Cervical adenitis refers to the inflammation of lymph nodes in the neck.
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Epidemiology
Most common cause of a pediatric neck mass following non-specific infectious/inflammatory insults.
Clinical presentation
In the pediatric population, a child will present with a painful cervical mass.
Pathology
Etiology
Most commonly from a self-limited viral upper respiratory infection (e.g. rhinovirus, adenovirus and enterovirus) causing bilateral cervical nodal enlargement. Unilateral cervical adenitis is usually a result of bacterial infection (e.g. Staphylococcus aureus or group A Streptococcus) of oropharyngeal origin.
Radiographic features
Ultrasound
Features of uncomplicated cervical adenitis include:
- conglomerate matted mass
- normal homogeneously low echogenicity parenchyma
- preservation of fatty hyperechoic hilum and ovoid morphology
Reactive adenitis maintains normal architecture, distinguishing this condition from lymphadenopathy. Useful in differentiating between simple and complicated adenitis. Further examination with cross-sectional imaging is not usually required.
When complicated, features include:
- suppuration
- central necrosis, seen as decreasing heterogeneous echogenicity
- central complexity with debris, septa, or hyperechoic foci of air
- reduction of hyperechoic fatty hilum/stripe
- decreased vascularity
- reactive edema of adjacent perilesional soft tissues
- abscess
- heterogeneous hyperechoic/hypoechoic mass
- thickened, irregular walls
- increased peripheral vascularity
Treatment and prognosis
Conservative, supportive medical treatment will often suffice. If a bacterial cause is suspected, antimicrobial therapy is warranted.
Complications
- suppuration
- abscess formation
Differential diagnosis
If the course of the disease differs from the expected progression associated with the usual viral and bacterial causes, other differential diagnoses should be considered, such as catscratch disease, tuberculosis, fungal disease, mononucleosis, acquired immunodeficiency syndrome, histiocytosis and sarcoidosis.
- tuberculous cervical lymphadenitis: uncommon in Western countries, but may be seen in the setting of immunocompromise
- malignant lymphadenopathy: painless, hard mass which is immobile
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