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more about Lymphadenopathy

  • There are "home bases" throughout the body which house collections of cells to fight infection, destroy debris, and attack foreign substances.  These home bases are the lymph nodes.  When they are very actively performing one of their functions, they enlarge.  Usually, a group of them enlarge at the same time.
  • Quite large lymph nodes can be felt through the skin or sometimes seen on X-ray.  This enlargement is called lymphadenopathy.

  • Spherical lumps beneath the skin, measuring approximately 1/4" to 1/2" diameter, which may or may not be tender.
  • The enlarged lymph nodes are especially likely in certain areas: in the neck, in back of the scalp, in the armpits, and in the groin area.

  • The cause is often unknown.  When a lymph node biopsy is done, it often shows only that there are more of the lymph node cells in the node than are usually present.  This is called "reactive hyperplasia," but doesn't reveal a specific cause.
  • At other times, a specific cause is identified.  A few examples follow:
    1. Pharyngitis, Tonsillitis, minor Skin Infections, minor scalp infections, ringworm, and other ailments that are usually minor
    2. Cat-Scratch Disease
    3. Infectious Mononucleosis ("mono")
    4. Tuberculosis
    5. Juvenile Rheumatoid Arthritis
    6. AIDS
    7. Medication side-effects such as sulfa drugs or Dilantin

  • Diagnosis often requires a very detailed history and physical examination.  At times, X-rays or blood tests are needed, or a lymph node aspiration (drawing tissue juice out of the node with a needle), or a lymph node biopsy.
  • Infectious Mononucleosis: There is often a history of weakness, tiredness, fever, and sore throat in a teenager.  Additionally, the tonsils are enlarged and a particular blood cell shows up in large numbers when a complete blood count is done.  This unusual blood cell is called an atypical lymphocyte.  The lymph nodes in the neck usually enlarge greatly.
  • Tuberculosis: There is often a history of cough, exposure to Tuberculosis, an X-ray showing the typical X-ray findings of childhood Tuberculosis in a lung, and a positive skin test for Tuberculosis, called a PPD.  Tuberculosis enlarges lymph nodes near the affected lung, and sometimes enlarges lymph nodes in the neck.

  • Childhood (past the age of infancy) is the major risk factor, since a child's lymph nodes over-react with much swelling to just about any cause of lymph node enlargement.  An adult's lymph nodes are not as likely to swell.

  • Treatment depends on treating the underlying condition; for example, treating an infection (Tonsillitis) or stopping the offending medication (sulfa drug).
  • When the cause of lymph node enlargement is unknown, a physician might choose watchful waiting for 3-4 weeks to see if the lymphadenopathy resolves, and then proceed with a lymph node biopsy if the condition is still present.
  • Another common approach, if the lymphadenopathy is in the neck, is to give the child a short course of antibiotics in the hopes that a minor bacterial infection will respond to this treatment.

  • Rarely, the enlarged lymph nodes will break open and drain some of their material onto the skin.
  • Rarely, when a lymph node is biopsied, it will heal with a draining connection to the skin surface.

  • If you feel any lump or lumps beneath your child's skin, whether the lump is tender or not, point this out to your child's physician so that this can be evaluated fully.

more about Lymphadenopathy

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