Pediatric emergency medicine trisk 0927 0927

submandibular or submental regions on physical examination should prompt a careful
oral and dental examination.
Preauricular nodes, located anterior to the ear, drain the conjunctiva and lateral eyelids.
These nodes enlarge with eye or conjunctival infections, of which viral infections are a
prominent cause. The combination of conjunctivitis and ipsilateral preauricular
adenopathy is called oculoglandular syndrome, or Parinaud syndrome. Infections that can
present as oculoglandular syndrome include adenovirus or chlamydial conjunctivitis in
neonates. Rarely, catscratch disease and tularemia manifest as an oculoglandular
syndrome.
Posterior auricular nodes, located behind the ear, and occipital nodes, found at the base
of the scalp, commonly enlarge in response to scalp infections or chronic inflammation.
Pediculosis (lice), tinea capitis, bacterial scalp infections, and inflammation from
seborrheic dermatitis are all common causes of such node enlargement in children.

Axillary and Epitrochlear
Axillary adenopathy is commonly present with any infection or inflammation of the upper
extremities. Most commonly, injuries to the hand, such as occur after falling or with
puncture wounds or bites, may present with concomitant axillary adenopathy as a reactive
response to disruption in skin integrity. Axillary adenopathy is also a common part of B.
henselae infection (catscratch disease), as outlined previously as a cause of cervical
adenopathy.
Epitrochlear adenopathy is significantly less common than axillary adenopathy in
children, and any epitrochlear node greater than 0.5 cm is considered enlarged.
Epitrochlear nodes may become inflamed after infections of the third, fourth, or fifth
finger; medial portion of the hand; or ulnar portion of the forearm. Most commonly, these
infections are caused by pyogenic bacteria (e.g., Streptococcus pyogenes or S. aureus,
including MRSA), but depending on the inciting event, other pathogens may be
responsible (e.g., Streptobacillus moniliformis and Spirillum minus in rat-bite fever or F.
tularensis in tularemia). Rare causes of both axillary and epitrochlear adenopathy include
rheumatologic disease of the hand or wrist and secondary syphilis.

Inguinal
Inguinal adenopathy most often results from lower extremity skin or soft tissue infection.
However, inguinal lymph nodes also drain tissues in the perianal region and unexplained
adenopathy in this area should prompt examination for perirectal abscesses, fissures, or
other inflammation. In addition, sexually transmitted diseases such as chlamydia or
gonorrhea may cause inguinal adenopathy. Acute genital infection with herpes simplex
virus-2 (HSV-2) often presents with tender inguinal adenopathy, occasionally as the only
sign. Chancroid, lymphogranuloma venereum, and syphilis are rare causes of inguinal
node swelling and tenderness. The presence of genital lesions, which may be either
painful (as in herpes simplex virus or chancroid) or painless (as in syphilis), offers clues
to these diagnoses. Therefore, careful history taking and physical examination are
necessary to exclude these possibilities.