![]() ![]() Worrisome findings which increase risk of malignancyīe sure to examine all the lymph nodes: Pre-auricular, post-auricular, tonsillar, submental, submandibular, anterior cervical, posterior cervical, occipital, supraclavicular, axillary, epitrochlear (in the antecubital fossa), inguinal, popliteal and don’t forget the liver and spleen!!įigure 1: “Diagram (c)EMIS 2011, as distributed at, used with permission.”Ī careful history and physical exam will help determine whether further investigation is needed. When palpating a lymph node it is important to consider the following: – Hepatosplenomegaly (this is actually considered part of your lymph node exam!) – Oropharynx for pharyngitis, dental problems, HSV ginivostomatitis In an infant with occipital lymphadenopathy, one should examine the scalp for lesions such as seborrheic dermatitis. Ask if the patient has had a sore throat or ear pain. For example, in a child with cervical adenopathy one should examine the orpharynx and consider the possibility of streptococcal pharyngitis or viral upper respiratory infection. Always pay special attention to the area of the enlarged node for a focus of infection. Are they febrile? Plot them on the appropriate growth chart have they lost weight? Then perform a complete systematic physical exam paying special attention to your head and neck, abdominal and dermatological examinations. Palpable nodes in the supraclavicular region are often associated with malignancy of the chest or abdomen and always require further investigation.Īlways perform a complete physical exam beginning with general appearance, vital signs and growth parameters. Nodes that are usually palpable include anterior cervical, inguinal, and axillary regions until about age 12. Ingestion of unpasteurized animal milk (brucellosis), or undercooked meats (toxoplasmosis, tularemia)Ĭhildren often have easily palpable nodes enlarged in response to infection. In adolescents, it is also important to ask about IV drug use and obtain a sexual history.Carbemazepine or phenytoin? There are a wide variety of medications which can cause lymphadenopathy. ![]() Could the child have picked up an infection while traveling? Has the child been in contact with infected individuals? Viral respiratory exposures such as EBV/CMV? TB exposure? Has this child been hospitalized in the past? Any ongoing medical conditions? Any surgeries? Any visits to the Emergency department?
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