Practice 10-Minute Consultation

A child with neck swelling

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e3171 (Published 08 May 2012) Cite this as: BMJ 2012;344:e3171
  1. Ian P Sinha, clinical lecturer and specialist registrar in paediatric respiratory medicine1,
  2. Anna Stickland, general practitioner2,
  3. Cheri Mathews John, consultant paediatrician3
  1. 1Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Alder Hey Children’s Hospital, Liverpool L12 2AP, UK
  2. 2Community Studies Unit, University of Liverpool, Liverpool L69 3GE
  3. 3Department of Paediatrics, St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool L35 5DR
  1. Correspondence to: I Sinha iansinha79{at}doctors.org.uk
  • Accepted 22 February 2012

A 5 year old boy presents with neck swelling and sore throat. He appears pale and tired, and has a 2 cm left sided neck swelling.

What you should cover

You should distinguish cervical lymphadenopathy secondary to local causes from other important diagnoses (box).

Differential diagnosis of neck swellings in children

Lymphadenopathy (enlarged lymph nodes)
Local causes
  • Viral or bacterial upper respiratory tract infection leading to lymphadenopathy*

  • Ear infection*

  • Oropharyngeal infection

  • Headlice infestation

  • Dental abscess

  • Cat scratch disease

Systemic causes
  • Malignancy (lymphoma or leukaemia)*

  • Viral infections (Epstein-Barr virus, cytomegalovirus, rubella)*

  • Kawasaki disease*

  • Mycobacterial infection (tuberculous or non-tuberculous)*

  • Sarcoidosis

  • Systemic lupus erythematosus

  • Juvenile idiopathic arthritis

Lymphadenitis (inflamed lymph nodes) or abscess
  • Bacterial lymphadenitis*

  • Mycobacterial lymphadenitis*

  • Abscess*

Non-lymphadenomatous neck swellings
  • Cystic hygroma

  • Sternocleidomastoid swelling

  • Thyroid gland enlargement*

  • Thyroglossal cyst

  • Dermoid cyst

  • Branchial cyst

  • Mumps*

  • *Commonly present to primary care with neck swelling or are particularly important diagnoses to consider

Important features in the history

  • Local causes of lymphadenopathy—Ask about upper respiratory tract infections, earache, toothache, and headlice. Lymphadenopathy related to upper respiratory tract infections does not usually persist beyond three weeks of onset

  • Systemic illness—Fever, night sweats, weight loss, or pruritus may suggest malignancy or mycobacterial disease (tuberculous or non-tuberculous)

  • Recurrent infections—Immunodeficiency, …

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