In the history, it should be asked how long the lymphadenopathy has been present, whether it is gradually growing, whether there is fever, sore throat, cough, sweating, joint pain, rash, easy bruising, nosebleeds, weight loss. In addition, medication use, vaccination history, animal bite, contact history with patients, travel history, use of raw milk and dairy products should be questioned.
Physical Examination: General systemic examination of patients brought for lymphadenopathy must be performed. Whether lymphadenopathy is localized or widespread, its number, size, consistency, whether it is mobile or not, and the presence of signs of inflammation are investigated. In addition, the presence of possible accompanying rash, icterus, petechiae, ecchymosis and hepatosplenomegaly should be investigated.
Laboratory: In children presenting with lymphadenopathy, complete blood count and peripheral smear
evaluation are the first laboratory examinations to be performed and are diagnostic and differential. It is very
valuable in diagnosis. Pancytopenia can be seen in the course of malignant diseases such as leukemia and neuroblastoma
and can also be detected in the course of systemic viral and bacterial infections. While elevated white blood cells and left shift are seen in bacterial infections, lymphomancytosis can also be seen in leukemias as well as systemic infections such as EBV, CMV, toxoplasmosis. Erythrocyte sedimentation rate and CRP are detected to be very high, especially in tuberculosis, collagen tissue diseases and malignancies. Increased liver function tests in blood biochemistry may indicate infectious mononucleosis, and increased uric acid may indicate malignant disease. Radiologically, direct radiographs and ultrasonography are the imaging methods used in the initial evaluation. In patients with lymphadenopathy, if there is no guidance from the history and physical examination, a two-way chest radiography should be taken with the suspicion of possible mediastinal lymphadenopathy or mass. Ultrasonography gives detailed information about the lymph nodes.
Their relationship with the surrounding tissues, their number and size, whether the hilus structure is preserved, whether an abscess
has developed is especially investigated. Abdominal ultrasound is performed to check for possible hepatosplenomegaly and lymphadenopathy.
From serological studies, tests for CMV, EBV and toxoplasma are primarily requested. See the phenomenon
Tests may be requested for agents such as cat scratch disease, tularemia, HIV, HHV-6, brucella
to be decided. PPD skin tests should be requested, especially in patients with an abnormal appearance on chest x-ray.
Bone marrow aspiration/biopsy: It is not performed in all cases of lymphadenopathy, but it should be evaluated in the following
cases:
>- Growing lymphadenopathy for at least 2 months
- Weight loss
- Bone pain
- Hepatosplenomegaly
- Maxillary/mandibular mass
- Retroorbital mass
- Abdominal mass
- Anemia, thrombocytopenia, blast
- If the chest radiography is abnormal
- If there is supraclavicular LAP
Biopsy: If the cause of lymphadenopathy cannot be determined and continues to be at pathological levels,< br /> Since aspiration will be insufficient to show a possible lymphoma and will cause waste of time, it is preferably recommended to perform an excisional biopsy. Biopsy is indicated in the following cases:
- Accompanied by persistent and unexplained fever, weight loss and night sweats
- Hard, painless and fixed to the surrounding tissue
- Appropriate treatment is required Despite the fact that the lymph node continues to grow or new ones appear, the enlargement of the lymph node is called lymphadenomegaly, and all lymph node diseases in which the size and structure of the lymph node are disrupted are called lymphadenopathy. Apart from this, the enlargement of the lymph node with signs of inflammation (pain, swelling, redness, increased temperature) is called lymphadenitis. In childhood, a size up to 0.3 cm in the supraclavicular region, 0.5 cm in the axillary, epitrochlear, occipital and postauricular regions, 1 cm in the cervical region, 1.5 cm in the inguinal region, 2 cm in the abdomen and 1.5 cm in the mediastinum can be considered normal.
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