Pediatric emergency medicine trisk 231

Site

Drainage area

Common causes

Less common causes

Cervical

Head, neck,
oropharynx

Acute:
Viral URI
Lymphadenitis (bacterial,
viral)
Pharyngitis
Oropharyngeal infections
EBV
Chronic:
EBV, CMV
Catscratch disease
Nontuberculous
mycobacterium (NTM)
lymphadenitis

Acute:
Kawasaki disease
Chronic:
Malignancy

(lymphoma,
neuroblastoma,
leukemia)
Tularemia
Toxoplasmosis
Sarcoid
Tuberculous
lymphadenitis
Histiocytosis
(Langerhans cell
histiocytosis,
Rosai–Dorfman
disease)
Autoimmune
lymphoproliferative
syndrome (ALPS)
Periodic fever,
aphthous stomatitis,
pharyngitis,
cervical adenitis
syndrome (PFAPA)
Kikuchi–Fujimoto
disease, Kimura
disease

Submental

Lower lip, gums,
teeth, and floor of
mouth

Submandibular Cheeks, buccal
mucosa, lips,
gums, teeth

Dental caries/infections
Gingivostomatitis

Dental caries/infections
Gingivostomatitis
Chronically cracked/dry
lips
Anterior
Anterior/temporal
Conjunctivitis
auricular
scalp, anterior ear
(viral/bacterial)
(preauricular)
canal, lateral

Oculoglandular
syndrome of


conjunctiva, and
eyelids

Chlamydia conjunctivitis
of neonate

Posterior
auricular

Temporal and
parietal scalp

Tinea capitis or other
scalp infections

Occipital

Posterior scalp,
neck

Pediculosis
Tinea capitis
Seborrheic dermatitis

catscratch disease,
tularemia
Rubella
Parvovirus
Roseola (HHV-6)
Rubella
Roseola (HHV-6)
Rubella

Supraclavicular Neck
Malignancy (lymphoma
or metastatic disease)

Right: mediastinum,
lungs
Tuberculosis
Left: upper
abdomen
Axillary

Epitrochlear

Inguinal

Iliac

Upper extremity,
Upper extremity
Malignancy
chest wall, upper
infections
(leukemia,
abdominal wall, Reactive adenopathy after
lymphoma)
breast
traumatic disruption in Rheumatologic
skin integrity
disease of the
hand/wrist
Catscratch disease
Toxoplasmosis
Rat-bite fever
Tularemia

Ulnar side of hand, Local infection of hand
Rheumatologic
forearm
disease of the
hand/wrist
Catscratch disease
Sarcoid
Tularemia
Secondary syphilis
Scrotum/penis,
Lower extremity skin/soft Syphilis
vulva/vagina,
tissue infections
Lymphogranuloma
perianal region, Perianal fissures or
venereum
lower extremities,
abscess
Chancroid
lower abdomen
Genital herpes
Chlamydial/gonococcal
infection
Lower extremities, Appendicitis
Iliac adenitis
abdominal
UTI


viscera, urinary

tract

FIGURE 47.3 Child with lymphadenitis that progressed to lymph node abscess.

There are several rare infectious causes of cervical lymphadenopathy that may be
encountered in the pediatric emergency department. Tularemia, caused by infection with
Francisella tularensis, occurs predominantly in the South Central United States
(Arkansas, Oklahoma, Missouri, and Kansas). It occurs after contact with infected
animals (rabbits, hamsters) or via tick or deerfly bites. The most common presentation in
children is a febrile illness with tender cervical or occipital adenopathy that may become
chronic. An associated papular or ulcerative lesion may be noted on the skin at the site of
animal contact or insect bite. Diagnosis is made by detecting serum antibodies to F.
tularensis, and antimicrobial therapy with doxycycline or a fluoroquinolone is appropriate
for mild illness. Toxoplasmosis, a parasitic infection caused by Toxoplasma gondii, is
acquired via contact with oocytes in cat feces or consumption of undercooked pork or


lamb containing cysts. Lymphadenopathy and fatigue are the most common symptoms of
this self-limited illness, and adenopathy is discrete, nonsuppurative, and may persist for
months in the cervical region. Serologic tests are the primary means of diagnosis.

FIGURE 47.4 Computed tomography (CT) image of lymph node abscess.