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August 2001
Tuberculous lymphadenitis
Discussion
In a child, the differential diagnosis of a cervical mass is broad and includes congenital lesions (such as cystic hygroma, branchial cleft cyst, or thyroglossal duct cyst), as well as a variety of infectious and neoplastic disorders. Most cervical masses in children represent infected lymph nodes. Reactive hyperplasia of one or more cervical lymph nodes can occur with infections of the head, neck, or upper respiratory tract. Upper anterior cervical lymph nodes are involved most commonly. Cervical lymph node enlargement also can occur with many other types of infections, including group A streptococcus or Staphylococcus aureus, Epstein-Barr virus (infectious mononucleosis), cytomegalovirus, HIV, toxoplasmosis, Bartonella henselae (cat scratch disease), and tuberculosis. Acute streptococcal or staphylococcal cervical adenitis usually is associated with the presence of fever and tenderness to palpation. Firm, nontender lymph node enlargement is typical of more chronic disorders such as tuberculosis or malignancy. Location also is a helpful differential diagnostic feature in that about one-half of masses located in the posterior triangle of the neck (including the supraclavicular area) are malignant tumors (especially lymphomas). In the case pictured here, the boy’s father was known to have pulmonary tuberculosis. Biopsy of the boy’s supraclavicular mass revealed caseating granulomas and cultures grew Mycobacterium tuberculosis.
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