![]() ![]() If the cause remains uncertain after the second stage evaluation and treatment and the adenopathy has not decreased in size, less common causes and causes that require specific treatment (eg, tuberculosis) are evaluated.If the cause remains uncertain after the initial evaluation, the second stage is to evaluate and/or treat common causes of generalized or localized lymphadenopathy (according to site) or to provide a two-week trial of antibiotic therapy or a two- to three-week period of observation.The first stage is to evaluate and treat conditions that appear obvious based upon the history and examination (eg, throat culture for group A streptococcal pharyngitis, heterophile antibodies or specific titers for Epstein-Barr virus or cytomegalovirus mononucleosis, serology for Bartonella henselae for cat scratch disease, medical or surgical therapy for NTM).(See "Nontuberculous mycobacterial lymphadenitis in children", section on 'Clinical suspicion' and "Nontuberculous mycobacterial lymphadenitis in children", section on 'Management'.) Early excisional biopsy is indicated for children with worrisome features ( table 3) it also may be indicated for suspected nontuberculous mycobacterial (NTM) infection (eg, young child with unilateral, nontender, cervicofacial lymphadenitis with violaceous, thin overlying skin). "Early" excisional biopsy refers to biopsy when the child is initially seen at a referral center.Step-wise approach - Our approach to the evaluation of peripheral lymphadenopathy in children occurs in stages over approximately four weeks: Sometimes the lymphadenopathy resolves without explanation before invasive diagnostic testing is undertaken. It can be more deliberate if the child looks well. The pace of the evaluation is rapid if the child is ill appearing. The urgency and extent of the evaluation is determined by how ill the patient appears and whether there are clinical features suggestive of malignancy ( table 3). It is not necessary to identify the underlying etiology in every patient, particularly at the time of initial presentation in the primary care setting. Urgency and extent of evaluation - Peripheral lymphadenopathy in children generally is benign and self-limited. Strictly speaking, "lymphadenitis" refers to enlarged lymph nodes that are inflamed, but it is often used interchangeably with "lymphadenopathy." The threshold for enlargement varies with location. "Lymphadenopathy" refers to enlargement of the lymph nodes. (See "Peripheral lymphadenopathy in children: Etiology" and "Cervical lymphadenitis in children: Etiology and clinical manifestations" and "Evaluation of peripheral lymphadenopathy in adults".)ĪNATOMY AND DEFINITIONS - The location of peripheral lymph node groups is shown schematically in the figures ( figure 1 and figure 2). The causes of peripheral lymphadenopathy in children ( table 1A-B and table 2), cervical lymphadenitis in children, and peripheral lymphadenitis in adults are discussed separately. The guidelines are intended to supplement clinical judgment in the absence of research that directly addresses how children with unexplained lymphadenopathy should be evaluated. This topic will provide guidelines for our approach to the evaluation of peripheral lymphadenopathy in children. The challenge for clinicians is to avoid aggressive evaluation and biopsy of most children, while making timely, specific diagnoses in children with serious underlying disease. However, it can be a manifestation of serious underlying disease. INTRODUCTION - Lymphadenopathy is common and usually not clinically important in and of itself. ![]()
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