Shotty anterior cervical lymph nodes differential update#
Shotty anterior cervical lymph nodes differential skin#

Shotty anterior cervical lymph nodes differential skin#

The history should include location (localized versus generalized), duration, associated symptoms (including viral symptoms, sore throat, periodontal disease, skin lesions/infections, arthralgias), recurrent infections, ill contacts, recent travel, exposures (animals, rodents, insects, unpasteurized milk, undercooked meat), sexual activity, immunization status, medications, constitutional or B symptoms (prolonged fever, weight loss, night sweats) suggestive of malignancy. However, some children may have a more serious infection, an underlying serious systemic disease, or malignancy.Įvaluation starts with a thorough history and physical exam. Most children with lymphadenopathy will have a benign, self-limited process. Lymphadenopathy (enlargement of a lymph node) is often used interchangeably with lymphadenitis (inflammation of a lymph node). Lymphadenopathy is a common presenting concern in childhood. She is discharged after 2 days of hospitalization to complete a 10-day course of oral cephalexin. She responds well to the drainage and antibiotics with decreased swelling and pain. Her antibiotics are changed to intravenous cefazolin. Culture of the pus grows out methicillin-susceptible Staphylococcus aureus. Gram stain shows numerous white blood cells and gram-positive cocci in clusters. A surgeon is consulted, and the abscess is incised and drained for a moderate amount of pus under general anesthesia. An ultrasound of the mass is performed which confirms a moderate central abscess. She is admitted to the pediatric ward and started on intravenous clindamycin. No axillary, supraclavicular, or inguinal lymphadenopathy is noted.ĬBC WBC 25.0 with a left shift, CRP is 93 mg/dL. Her neck is supple with a 3 cm by 4 cm tender, warm, mobile, firm right submandibular mass with overlying erythema central fluctuance is questionably present. Sclera is white and conjunctiva are clear. She appears tired, but is in no distress. Weight and height are at the 50th percentile.

Her past medical history, family history and social history are noncontributory.Įxam: VS T39, HR 120, RR 20, BP 100/60, oxygen saturation 100% on room air. Her history is negative for rhinorrhea, cough, vomiting, diarrhea, recent skin infection, skin rash, weight loss, night sweats, dental problems, exposure to cats or other animals, or travel. No one at home has been ill, but she does attend pre-school and several children have been ill recently with sore throats and upper respiratory symptoms. Her appetite for solid foods is decreased, but she is drinking fluids well and her urine output is normal. She has had 2 days of fever up to 40 degrees C (104 degrees F).

The mass started as a small lump that has enlarged to the size of a walnut and is now becoming painful with overlying redness.

Shotty anterior cervical lymph nodes differential update#

This current third edition chapter is a revision and update of the original author’s work.Ī 3-year-old female presents to her primary care physician with a chief complaint of an enlarging right-sided neck mass first noted 4 days ago. The editors and current author would like to thank and acknowledge the significant contribution of the previous author of this chapter from the 2004 first edition Dr.