Pediatric Masses/Lymphadenopathy Flashcards
What is Lymphadenopathy?
Lymph nodes that are abnormal in size, consistency or number
What is Lymphadenopathy?
Lymph nodes that are abnormal in size, consistency or number
Lymphadenopathy is often interchangeable with?
Lymphadenitis
Lymphadenopathy is usually due to what 2 general categories?
- Proliferation of normal cells due to infection
2. Infiltration by foreign/malignant cells
What is the most important part of a work-up of a child with lymphadenopathy?
HISTORY AND PHYSICAL
What is the most important part of a work-up of a child with lymphadenopathy?
HISTORY AND PHYSICAL
Lymph nodes greater than ____ are considered “enlarged”
2 cm
What qualities of lymph nodes are more reassuring?
Expected location
Soft and mobile
Not warm, red or tender
Child is feeling overall ok
What qualities of lymph nodes are less reassuring?
Unusual location
Large, hard and “stuck down” (fixed)
Associated with a big liver/spleen
If a child present with lymphadenopathy, what should you always check?
Liver and Spleen size
If the liver/spleen are enlarged, what could that indicate?
Systemic infection
Malignancy
2 common viruses that can cause pediatric LAD?
EBV
HIV
EBV symptoms
Mononucleosis
- Pharyngitis, fatigue, splenomegaly
HIV symptoms
Child wasting with diffuse LAD
4 common bacteria/illness that can cause pediatric LAD?
Cat Scratch Disease
Tularemia
Staph/Strep
Strep. Pyogenes
Bartonella Henselae
Cat Scratch Disease
Cat Scratch Disease symptoms
Axillary LAD on SAME side as cat scratch
Tularemia is caused by?
Skinning rabbits
Staph/Strep LAD is common. What should you look for?
Lesions in region that would drain into the lymph node
Strep. Pyogenes symptoms
Strep throat
- Sore throat, headache/stomachache and cervical LAD
What signs may be present with Lymphoma?
B signs
= Fever, weight loss, night sweats
Fever, weight loss, night sweats and LAD could indicate?
Lymphoma
In a child that presents with LAD and dyspnea, what should you order?
CXR!
- check for mediastinal mass to rule in/out Lymphoma
In a child that presents with LAD and dyspnea, what should you order?
CXR!
- check for mediastinal mass to rule in/out Lymphoma
In an overall well patient with LAD, what treatment can you try?
Watchful waiting and antibiotics
If you are watching the LAD or trying antibiotics, when should you consider a biopsy?
If the node(s) gets bigger or persists for longer than 4-6 weeks
If watching the LAD is the plan, what should you instruct your patient to do?
Return sooner if things worsen
In an ill patient with B signs/respiratory symptoms a CXR is usually performed. What should do then do?
Look for the results ASAP and communicate with the family
Are there any absolutes when deciding when to biopsy?
No
What is the best biopsy type for LAD?
Excisional biopsy
Most common benign tumor of childhood?
Hemangioma
- Cavernous (big dilated vessels) or Capillary (small vessels)
Most common benign tumor of childhood?
Hemangioma
- Cavernous (big dilated vessels) or Capillary (small vessels)
Hemangioma treatment?
None - usually regress with age
Hemangiomas usually regress with age, what may they do before regressing?
Raise up and get bigger
What is a type of Hemangioma that is usually permanent?
Port wine stain
Sturge Weber Syndrome
Facial port wine stain + developmental delay
Any growth that you can NOT see the bottom of over the ______ area you should get a ______
Lumber/sacral area
MRI or US
Any growth that you can NOT see the bottom of over the Lumbar/Sacral area you should get?
MRI or US
Why should you get an MRI or US for growths that you can NOT see the bottom of over the Lumber/Sacral area?
To check for spinal cord or vertebral abnormalities
Why should you get an MRI or US for growths that you can NOT see the bottom of over the Lumbar/Sacral area?
To check for spinal cord or vertebral abnormalities
Besides Hemangiomas, the rest of the tumors in this deck are?
Malignant tumors of childhood
Neuroblastoma
Tumor of the sympathetic ganglion or adrenal medulla
Symptoms of Neuroblastoma?
Blueberry muffin baby
- VMA and HVA in urine
Symptoms of Neuroblastoma?
Blueberry muffin baby
- VMA and HVA in urine
Wilms Tumor and when it commonly presents
Renal tumor presenting between ages 2-5
Renal tumor presenting between ages 2-5
Wilms tumor
What are 3 congenital malformations that increase chances of developing a Wilms (renal) tumor?
- Beckwith - Wiedemann Syndrome
- WAGR Syndrome
- Denys - Drash Syndrome
Beckwith - Wiedemann Sydrome
- increased risk of wilms tumor
= Macroglossia, hemi-hypertrophy, organomegaly
WAGR Syndrome
= Wilms tumor, aniridia, genital anomalies, mental retardation
Denys-Drash Syndrome
- 90% chance of developing a wilms tumor
= Gonadal dysgenesis and nephropathy in males
Retinoblastoma
Ocular malignancy
Red reflex signs with Retinoblastoma
Dull, irregular and gray
Ewing Sarcoma
Bone or soft tissue around bone affected
Symptoms of Ewing Sarcoma
Chronic bone pain or associated fracture
Fibrosarcomas
Fibroblasts that divide excessively without control
What is the most common malignancy in kids less than 10?
Leukemia
What is the most common malignancy in kids less than 10?
Leukemia
What is the most common malignancy in kids between 15-19?
Hodgkin Lymphoma
What is the most common malignancy in kids between 15-19?
Hodgkin Lymphoma
