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Do otherwise well, healthy children with palpable cervical lymph nodes require investigation with neck ultrasound?
  1. Michael Paddock1,2,
  2. Amy Ruffle3,
  3. George Beattie4,
  4. Amit Prasai5,
  5. Annmarie Jeanes6
  1. 1 Medical Imaging Department, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, UK
  2. 2 Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
  3. 3 Department of Oncology, Leeds Children’s Hospital, Leeds, West Yorkshire, UK
  4. 4 Emergency Department, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, UK
  5. 5 Ear, Nose & Throat Department, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
  6. 6 Department of Radiology, Leeds Children's Hospital, Leeds, West Yorkshire, UK
  1. Correspondence to Dr Michael Paddock, Medical Imaging Department, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, UK; michael.paddock{at}doctors.org.uk

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Clinical bottom lines

  • Otherwise well, healthy children with palpable cervical lymph nodes do not require investigation with neck ultrasound (Grade B).

  • Ultrasound should not be used as a screening tool to ‘exclude malignancy’ (Grade B).

  • Children with palpable cervical lymph nodes greater than 2 cm persisting for more than 6 weeks, or supraclavicular nodes, warrant referral for specialist assessment. An ultrasound at this stage may help direct further investigation and management (Grade B).

Clinical scenario

You are the speciality registrar seeing a 6-year-old girl in clinic who was referred by her general practitioner (GP) with a 4-week history of ‘persistent lymphadenopathy’. She is otherwise well with no fever, recent history of illness or infection. There is no medical history of note. There are palpable cervical lymph nodes on examination. There is no hepatosplenomegaly. The GP has also referred the patient for an urgent neck ultrasound in which the request states ‘persistent lymphadenopathy, otherwise well, exclude malignancy’.

Structured clinical question

Do otherwise well, healthy children …

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Footnotes

  • Contributors Guarantor of integrity of the entire study: MP. Study concepts and design: MP. Literature research: MP. Clinical studies: n/a. Experimental studies/data analysis: MP, AR. Statistical analysis: n/a. Manuscript preparation: MP, AR, GB. Manuscript editing: MP, AR, GB, AP, AJ.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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