Pediatric Lymphadenopathy Flashcards
Define lymphadenopathy
Lymph nodes that are abnormal in:
- Size
- Number
- Consistency
The history and PE is the most important component of the work-up in a pediatric pt with LAD. What are some important aspects of the history in this pts?
- Age of pt
- Location of node(s)
- Onset and duration of enlargement of node(s)
- Localized symptoms (cough, headache, sore throat, skin sores or redness, etc.)
- Generalized sxs (fever, wt loss, appetite loss, fatigue, arthralgias, pain, night sweats, pruritis)
- Travel, meds, dental problems, bites (flea, tick, mosquito), immunizations, high risk behaviors, hx of LAD, exposures (uncooked meats, animals, unpasteurized milk/soft cheeses, symptomatic individuals)
Important components of PE in evaluating a pediatric pt with LAD
Vitals: fever? Weight loss?
Size of nodes
Location of nodes
Quality of nodes — firm, matted, soft, fluctuant, etc.
Localized or generalized
Tenderness, erythema, warmth
Distal lesions (inguinal nodes —look for leg lesion)
Spleen/liver size
In evaluating LN size, what is considered to be enlarged?
2+ cm
When evaluating the location of LAD, what location is considered abnormal?
Supraclavicular
If the quality of the LNs on exam is tender, warm, red, and fluctuant, you should consider _____ in the Ddx
Lymphadenitis
Soft, mobile, smooth LNs are considered benign, while firm and rubbery indicate possible _____
Lymphoma
Fixed and matted LNs may indicate malignancy or ___
TB
Common causes of LAD in children
Viral illness —> “shotty” nodes of early childhood (cervical, axillary, inguinal)
Reactive cervical LAD common in preschool/early school age (URI, OM, conjunctivitis)
When it comes to treatment plan for pediatric LAD, the “shotgun” approach is not appropriate. What are your 3 main options?
- Watchful waiting — if etiology is obvious or if node(s) are not concerning; with or w/o abx therapy
- Abx — if bacterial infection in LN itself or the drainage region is suspected
- Possible bx
When should you proceed with LN biopsy?
If watchful waiting is the plan but nodes never improve
If 4-6 wks of abx fail to improve LAD
Right away if enlarged supraclavicular node is palpated along with findings consistent with malignancy (night sweats, weight loss, abnormal CXR or CT)
Etiologic organism and manifestations of cat scratch disease
Bartonella henselae
Isolated adenopathy, visceral organ (liver and spleen) involvement, parinaud’s syndrome and/or neuroretinitis (PE finding of macular star), CNS involvement with encephalopathy, transverse myelitis, radiculitis, cerebellar ataxia
2 categories of tumor-like lesions of infancy and childhood
- Heterotopic — microscopically normal cells or tissues that are present in abnormal locations; usually insignificant but rarely can become malignant
- Hamartoma — excessive, focal overgrowth of cells and tissues native to the organ in which it occurs (hemangiomas, rhabdomyomas of the heart, etc.); benign histology, can cause clinical problems d/t location, size, etc.
Most common tumors of infancy; most commonly affect the skin in children and usually regress with age
Hemangioma
Benign lymphatic tumors seen in pediatrics
Lymphangiomas (hamartomatous or neoplastic)
Lymphangiectasis
Benign tumors seen in children
Hemangiomas
Lymphatic tumors (lymphangiomas, lymphangiectasias)
Fibrous tumors (fibromatosis, fibrosarcoma)
Teratomas (sacrococcygeal most common)
The most frequent malignant cancers in childhood arise in what 5 organ systems?
Hematopoietic system
Nervous tissue
Soft tissues
Bone
Kidney
What malignancies show sharp peaks in incidence in children <10 y/o?
Leukemia (mainly ALL) Neuroblastoma Wilms tumor Hepatoblastoma Retinoblastoma Rhabdomyosarcoma Teratoma Ewing sarcoma Juvenile astrocytoma Medulloblastoma Ependymoma
Most common extracranial solid tumor of childhood
Neuroblastoma
Presentation of neuroblastoma
In children <2: fever, large abdominal mass, possible wt loss, “blueberry muffin baby”
Older children: may not be diagnosed until metastatic — bone pain, respiratory sxs, GI complaints, periorbital region (common site of mets)
About 90% of neuroblastomas produce catecholamines which produce elevated urine ____ and _____, which are important diagnostic features
VMA; HVA
Most common primary renal tumor of childhood and 4th most common pediatric malignancy
Wilms tumor
The risk of wilms tumor is increased with at least 3 recognizable groups of congenital malformations associated with distinct chromosomal loci. These include WAGR syndrome, Denys-Drash syndrome, and ______________. The latter being characterized by enlargement of body organs, macroglossia, hemihypertrophy, omphalocele, abnormal large cells in adrenal cortex, and chromosomal WT2 abnormality
Beckwith-Wiedemann syndrome
Various presentations of wilms tumor
A large abdominal mass
Hematuria
Pain in abdomen after some traumatic incident
Intestinal obstruction
HTN
Pulmonary metastases
