Encrypted as R59, I88, L04 in ICD-10, lymphadenopathy in children is relatively common. The term is used to denote a condition in which the lymph node (or group thereof) becomes larger. The causes of the phenomenon can be very different - from caries to severe cancer. To determine the etiology, an examination of the body, a number of specific laboratory and instrumental studies are required.
Relevance of the issue
There are many cases where enlarged lymph nodes were the first signal of a serious illness. For example, it is quite rare, but lymphadenopathy occurs in children, in ICD-10 the code of which is B23.1, that is, a generalized pathology due to HIV. The condition is persistent, indicating a danger to life. In other cases, the problem in question may signal other serious pathologies, including malignant neoplasms. From medical statistics it is known that in an impressive percentage of cases the determination of the factors of the inflammatory process requires numerous laboratory tests.
A system for classifying all cases into groups was introduced. It is reflected in the current ICD-10 code assignment rules. Lymphadenopathy in children is categorized based on signs of a case. Assess the severity of the process and the nuances of its progress, the abundance and variety of manifestations.
About classification
Assessing the prevalence of a pathological condition, all cases are divided into local and generalized. The first suggests that inflammation has affected only a single lymph node or a limited group of them. Perhaps the definition of pathology as regional. Generalized type lymphadenopathy is much more severe in an adult and a child. With a local format, usually a process only affects a certain group. The reactive form is possible as a result of the presence in the body of a focus of inflammation, invasion of an infectious agent. Sometimes the pathology is explained by an allergic response or an autoimmune process.
There are such cases when, when specifying the diagnosis, lymphadenopathy in children and adults is recognized as unclear, that is, the etiology cannot be established. In the ICD-10, a special code R59.9 is introduced for this form. They code all unspecified cases.
Assessing the condition of the patient, it is possible to understand whether the case refers to a tumor or not. However, you need to understand: both types are dangerous for the patient.
Primary diagnosis
Based on the signs of lymphadenopathy in children, the initial diagnosis can already be made quite accurate. First of all, the size of the inflamed area is estimated. It is believed that the size of the lymphatic catch is the main evaluation criterion. The normal sizes for different nodes differ: it depends on the nuances of localization, the characteristics of the functioning of the body of a particular patient. Typically, in a healthy body, the lymph nodes vary within 1-1.5 cm in diameter. Already with palpation of the area, you can understand how much the areas available for the initial examination are increased relative to the norm.
Another symptom that allows you to suspect lymphadenopathy in a child is soreness of certain areas. These sensations, as a rule, signal the beginning of the inflammatory process. Examination of the zone may show the presence of an abscess, necrotic processes.
When studying sites, you should evaluate the cohesion of the nodes. Its detection suggests a tumor or tuberculosis.
Symptomatology
As in adults, cervical lymphadenopathy, abdominal, mesenteric, and any other type are possible in children. In total, there are about 600 lymph nodes in the human body , and in any of them the inflammatory process can begin. You can freely feel the inguinal zone, axillary fossa, the area under the jaw, as well as some other areas. They are checked first of all, suspecting lymphadenopathy. Non-standard dimensions, pain in the lymph nodes of any location - an occasion to contact a doctor for help. The cause of the phenomenon can only be determined by a doctor.
Not always a pathological condition is noticed with palpation of the lymph nodes. There are frequent cases when the primary signs of lymphadenopathy in children (abdominal, cervical or other) were weight loss, skin rashes and constant fever. Active causeless work of the sweat glands is possible, especially characteristic of the period of night rest. In some patients, instrumental examinations show an increase in the spleen and liver.
Since lymphadenopathy can form due to a huge number of factors, it is considered only a marker of some disease. Therefore, treatment is prescribed by determining the root cause of the phenomenon.
Causes and consequences
A fairly common cause of lymphadenopathy in children and adults is the infectious process in a single node or several. Bacterial invasion is possible: tuberculosis or brucellosis. Sometimes lymphadenopathy indicates syphilis. In some cases, an increase in lymph nodes allows you to notice infection with chlamydia, toxoplasma, lamblia, cytomegalovirus. In some cases, the cause is serum sickness, caused by an unsuccessful course of medications.
There are cases when lymphadenopathy in a child, an adult began against a background of viral diseases, including hepatitis and HIV. Toxocariasis, sarcoidosis, histoplasmosis, actinomycosis can lead to a pathological condition. Sometimes the cause is rheumatoid arthritis, a connective tissue injury, or a disease that affects such structures. There is a possibility that the condition is due to the tumor process.
Types and forms: locations and dependence
As can be seen from medical statistics, the cause of lymphadenopathy of the submandibular lymph nodes in children and adults is often the infectious process. The increased likelihood of pathology is explained by the proximity of the nodes to the zone of infection in the body, that is, the nature of the disease is subclinical. It is known that in children this form of lymphadenopathy occurs many times more often than among adults. There is a theory that considers lymphadenopathy the norm for children.
Inguinal lymphadenopathy is less common. It is more characteristic of children and youth, among older patients a little less common. In most cases, due to infectious processes in the body.
The cause of lymphadenopathy of the cervical lymph nodes in children can be an infectious process in the oral cavity, infection of the salivary glands. Mumps, rubella, and other infections common among babies often lead to this complication. Perhaps the development of pathology against the background of inflammation in the larynx, lipomatosis, swelling of the parotid gland.
Locations and features
It is known that lymphadenopathy of the cervical lymph nodes in children and adults is common, and its likelihood is highest among people before reaching adulthood. It does not require special treatment; it passes on its own when the cause that caused the enlargement of nodes is eliminated.
The mediastinal form may accompany pulmonary inflammation, malignant processes in this area, and tuberculosis. If lymphadenopathy is established in a child, it is important to control the development of the process. This allows you to timely evaluate the effectiveness of the selected therapeutic program, replace it with another if lymphadenopathy does not regress.
Retroperitoneal form allows to suspect a neoplasm. Typically, a patient is first checked for lymphoma. The inflammatory process near the ears may indicate keraticonjunctivitis, adenovirus infection.
Chest, Mediastinum, and Axillary Pit
One of the most dangerous forms of lymphadenopathy in a child and an adult is intrathoracic. Often, it indicates a neoplasm or spread of the tumor within the chest, the formation of metastases. Children are rarely given such a diagnosis, the likelihood of lymphadenopathy of this type is higher in people over the age of forty, nevertheless, risks are inherent in any age, including young people. Abdominal lymphadenopathy in children and adults is also sometimes explained by neoplasms, although in some cases the pathological condition indicates inflammatory, infectious processes.
Relatively often there is an increase in lymph nodes in the mediastinum. The reason for this phenomenon is not always easy to identify, and a considerable percentage of cases of unknown etiology account for just such a localization. It was established that lymphadenopathy is possible due to neoplasm in the gastrointestinal tract, lungs. It is likely that the lymph node has become the localization area of atypical cells.
In the armpit, lymphadenopathy is more often due to a recent injury or an infectious disease. The nodes located in this area quite often become inflamed, increase in size even with minor problems.
Types and forms: pay attention!
Very rarely in children, but relatively often in middle-aged women, axillary lymphadenopathy occurs. This diagnosis is made if the proliferation is due to cancerous processes in the mammary gland.
Pulmonary lymphadenopathy is a much more common condition in childhood. He is considered the normal response of the body to inflammatory processes, acute viral diseases, colds. Lymphoid tissues thus respond to irritating factors. The lymphadenopathy attributed to this cause in children does not require treatment.
Another possible form of the disease is secondary. She is inherent in the complete absence of pain, which greatly complicates the diagnosis. Pathology is observed against a background of low immunity activity. In some cases, the reason is a medical course, taking chemical compounds.
Classification: finalizing the review
Abdominal lymphadenopathy in children is a pathological condition that may indicate intestinal infection. Sometimes its cause is the spread of the tumor process, metastasis from the intestinal tract; a possible factor is leukemia.
Angioimmunoblastic lymphoma is another possible initiator of lymphadenopathy. This diagnosis has been identified relatively recently; a description has now been drawn up, but work on the study and refinement of the disease is still underway.
Persistent lymphadenopathy is a condition characteristic of chronic patients. Its distinctive feature is the symmetry of the localization regions. A diagnosis is made if it is not possible to identify a disease or a chemical, drug factor that can cause lymphadenopathy, while the syndrome is observed for a long period (months). This form may indicate HIV.
In any of the options for localization, whether it is cervical or abdominal, mesa-gastric lymphadenopathy, lymph nodes in a child of an increased volume should attract the attention of parents. Only the doctor can determine the exact cause of the phenomenon by conducting research. It’s not worth panicking in advance, but you cannot delay a trip to the clinic.
Status Update
The diagnosis involves an initial comprehensive examination of the patient, a study of the medical history. Assign blood tests: general, for biochemistry and cancer markers. Check the patient for HIV and hepatitis. Regardless of the area of localization, ultrasound examination of the abdominal cavity, chest x-ray can be prescribed to clarify the causes of lymphadenopathy in children (cervical, abdominal, inguinal and any other). The described pathological condition is a symptom indicating a certain problem, illness. It is her definition that is the main task of the doctor formulating the diagnosis.
My baby is healthy!
Indeed, from medical statistics it is known that affecting submandibular, cervical lymph nodes, lymphadenopathy in children is sometimes found against the background of almost complete health. Even if the parents are sure that the child does not have any serious problems, with an increase in these glands, you should consult a specialist. The main task of the lymph nodes is to filter biological fluids, purifying the blood from dangerous microflora and other inclusions. Overgrowth of a node is observed if too many foreign objects accumulate here. The abundance of bacteria, viruses, microbes increases the risk of inflammation.
There are also frequent cases when no special research is appointed. For example, if reactive lymphadenopathy in children is observed with a cold or flu, the doctor puts the patient on record until complete recovery. By the end of the disease, the lymph nodes should return to normal on their own. In some cases, the appointment of an additional course of antibiotics is required. However, specific tests (including those indicated above) will have to be passed if the picture of the disease makes it possible to suspect an atypical cause.
As can be seen from the statistics, 95% of cases of enlarged lymph nodes in childhood are explained by simple infections.
To treat or not?
If you start the infectious process, do not treat the root cause of the disease and do not pay attention to the state of the lymph nodes, the likelihood of complications is high. In childhood, a subcutaneous infection is more common. As a rule, with lymphadenopathy of the cervical lymph nodes in children, treatment involves a course of antimicrobial agents. If the cause of the enlargement of the node was a viral infection or a malignant neoplasm, antimicrobial therapy will show inefficiency. As a rule, already at the stage of diagnosis and the choice of treatment program, the doctor determines the nature of the process, therefore, it is possible to avoid taking ineffective compounds, but exceptional cases are possible. In any case, it is unacceptable for a child to undergo lymphadenopathy treatment on his own, at his discretion - it can be damaged without achieving any improvement in the condition.
If blood tests showed infection with dangerous microbes, but the course of antibiotics does not change the state of the lymph nodes, with lymphadenopathy in children (mesenteric, mediastinal, abdominal), a biopsy of the swollen area is prescribed. Another option is the removal of this gland with subsequent examination under a microscope. About 5% of cases of lymphadenopathy are attributable to serious health problems, including oncology. It is more likely that a serious illness will be detected, if the lymph nodes enlarge and become inflamed often, the process spreads throughout the body.
Preparations: are there any negative effects?
Most often, with lymphadenopathy, a course of antibacterial agents is prescribed. Although the majority of patients tolerate such medications well, some adverse reactions are possible. Most often, they affect the work of the gastrointestinal tract, appetite and stools are impaired, nausea or vomiting is possible. Relatively high incidence of allergic reactions.
In extremely rare cases, the patient’s response is more serious. To minimize the risks of such phenomena, it is important to use drugs only in consultation with the doctor, in the doses indicated by him and at a certain frequency. The duration of the program of use is as the doctor says. As a rule, the symptomatology disappears a little earlier, but it is impossible to stop taking medications, the probability of relapse and the development of superinfection is growing.
The nuances of pathology
Lymphadenopathy in children (mesenteric, pulmonary, abdominal, inguinal and other) usually lasts a week or several. With certain diagnoses, an increase in the node, observed over the years, is possible. This phenomenon does not always indicate serious health problems, sometimes the reasons are completely safe, everything is explained by the individual characteristics of the functioning of the body. To clarify this fact should undergo a comprehensive examination.
A strong enlargement of the lymph node, tenderness of the site, skin redness are symptoms of lymphadenopathy complications. With such manifestations, you need to get an appointment with a doctor as soon as possible.
If the child is recommended sick leave due to lymphadenopathy, special monitoring of treatment is often not required. If the cause is established precisely, the phenomenon is explained by the common cold, flu or other similar factors, the child is discharged when the condition stabilizes, and the lymph nodes gradually return to normal on their own. Special means and preparations for this are not required. If lymphadenopathy becomes the reason for the appointment of an antibacterial course, at the end of such a program you will have to come to an appointment to monitor the results.
Lymphadenopathy: degree of development
It is customary to divide all cases into local, regional, systemic. Statistics show: most often local lymphadenopathy occurs, it accounts for about 75% of all cases. A regional form is established if several lymph nodes in one area or adjacent (no more than two) are inflamed and enlarged at the same time. If inflammatory processes are detected in different parts of the body that do not intersect with each other, they talk about the systemic form that is most dangerous to humans.
In some patients, lymphadenopathy manifests itself by the formation of a kind of cone in the diseased area. Touching and pressing on this site is accompanied by unpleasant sensations. Visually, you can notice reddish areas - this is an important incentive to contact a doctor as soon as possible. Another possible form of the disease is visceral. With it, the lymph nodes located deep in the body suffer, so the diagnosis is a lot of difficulty. You can identify the disease during laboratory, instrumental studies.
Lymphadenopathy can be suspected by a tendency to edema, sudden fever and fever. In acute form, there is a risk of transformation of the infectious process into phlegmon. This complication can be prevented by timely opening of the site under sterility conditions. But chronic lymphadenopathy often does not manifest itself at all.
Specifics of the situation
In childhood, a person is susceptible to lymphadenopathy due to frequent inflammatory, catarrhal diseases. In children, more often than in adults, there is caries, also capable of provoking inflammation of the lymph nodes. Cases of tonsillitis in a chronic form are frequent. In addition, lymphadenopathy often accompanies the period after receiving the vaccine, recovery after a therapeutic course. At the same time, there are often no symptoms, less often you can hear complaints about the throat and neck.
Approximately every third baby can manually feel the lymph nodes, the diameter of which is 30 mm or more. Up to a year, most children can easily isolate lymph nodes on the neck. With tumor processes, the growth of this area is possible. The diameter of the node can reach 4 cm. Known neglected cases of even greater proliferation. In this case, the area acquires increased density and responds with pain when touched.
Lymphadenopathy is diagnosed if there are more than a centimeter of lymph nodes on the neck and axillary fossa . For the inguinal region, a diameter of up to 1.5 cm is considered the norm. The remaining lymph nodes during palpation should not be palpated at all. Their identification, responsiveness to examination by pain indicates the unhealth of the child.
Diseases and their manifestations
Lymphadenopathy is often triggered by staphylococcus aureus, streptococci, CMV, hepatitis and measles, toxoplasma, histoplasma. It can appear against the background of coccidiomycosis, infection with the Epstein-Barr virus. A fairly characteristic picture is observed with rubella - the inflammatory process covers the lymph nodes in the neck. If the child is sick with tuberculosis, one of the symptoms is swelling of the nodes in the chest, sometimes cervical. Sarcoidosis, lupus, arthritis, an allergic reaction can cause lymphadenopathy. The latter phenomenon is accompanied by breathing problems, skin rashes, swelling.
A fairly common case among children is the so-called cat scratch disease. This disease provokes Bartonella, a feline-borne bacterium. This is indicated by a prolonged non-healing wound, suppuration of this area. The lymph node closest to the wound is enlarged.
In general, purulent processes can cause lymphadenopathy in various parts of the body. If the area filled with pus is not opened on time in a hospital setting, a rupture will occur, therefore, purulent discharge will impregnate the surrounding tissue. This complication is called phlegmon.
Special occasion: babies
In newborns, the local form is more common. In most cases, the cause is local infection, suppuration of areas of the skin. The generalized form is more often observed in autoimmune diseases. The clinical manifestations of lymphadenopathy will depend on the root cause. With a generalized form, the child needs emergency care. If you suspect this pathology, you should immediately contact the clinic.
It is known that in infants lymphadenopathy is observed due to infectious infection or viral, cumulative diseases, autoimmune processes. Possible causes are neoplasms affecting the bone marrow, circulatory system. A distinctive feature of the condition is the extremely rapid spread of the inflammatory process throughout the child's body. As a rule, there is very little time to diagnose and select the optimal therapeutic course, so it is important to consult a doctor in a timely manner without losing a day.
Suspect that you need to see a doctor if lymph nodes are felt on the child’s neck, the diameter of which is comparable to a pea or even more. The process may be symmetrical, but it is not necessary. Perhaps a change in consistency. Normally, the lymph nodes are soft and smooth, supple. With lymphadenopathy, they acquire density, become tuberous, lose mobility.