From the Guidelines
The correct answer is C- Jugulodigastric lymph nodes. In a 3-year-old girl with high-grade fever, difficulty swallowing, and inflammation of the palatine tonsils (tonsillitis), the jugulodigastric lymph nodes would most likely be enlarged. These nodes, also known as the tonsillar nodes, are located at the angle of the mandible where the facial vein joins the internal jugular vein. They are the primary drainage site for the palatine tonsils and are commonly affected in tonsillitis, as supported by the anatomy and function of the tonsils described in the study by 1.
When the palatine tonsils become inflamed due to infection, the pathogens and inflammatory mediators drain to these regional lymph nodes, causing them to enlarge as they mount an immune response. This lymphadenopathy is often tender on palpation and may be visible or palpable at the angle of the jaw. The other lymph node groups listed (sublingual, buccal, submandibular, and jugulo-omohyoid) primarily drain different anatomical regions and would not be the primary nodes affected in isolated palatine tonsillitis.
Key points to consider in this diagnosis include:
- The age of the patient, as the tonsils are most prominent and immunologically active between the ages of 3 and 10 years, as noted in the study by 1.
- The symptoms presented, such as high-grade fever and difficulty swallowing, which are consistent with tonsillitis.
- The anatomical location and function of the jugulodigastric lymph nodes in relation to the palatine tonsils, making them the most likely to be enlarged in response to tonsillar infection.
Given the information provided and the focus on the most recent and highest quality evidence, the study from 1 published in 2019 provides the most relevant and up-to-date information regarding the structure, function, and clinical relevance of the tonsils, supporting the conclusion that the Jugulodigastric lymph nodes would be the primary nodes affected in this scenario.
From the Research
Lymph Node Enlargement in Tonsillitis
The symptoms presented by the 3-year-old girl, such as high-grade fever and difficulty in swallowing, along with inflammation of the palatine tonsils, are indicative of tonsillitis 2, 3, 4.
Relevant Lymph Nodes
In cases of tonsillitis, the lymph nodes that are typically involved are those in the neck, particularly the jugulodigastric nodes, which are responsible for draining the tonsillar area 2.
Specific Lymph Node Enlargement
Given the location of the inflammation (palatine tonsils), the lymph node that will most likely be enlarged is the one closely associated with the drainage of this area. The options provided are:
- A- Sublingual
- B- Buccal
- C- Jugulodigastric
- D- Submandibular
- E- Jugulo-omohyoid The jugulodigastric node is specifically mentioned as being relevant in the context of tonsillar infections due to its role in draining the tonsillar area, making option C the most appropriate choice.
Clinical Relevance
Understanding which lymph nodes are involved in tonsillitis is crucial for diagnosis and treatment, as it can help differentiate between viral and bacterial causes and guide antibiotic therapy if necessary 3, 4.