Differential Diagnosis for a 9-year-old boy with a 2.5 cm palpable neck lymph node
- The patient's symptoms and history are crucial in determining the possible causes of the lymph node enlargement.
- The fact that the lymph node has been present for 4 years without progression and is moveable suggests a benign condition, but other possibilities must be considered.
Single most likely diagnosis
- Reactive lymph node: This is the most likely diagnosis given the lymph node's long-standing presence, mobility, and fluctuation in size with illness. Reactive lymph nodes are a common response to infection or inflammation and can remain enlarged for years.
Other Likely diagnoses
- Tuberculous lymphadenitis: Although less common in children, this condition can cause chronic lymph node enlargement. The fact that the lymph node increases in size during illness and then decreases could be consistent with a tuberculous infection.
- Catatrophic lymphadenitis: This condition is characterized by recurrent episodes of lymph node enlargement, often in response to minor infections. It is a benign condition but can cause significant concern for patients and families.
- Kikuchi disease: This is a rare condition that can cause lymph node enlargement, but it is typically seen in older children and young adults. It is often accompanied by other symptoms such as fever and fatigue.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Lymphoma: Although the long-standing nature of the lymph node and its mobility make lymphoma less likely, it is essential to consider this diagnosis due to its potential severity. Lymphoma can cause lymph node enlargement, and a delay in diagnosis can significantly impact treatment and prognosis.
- Metastatic disease: Similar to lymphoma, the likelihood of metastatic disease is low, but it is crucial to rule out this possibility due to its severe consequences. Metastatic disease can cause lymph node enlargement, and a prompt diagnosis is essential for effective treatment.
Rare diagnoses
- Castleman disease: This is a rare condition that can cause lymph node enlargement, often accompanied by other symptoms such as fever and weight loss. It is typically seen in adults but can occur in children.
- Rosser-Sutton syndrome: This is a rare condition characterized by recurrent episodes of lymph node enlargement, often in response to minor infections. It is a benign condition but can cause significant concern for patients and families.
- Kimura disease: This is a rare condition that can cause lymph node enlargement, often accompanied by other symptoms such as eosinophilia and skin lesions. It is typically seen in Asian males.