Presentation
Swelling in neck.
Patient Data
Soft, tender, echogenic lymph node in left Va station measuring 29 x 20 x 27 mm with normal-appearing flow through its hilum. Surrounded by much smaller echogenic lymph nodes.
Numerous bilateral lymph nodes of normal appearance in all cervical stations and bilateral retroauricular.
Oblong submandibular (IIa) lymph node 17 mm in short axis diameter (SAD) on either side. Oblong supraclavicular (IV) node 11 mm in SAD. Normal flow in said lymph nodes.
Normal-appearing bilateral axillary lymph nodes, up to 17 mm in SAD on either side.
Case Discussion
A previously well 17-year-old girl had complained of fatigue and a swollen neck, painful on the left. Neck ultrasound (not shown) revealed bilateral cervical lymphadenopathy consisting of normal appearing lymph nodes with mildly increased internal flow; prominent lymph node on the left. Treated with IV amoxicillin-clavulanate. The pain subsided. Serology was positive for EBV IgM, EBV IgG, and EBV EBNA, and negative for CMV, toxoplasma, and Bartonella henselae. After about a month, she came back for a neck ultrasound, as the swelling had persisted. Now the ultrasound showed an enlarged, echogenic lymph node with apparently normal flow characteristics in the left neck. A biopsy was obtained from it. The pathology turned out to be acute myelogenous leukemia.
In cases of persistent cervical lymphadenopathy, hematologic disease should be suspected.
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