Enlarged cervical lymph nodes represent the most common swellings in the neck in children. Most are benign, but they can challenge the clinical acumen of even the astute physician, as indicated by the following dilemma. When is lymph node biopsy indicated? Which features distinguish inflammatory changes and “reactive hyperplasia” from malignancy?
Acute Suppurative Lymphadenitis-The drainage route from the oropharynx to the cervical lymph nodes can result in bacterial lymphadenitis secondary to Staphylococcus aureus and Streptococcal species. Unchecked, these lesions become suppurative with all the classic signs of infection (calor, dolor, tumor, rubor). Early institution of antibiotics (i.e. Septra, Cephalosporins, Augmentin) may prevent abscess formation. Needle aspiration may allow one to avoid formal incision and drainage.
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