Neck Swelling
Stephen Ludwig
Approach to the Patient with Neck Swelling
I. Definition of the Complaint
Neck swelling in children is a finding that elicits immediate parental concern
and often a prompt visit to the physician. The finding of a neck mass provokes
response because it is often associated with malignancy. Although malignancy is
part of an extensive differential diagnosis, it is not the most common cause by
far. More primary considerations include reactive adenopathy, infections
(either acute or subacute), and congenital anomalies. There are oncologic
causes as well. Because children often have palpable lymph nodes that are
normal, a significant neck mass must be defined as a swelling that exceeds 2 cm
in diameter. In only rare cases, smaller nodes may have characteristics that
deserve diagnostic attention. Congenital lesions, although present at birth,
may not become apparent until the child is school age or older. Neck masses may
be categorized by their location in the neck. Location may help to limit the
diagnostic possibilities. Another defining characteristic is the feel of the
swelling: hard or spongy, painful or nonpainful to palpation. Hospitalization
is required if neck masses are present in conjunction with systemic symptoms
such as fever, fatigue or pallor; if the nodes are large enough to compromise
the airway; or if the masses have not responded to outpatient therapy.
II. Complaints by Cause and Frequency
A differential diagnosis list for neck masses is shown in Table 13-1. This list
of potential diagnoses is extensive and often requires a thorough diagnostic
evaluation. Table 13-2 indicates the conditions that require immediate
diagnosis and treatment. Table 13-3 shows the most common causes of neck
swelling. Table 13.4 indicates the type of mass by location.
III. Clarifying Questions
• Is the airway compromised?
— The first and most important question to be asked relates to the presence of
airway compromise. If present, airway compromise demands immediate attention.
Airway compromise may result from an intrinsic occlusion or from extrinsic
compression of the airway. Airway edema may result from swelling caused by
trauma or allergic reaction. Neck masses may also be associated with
intrathoracic masses that cause respiratory distress.
• Is the swelling adenitis or adenopathy?
— With this question one should determine whether there ae signs of active
infection or adenitis. Signs of adenitis include swelling, redness, warmth, and
tenderness. Adenopathy is more indicative of a reaction of the nodes. With
adenopathy, swelling may be present, and possibly mild tenderness, but not
redness, warmth, or exquisite pain.
• Is the swelling acute, subacute, or chronic?
— This question also gives insight to possible etiologies. Bacterial infections
are usually acute and progressive. Other infections are more subacute,
including Epstein-Barr virus (EBV) infection, cat-scratch disease, or
tuberculosis. Congenital defects may be more chronic, perhaps with an acute
flare that draws attention. Tumors may progressively increase in size over a
variable time course, depending on the histologic characteristics of the tumor.
• Are there systemic signs of illness?
— Also helpful in the differential diagnosis process is a determination of the
presence or absence of systemic signs such as fever, weight loss, anorexia,
night sweats, lethargy, or fatigue. Some elements of the differential diagnosis
are associated with these systemic markers, and others are clearly more local.
Pictures
Book Source Details
- Book Title: Pediatric Complaints and Diagnostic Dilemmas
- Author(s): Samir S Shah MD; Stephen Ludwig MD
- Year of Publication: 2003
- Copyright Details: Pediatric Complaints and Diagnostic Dilemmas, Copyright © 2003 Lippincott Williams & Wilkins.
Other Book Chapters Related to Neck swelling
Read excerpts from these other book chapters related to Neck swelling:
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- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
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- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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- "Nursing: Interpreting Signs and Symptoms" (2007)
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- NECK PAIN
- "Differential Diagnosis in Primary Care" (2007)
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Copyright Details: Pediatric Complaints and Diagnostic Dilemmas, Copyright © 2008 Williams & Wilkins.
More About Causes of Neck swelling
» Next page: Neck Swelling - Case 13-3: 2-Month-Old Boy (Pediatric Complaints and Diagnostic Dilemmas)
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