Cervical Lymphadenopathy

Question 1

DDx for acute adenitis and differentiate the lymphadenopathy in each.

Answer 1

Acute generalised: 
1. Viral/post-viral - reactive nodes:
• Small, firm, non-tender
• Mobile
• Weeks-months

Acute localised:
1. Viral URTI (same as viral)
2. Bacterial lymphadenitis
○ Larger nodes > 10mm
○ Tender
○ Fluctuant
○ Most typically in anterior neck
○ Fever, warmth over area, erythema of skin

3. Kawasaki
   • Unilateral, localised to cervical
   • >15mm
   • Painful
4. Other: infectious mononucleosis

Question 2

Duration considered persisting adenitis?

Answer 2

> 2 weeks

Question 3

List some DDx for persisting adenitis.

Answer 3

Persisting generalised:

1. Infective: CMV, toxoplasmosis, mononucleosis, HIV
2. Malignancy: lymphoma, leukaemia
3. AI: Juvenile chronic arthritis, SLE

Persisting localised:

1. Infective: TB, mononucleosis, cat scratch
2. Atopic eczema: usually posterior neck, bilateral

Question 4

What Ix could you order for persisting adenitis?

Answer 4

• FBE/film
• Serology - EBV, CMV, HIV, Toxoplasmosis, Cat scratch
• Mantoux test
• CXR
• CT may be required preoperatively
• Excision biopsy

Question 5

How might you manage an acute fluctant node?

Answer 5

• Incision and drainage (contraindicated in suspected TB as may result in sinus formation)

Question 6

What Abx might you give for an acute infective adenitis?

Answer 6

Fluclox:

• oral for 10 days if well
• IV for unwell/neonates/failed oral