Diagnostic approach to childhood lymphadenopathy

AİM: Lymphadenopathy is a frequent symptom and physical examination findings in childhood. Lymphadenopathy is usually associated with various infections in children, but it can also be the first sign of some malignancies and systemic diseases. Diagnosis is extremely important to avoid being late. Aim of this study is; evaluate the clinical and etiological characteristics of lymphadenopathy, making distinction between malignant and benign etiologies which may be useful in laboratory studies to reveal more of us to work. In addition, the radiological evaluation of benign and malignant lymphadenopathy determine whether doppler ultrasonography is superior to superficial tissue USG. METHOD: 73 cases, between January 2010 and December 2011, pediatric oncology and pediatric emergency clinics or physical examinations LAP lymphadenopathy detected were evaluated. Evaluation was performed prospectively in 50 patients, by leaving out of the working group patients with non-pathological adenopathy size and that does not follow-up of patients presenting with lymphadenopathy. Leave the 4 groups according to their last diagnosis; viral diseases, tularemia, malignant diseases and group of other diseases, including diseases such as Kawasaki, PFAPA, pulmonary tuberculosis. History, physical examination and laboratory findings were compared in terms of characteristics. SPSS-13.0 was used for statisticall analysis. FİNDİNGS: Patients with peripheral lymphadenopathy were 30 male 20 girls. Ages ranged from 1 to 16. 42 patients were diagnosed with benign disease. 8 patients were diagnosed with benign disease. Lymphadenopathy is the consistency of rubber (p: 0,022), anemia (p: 0,024), thrombocytopenia (p: 0.008), high uric acid levels (p:0,002) organomegaly (p: 0,014), hyperechoic lymph nodes in the süperficial gray-scale ultrasonography (p: 0,007) and to show peripheral type vasculature the lymph nodes in the doppler ultrasonography (p: 0,005) were valuable criterias in distinguishing benign and malign lymphadenopathies. Drinking contaminated water, contact with animals, with a history of chronic, large cervical, pain, tenderness and warmth accompanied by such findings in patients with lymphadenopathy were higher probability of tularemia. CONCLUSİON: Patients presenting with peripheral lymphadenopathy, detailed history, lymph nodes draining the region's carefully and physical examination of the patients will not diagnosis, patients with anemia, thrombocytopenia at the complete blood count peripheral blood smear should be evaluated carefully. Patients with normal peripheral blood smear, bone marrow aspiration should be ruled out leukemia. The necessary, chest X-ray, abdominal ultrasound, superficial tissue USG and Doppler USG will aid the differentiation of malignant or benign etiologies. Biopsy should be done in patients with high suspicion of without delay. The etiology of the neck lymphadenitis detected frequently in our country in recent years tularemia, is known to be endemic in our region and in other regions, although antibiotic treatment does not improve, painful and large cervical lymph nodes do should be excluded. Key Words: Peripheral lymphadenopathy, children, malign, risk factors, tularemıa