Enlargement of cervical lymph glands is common in children and in most cases represents a transient response to a benign local or generalized infection, most often of viral etiology. The increase in size may involve a single node or a localized group of nodes (regional adenopathy); it may be unilateral or bilateral; and it may be acute, subacute, or chronic in onset and course. Almost all normal children have small palpable cervical, axillary, and inguinal nodes. About 5% have small palpable suboccipital nodes. Distinctly uncommon are palpable postauricular, supraclavicular, epitrochlear, or popliteal nodes or radiologic evidence of mediastinal or abdominal adenopathy. The increase in size of a node may be the result of one of two processes: 1) proliferation of cells intrinsic to the node, including lymphocytes, plasma cells, monocytes, or histiocytes; or 2) infiltration of cells external to the node, such as malignant cells or neutrophils, having the potential for developing necrosis and suppuration.

In some instances the cause of the adenopathy may be obvious, such as in the case of lymph glands draining an obvious source of infection. In other cases of unexplained neck masses, congenital and neoplastic causes also must be considered before the etiology is assumed to be infectious.

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