noninfectious causes. In difficult cases, consultation with a specialist in pediatric infectious diseases can help to direct the evaluation and management. The initial laboratory evaluation and management depend upon the findings from the history and examination, and may range from observation and reassurance (for well-appearing children with acute bilateral cervical lymphadenitis that is only slightly enlarged and minimally tender) to comprehensive diagnostic testing and aggressive medical and surgical therapy (for ill-appearing children or those with suspected malignancy or mycobacterial disease). The goal of the evaluation is to determine the underlying cause, which affects initial management. Overview - The evaluation of children with cervical lymphadenitis includes a thorough history and physical examination ( table 3). (See "Cervical lymphadenitis in children: Etiology and clinical manifestations".) (See "Peripheral lymphadenopathy in children: Etiology", section on 'Generalized lymphadenopathy'.)ĬAUSES - There are numerous infectious and noninfectious causes of enlarged cervical lymph nodes in children ( table 1 and table 2). Generalized lymphadenopathy – Enlargement of two or more noncontiguous lymph node regions (eg, cervical and axillary) and is the result of systemic disease.Subacute/chronic lymphadenitis – Develops over weeks to months.Acute lymphadenitis – Develops over a few days (but may persist for weeks to months).Cervical lymphadenitis – Enlarged, inflamed, and tender lymph node(s) of the neck although strictly speaking, "lymphadenitis" refers to inflamed lymph nodes, the terms "lymphadenitis" and "lymphadenopathy" often are used interchangeably.Cervical lymphadenopathy – Enlarged lymph node(s) of the neck, including preauricular, parotid, jugulodigastric, submental, submandibular, posterior cervical, superficial cervical, deep cervical, occipital, and posterior auricular (mastoid) ( figure 1) lymphadenopathy encompasses both inflamed and noninflamed lymph nodes.(See "Cervical lymphadenitis in children: Etiology and clinical manifestations" and "Peripheral lymphadenopathy in children: Etiology" and "Peripheral lymphadenopathy in children: Evaluation and diagnostic approach".) The pathogenesis, etiology, and clinical manifestations of cervical lymphadenitis and other causes of peripheral lymphadenopathy in children are discussed separately. INTRODUCTION - The evaluation and initial treatment of cervical lymphadenitis in children will be reviewed here. ![]()
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