![]() ![]() One after the other, the submental and submandibular lymph nodes, the lymph nodes at the angle of the mandible, the pre- and post-auricular lymph nodes and the (sub-)occipital lymph nodes are palpated. The lymph nodes and diseases associated with them are listed in Table 2 (Tab. It is advisable to work in a fixed order. Palpation is similarly not restricted to the conspicuous lymph nodes and includes thorough examination of the head and neck region. A family anamnesis not only includes acute infections but also chronic and systemic diseases such as sarcoidosis or tuberculosis. Other environmental influences and noxa (including drugs) may more rarely be the cause of lymphadenopathy, but they should nevertheless always be considered. The same applies to symptoms such as bone/joint pain, weakness and lowered resilience or anorexia.ĭetails of foreign travel and possible contact with animals (in particular cats, rabbits, rodents, tick bites) and equally of all vaccinations must also be obtained in the anamnesis. Positive B symptoms typically occur in malignant lymphomas (classification as A/B symptoms according to Ann Arbor), but may also accompany infectious diseases (tuberculosis, HIV, parasitosis). Other B symptoms include night sweats (drenching) and weight loss (>10% of body weight in a period of 6 months). Local tenderness suggests an inflammatory component, while fever can occur equally in infections and as part of the B symptoms. The anamnesis must include any reference to a focus, including in the past, such as a sore throat, earache or toothache, insect bites or injuries. Such an approach is described in the following paper. The spectrum of differential diagnoses and the varying degrees of clinical relevance – from banal infections to malignant diseases – demand a clear and considered approach to the child’s individual clinical presentation. ![]() Sonography also plays an important role in differential diagnosis of lymph node swelling in children and is useful in answering one of the critical diagnostic questions: is there a suspicion of malignancy? If so, full dissection of the most conspicuous lymph node may be necessary to obtain histological confirmation.ĭiagnosis and treatment of childhood cervical lymph node disorders present the attending pediatric and ENT physicians with some particular challenges. The basis of diagnostic decisions is a detailed anamnesis and clinical examination. In the interests of time, patient wellbeing and cost, a careful choice of these must be made to permit appropriate treatment. Involvement of the lymph nodes in multiple conditions is accompanied by a correspondingly large number of available diagnostic procedures. The cervical lymph nodes are particularly important because they are the first drainage stations for key points of contact with the outside world (mouth/throat/nose/eyes/ears/respiratory system) – a critical aspect especially among children – and can represent an early clinical sign in their exposed position on a child’s slim neck. The lymph nodes are an essential part of the body’s immune system and as such are affected in many infectious, autoimmune, metabolic and malignant diseases. ![]()
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