My 7 year old has multiple enlarged nontender cervical lymph nodes since Jan. He has been on antibiotics twice. Strep culture, mono spot test, and CBC were normal. Has not had many URI at all this winter. Any ideas?
Reply: ---------------------------------
If the "enlarged" nodes are greater than 2 cm on palpation and if the nodes have been persistently enlarged for this long (> 4 months), a biopsy is indicated. Initially, one might consider a fine needle biopsy in which a small needle is passed into an enlarged node multiple times under aspiration to obtain cells for microscopic analysis. This can occasionally be done under local anesthesia in children. However, fine needle aspiration cell analysis is often not helpful in the diagnosis of enlarged lymph glands and therefore frequently open excisional biopsy may be the preferable initial approach.
It is important to note that children may have lymph nodes that stay enlarged for prolonged periods after upper respiratory illnesses, particularly when there have been multiple infections over a relatively short period such as a winter season. Chronic tonsil problems such as those associated with large cryptic tonsils may be associated with persistent lymphadenopathy even without a history of significant strep throat episodes. Therefore the decision to pursue a lymph node biopsy in a child with non-tender lymphadenopathy and no obvious systemic illness requires a thorough assessment of the upper respiratory and digestive tract over at least a couple of months.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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