Many children in preschool and early school age have enlarged lymph nodes, which is often of concern to parents. Lymph nodes ultrasound is the basic diagnostic test that enables a quick and accurate assessment of the size, shape, morphology and vascularization of the lymph nodes. In ultrasound, it is possible to initially determine the cause of lymphadenopathy and to distinguish the physiological state from the pathological one. Ultrasound allows you to exclude most serious systemic diseases or neoplastic conditions. In case of doubt, ultrasound provides the physician with useful information to help guide further diagnosis.
The causes of enlarged lymph nodes in a child
Lymph nodes play an important role in the body's immune processes. The lymph nodes collected in the lymphatic vessels pass through the lymph from the intercellular spaces of the body. In the lymph nodes, various infectious agents are neutralized. Lymph nodes can become enlarged as a result of the proliferation of normal cells involved in immune processes, or as a result of the influx and infiltration of foreign or pathologically altered cells.
As a rule, newborns have undetectable lymph nodes. Exposure of a child to various types of antigens causes natural enlargement of the lymph nodes associated with the activation of immune processes. The symptom may be a palpable lump on the child's neck or an increase in the volume of soft tissues under the mandible. Enlarged lymph nodes are often palpable during viral infections and other childhood diseases. If your child's lymph nodes are soft and easily moved, the lesion is usually mild. Normal cervical and axillary lymph nodes are 1 cm in diameter, and 1.5 cm in inguinal lymph nodes.
The condition of enlarged lymph nodes can occur in the course of various diseases. Most often they are the so-called reactive nodes, which respond to an infection present in the area from which lymph drains to the lymph nodes. Examples include enlarged cervical nodes in response to pharyngitis, or enlargement of nodes in the armpits after a cat scrapes a child's hand ("cat scratch disease").
Diseases and pathologies in which there is an enlargement of the lymph nodes:
Infections:
bacterial, e.g. pharyngitis, periodontal disease, cat scratch disease, tularemia, diphtheria, typhoid fever,
viral, e.g. cytomegaly, herpes, parotitis (mumps), measles, rubella,
fungal, e.g. toxoplasmosis,
others, e.g. tuberculosis, Lyme disease, syphilis.
Immunological diseases, e.g. autoimmune lymphoproliferative syndrome, chronic granulomatous disease, systemic lupus erythematosus.
Hormonal disorders, e.g. Addison's disease, hypothyroidism.
Tumors:
leukemia
lymphomas,
metastasis of solid tumors.
Others: amyloidosis, sarcoidosis.
Indications for ultrasound of lymph nodes in children
Performing an ultrasound allows you to make a quick decision whether it is necessary to perform a lymph node biopsy. The indications for an urgent ultrasound of lymph nodes in children are:
hard, painful and non-moveable lumps,
nodular changes on the neck of significant dimensions (over 2 cm),
nodules occurring in clusters,
enlarged lymph nodes in the supraclavicular area,
no symptoms suggesting infection,
persistence of the enlarged nodule for more than 4 weeks.
How is the ultrasound examination of lymph nodes in children?
The ultrasound examination is preceded by an interview, during which the doctor determines:
the beginning of the appearance of an enlarged lymph node,
whether the number of enlarged lymph nodes is increasing,
symptoms that indicate the presence of infection
medications taken by a small child,
contact with animals,
other symptoms, eg weight loss without cause.
Ultrasound examination of lymph nodes is completely safe and painless for children. During the examination, the doctor puts a special gel on the examined area of the body, to which he then applies an ultrasound head. The most frequently assessed lymph nodes during ultrasound examination are:
lymph nodes in the neck
supraclavicular lymph nodes,
axillary lymph nodes,
inguinal lymph nodes,
abdominal lymph nodes.
A normal lymph node has an oval shape, and its enlargement results from the accumulation of multiplied cells involved in immune processes. When pathological conditions lead to uncontrolled division of neoplastic cells, the shape of the node is more round. Reactive nodes (physiologically enlarged in case of infection) maintain the correct zonal structure. Cancerous nodes may show a disturbance in the arrangement of cells inside them, which is manifested by changes in the ultrasound image. During the ultrasound examination, the doctor also determines the degree of vascularization of the lesions and the organization of blood vessels. The pathological chaotic pattern of vascularization may be typical of neoplastic changes. Moreover, ultrasound of the neck in infants allows for the differentiation of enlarged lymph nodes from malformations, e.g. gillogenous cysts or thyroid-lingual cysts.
Source:
- Friedmann A. Diagnostyka i leczenie limfadenopatii u dzieci. Pediatria po Dyplomie (2010) 2: vol. 14 Nr 1.
- Batko T, Kosiak W. Zastosowanie badań ultrasonograficznych węzłów chłonnych u dzieci i młodzieży w gabinecie lekarza rodzinnego i pediatry – na podstawie doświadczeń własnych. Developmental Period Medicine, (2013),17, 213.
Frequently asked questions about ultrasound of a child's lymph nodes:
Parents should not underestimate the chronic enlarged lymph nodes associated with weight loss, the presence of hard and painful lumps in the neck, or the constant enlargement of the observed lesion. In addition, frequent abdominal pain and excessive fatigue in a child may be disturbing. If you notice the above symptoms, you should immediately consult a pediatrician who will perform an examination and order an ultrasound of the lymph nodes.
An ultrasound scan can detect even minor changes in your lymph nodes, which may or may not be a serious disease. In most children, enlarged lymph nodes are associated with an infection that the child's body is fighting against. Ultrasound examination distinguishes physiological lymphadenopathy from the presence of a chronic systemic disease or neoplastic infiltration.
Ultrasound examination of lymph nodes is completely painless and safe for the child. Ultrasound is often a form of screening test that allows for early detection of pathological changes. The ultrasound examination recommended by the pediatrician should not be delayed, as this may delay the diagnosis of the disease and the implementation of appropriate treatment.
