Transcript Left tender Cervical Mass

Presenting Manifestation
RIGHT LATERAL CERVICAL MASS
Approach to Diagnosis
• Symptom with the least number of diseases
Cervical Lymphadenopathy in children
•
•
•
•
•
Dental Caries
Upper Respiratory Tract infection
Mumps
Tuberculosis
Lymphoma
Approach to Diagnosis
• History
– Duration and laterality of adenopathy and change in size
over time
– Associated symptoms
– Ill contacts
– Ingestion of unpasteurized animal milk or undercooked
meats
– Dental problems or mouth sores
– Skin lesions or trauma
– Animal exposures
– Immunization status
– Medications
– Geographic location and travel
Approach to Diagnosis
• Physical examination
– Examination of the lymphatic system, including
assessment of the liver, spleen, cervical lymph
nodes, and noncervical lymph nodes should be
performed.
• Hepatosplenomegaly with generalized adenitis
indicates a possible infection with EBV, CMV, HIV,
histoplasmosis, TB, or syphilis.
• These findings also may be signs of neoplastic disease,
collagen vascular disease, or other noninfectious
etiology
Approach to Diagnosis
• Physical examination
– The lymph node number, location, size, shape, consistency,
tenderness, mobility, and color should be recorded.
• "Reactive" lymph nodes are usually discrete, mobile, feel rubbery,
and are minimally tender.
• Infected lymph nodes are usually isolated, asymmetric, tender,
warm, and erythematous; they may be fluctuant; they are less
mobile and discrete than reactive lymph nodes.
• Malignant lymph nodes often are hard, fixed or matted to the
underlying structures; they are usually nontender.
– Oral cavity —periodontal disease, herpangina,
gingivostomatitis, or pharyngitis
– Eyes — Conjunctival injection
– Skin — generalized rash, pustular or papular lesions
Differentials
Patient: 6y.o./ Female
((+) 5x3cm – progressive in
size, unilateral, semi-solid,
tender (initially non-tender),
fixed, mass on the left
retroauricular area,
extending to the
submandibular area
(+) non-productive cough
for 2 weeks
(+) undocumented fever for
2 weeks
(+) weight loss
(-) colds
Dental Caries
Lymphoma
painless lymphadenopathy,
usually cervical,
supraclavicular, axillary, or,
less often, inguinal
-rubbery and more firm
than inflammatory
adenopathy
-may be sensitive to
palpation if they have grown
rapidly
presence of pits and fissures Fever, weight loss,
on the affected tooth
hepatosplenomegaly, night
surface
sweats
(+) mediastinal mass on CXR
Differentials
Patient: 6y.o./
Female
URTI
Mumps
TB Infection
(+) 5x3cm –
progressive in size,
unilateral, semisolid, tender
(initially nontender), fixed, mass
on the left
retroauricular area,
extending to the
submandibular area
Most often
unilateral; but can
be bilateral; usually
is 3 to 6 cm in
diameter, tender,
warm, nondiscrete,
and poorly mobile
local tenderness of
the area of the
parotid, with ear
pain followed by
swelling of the
parotid gland
unilateral nontender
firm discrete mass or
matted nodes, fixed
sometimes
accompanied by
overlying skin
induration;
submandibular and
supraclavicular
lymph node
involvement also
occurs
Bilateral (90%)
Parotid swelling can
last up to 10 days
Differentials
Infectious Causes
Patient: 6y.o./
Female
URTI
Mumps
TB Infection
(+) non-productive
cough for 2 weeks
(+) undocumented
fever for 2 weeks
(+) weight loss
(-) colds
Nasal congestion,
(+/-) fever, sore
throat, cough,
irritability, difficulty
sleeping, and
decreased appetite,
may include
erythema and
swelling of the nasal
mucosa, as well as
moderate anterior
cervical
lymphadenopathy.
low-grade fever,
malaise, headache,
myalgias, and
anorexia within 48
hours after parotitis
Cough/ wheezing of
2 or more weeks
Unexplained fever of
2 or more weeks;
loss of appetite, loss
of weight, failure to
gain weight; failure
to regain previous
state of health after
infection; fatigue,
reduced playfulness
or activity
Clinical Impression
T/C KOCH’S INFECTION
Approach to Diagnosing a TB symptomatic
child who has no/unknown exposure
0-4 years old
No/Unknown
(+) signs/
symptoms of
TB
TB
Close contact
of a source
case
5-9 years old
Yes
…
Tuberculosis in Infency and Childhood 3rd
ed. 2010 PPS, Inc. p.123
5-9 years
old
Can
produce
sputum?
NO
DSSM
TST
Negative
Negative
Positive
Evaluate
further and
refer
TB Disease
Positive
Tuberculosis in Infency and Childhood 3rd
ed. 2010 PPS, Inc. p.123