Management of Enlarged Lymph Nodes

Lymphadenopathy is defined as a lymph node with 1 cm or more of diameter (1.5 cm in the inguinal zone) and is a common finding in children, mostly benign, but sometimes there are several characteristics that are of concern. The surgeon plays an important role for obtaining a diagnosis. Clear signs of upper respiratory disease, inflammatory findings near an enlarged lymph node, and odontogenic disease are suggestive of a benign origin of lymphadenopathy, especially if it’s located in the neck, and our recommendation is to wait and see. There are several alarming signs that should raise the suspicion of malignancy as a cause of an enlarged lymph node. When one or more of these findings is present or elevated, it is mandatory to perform a thorough anamnesis searching for risk factors, behavioral or environmental elements, and a detailed physical examination. Laboratory and imaging help to characterize and elucidate possible differential diagnosis. Biopsy should be warranted if there is no definitive etiology after 4–6 weeks, lymphadenopathy is stable or grows, and/or an attempt of treatment is ineffective.