Neck lump in a child

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A 2 year old girl is brought into the Emergency Department by her parents. She has recently had some coryzal symptoms. Today when the child was picked up from kindergarten, the parents noticed a lump on the left side of the neck. It had not been there the morning before. The child is febrile at 38.3, but otherwise has a normal examination. She looks well, is happy and playful.

She has a unilateral cervical node swelling of about 15mm diameter. Nil else.

Diagnosis:

Cervical adenitis(adenopathy)

Aetiology

If the lump is only in the cervical region and of recent onset, it is most probably going to be VIRAL. Think of URTI, or Infectious mononucleosis. It can also be bacterial (especially if the node is >15mm) and can be related to dental infection and tonsillitis. Be sure to exclude Kawasaki Disease. If persistent, think of TB.

If not localised to the cervical region, some of the same causes as above apply i.e. infectious mononucleosis, CMV, Toxo. But now we need to also start thinking of the leukaemia and lymphoma as well.

Management

If the node is large and fluctuant , consider incision, but beware that this is not TB.

Most bacterial causes are from Staph aureus or Group A Strep (pyogenes).

If the child is well, antibiotics (flucloxacillin/Cephalexin).

If the child is unwell, or has failed antibiotics or is <1 month old, admit for IV antibiotics.

Dr Peter Kas

Emergency Physician, Educator. Key Interests: Resuscitation, Airway, Emergency Cardiology, Clinical Examination. Creator resus.com.au.

1 Comment

  1. Ben burford on 01/08/2011 at 1:41 pm

    What about heel stab for fbc and if viral looking fbc then no antibiotics, could this be an option, does extend time to sort the kid out, but most likely viral and minimization antibiotic use
    This is what I would do in the country if no pediatrician around -if bacterial and send away with orals , good chance to return back to you at the hospital
    Check no overseas trave/ tb contact also wise

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