A 3-year-old boy is brought to clinic by his mother because she is concerned regarding neck swelling and fevers. Three weeks ago, the patient developed viral upper respiratory infections. He attends day care, where several children have had the same symptoms. His symptoms had briefly resolved 10 days ago, but the fever recurred last week after the patient returned to day care. Since then, his mother has noticed a swelling in the neck region which suddenly appear. Temperature is 38.3 C (100.9 F). Examination shows enlarged lymph nodes in the neck region. Lymphadenopathy at which of the following locations is most concerning for malignancy rather than infection in this patient?

Question

A 3-year-old boy is brought to clinic by his mother because she is concerned regarding neck swelling and fevers.  Three weeks ago, the patient developed viral upper respiratory infections.   He attends day care, where several children have had the same symptoms. His symptoms had briefly resolved 10 days ago, but the fever recurred last week after the patient returned to day care.  Since then, his mother has noticed a swelling in the neck region which suddenly appear.  Temperature is 38.3 C (100.9 F).  Examination shows enlarged lymph nodes in the neck region.  Lymphadenopathy at which of the following locations is most concerning for malignancy rather than infection in this patient?

Quizplus · Accepted Answer

Eductional Objective: Lymph node enlargement is most commonly due to infection-triggered cellular proliferation but can be caused by clonal expansion of malignant cells.  Enlargement of the supraclavicular lymph nodes, which drain the chest and abdomen, is unlikely to be caused by common childhood infections and is concerning for malignancy.

A 3-Year-Old Boy Is Brought to Clinic by His Mother