Erkrankungen der Halslymphknoten im Kindesalter

Abstract

The lymph nodes are an essential part of the body's immune system and as such are affected in many infectious, autoimmune, metabolic and malignant diseases. The cervical lymph nodes are particularly important because they are the first drainage stations for key points of contact with the outside world (mouth/throat/nose/eyes/ears/respiratory system) - a critical aspect especially among children - and can represent an early clinical sign in their exposed position on a child's slim neck. Involvement of the lymph nodes in multiple conditions is accompanied by a correspondingly large number of available diagnostic procedures. In the interests of time, patient wellbeing and cost, a careful choice of these must be made to permit appropriate treatment. The basis of diagnostic decisions is a detailed anamnesis and clinical examination. Sonography also plays an important role in differential diagnosis of lymph node swelling in children and is useful in answering one of the critical diagnostic questions: is there a suspicion of malignancy? If so, full dissection of the most conspicuous lymph node may be necessary to obtain histological confirmation. Diagnosis and treatment of childhood cervical lymph node disorders present the attending pediatric and ENT physicians with some particular challenges. The spectrum of differential diagnoses and the varying degrees of clinical relevance - from banal infections to malignant diseases - demand a clear and considered approach to the child's individual clinical presentation. Such an approach is described in the following paper.

Differentiation of malignant cervical lymphadenopathy by dual-energy CT: a preliminary analysis

“…Previous studies have shown that age and sex are important factors for classifying neck masses 1 17 . In general, neck masses in children and young adults are more inflammatory than congenital and neoplastic diseases and are only found occasionally 4 . However, masses in older adults are often neoplastic 48 .…”

“…Lymph node metastatic carcinoma and lymphoma are the most common cervical malignant lesions, with cervical lymph node metastatic carcinoma accounting for approximately 3/4 of all malignant neck tumours. Most cervical malignant lesions (85%) include primary lesions located in the head and neck, and the most common lesions are nodal metastases of thyroid carcinoma (TC), salivary gland carcinoma (SC) and squamous cell carcinoma (SCC) 3 4 . Therefore, it would be valuable to identify the nature and types of cervical lymph node lesions before selecting clinical treatments 5 6 .…”