Erkrankungen der Halslymphknoten im Kindesalter

Zusammenfassung

Die Lymphknoten des Körpers sind essenzieller Bestandteil des Immunsystems und aus diesem Grund bei vielen infektiösen, autoimmun bedingten, metabolischen und malignen Erkrankungen betroffen. Gerade die zervikalen Lymphknotenstationen sind von zentraler Bedeutung, da sie einerseits als erste Abflussstationen wichtiger Kontaktstellen mit der Außenwelt (Mund/Schlund/Nase/Augen/Ohren/Atemwegssystem) fungieren – ein Aspekt, der insbesondere bei Kindern eine wesentliche Rolle spielt –, andererseits in einem exponierten Areal liegen und gerade bei den kindlich schlanken Hälsen früh klinisch auffällig imponieren können.

Der Beteiligung bei multiplen Erkrankungen entsprechend steht eine große Zahl an diagnostischen Maßnahmen zur Verfügung. Aus zeitlichen, Belastungs- und Kostengründen muss deshalb hieraus eine sinnvolle Auswahl getroffen werden, um eine adäquate Behandlung zu ermöglichen. Die Basis für die diagnostischen Entscheidungen legen eine fundierte Anamnese und klinische Untersuchung. Die Sonografie ist ein wichtiges Hilfsmittel in der Differenzialdiagnose der kindlichen Lymphknotenschwellungen. Sie unterstützt auch bei der Beantwortung einer der entscheidenden Fragen im Rahmen der Abklärung: Besteht ein Anhalt für ein malignes Geschehen? Gegebenenfalls muss dann eine histologische Sicherung durch die möglichst vollständige Exstirpation des auffälligsten Lymphknotens erfolgen.

Diagnostik und Therapie der Halslymphknoten­erkrankungen im Kindesalter stellen die behan­delnden Kinder- und Hals-Nasen-Ohrenärzte vor besondere Herausforderungen. Das breite Spekt­rum der Differenzialdiagnosen und die unterschiedliche klinische Relevanz – von banalen Infekten bis zu malignen Erkrankungen – erfordern ein besonnenes, klares Handlungskonzept, das der individuellen klinischen Präsentation des Kindes angepasst ist und nachfolgend dargelegt wird.

Abstract

Diseases of the Cervical Lymph Nodes in Childhood

The lymph nodes are an essential part of the body‘s immune system and as such are affected in many infectious, autoimmune, metabolic and malignant diseases. The cervical lymph nodes are particularly important because they are the first drainage stations for key points of contact with the outside world (mouth/throat/nose/eyes/ears/respiratory system) – a critical aspect especially among children – and can represent an early clinical sign in their exposed position on a child‘s slim neck.

Involvement of the lymph nodes in multiple conditions is accompanied by a correspondingly large number of available diagnostic procedures. In the interests of time, patient wellbeing and cost, a careful choice of these must be made to permit appropriate treatment. The basis of diagnostic decisions is a detailed anam­nesis and clinical examination. Sonography also plays an im­portant role in differential diagnosis of lymph node swelling in children and is useful in answering one of the critical diagnostic questions: is there a suspicion of malignancy? If so, full dissection of the most conspicuous lymph node may be necessary to obtain histological confirmation.

Diagnosis and treatment of childhood cervical lymph node disorders present the attending pediatric and ENT physicians with some particular challenges. The spectrum of differential diagnoses and the varying degrees of clinical relevance – from banal infections to malignant diseases – demand a clear and considered approach to the child‘s individual clinical presentation. Such an approach is described in the following paper.

Schlüsselwörter

Lymphadinitis colli - Differenzialdiagnosen kindlicher Lymphknoten­erkrankungen - zervikale Raumforderung - Lymphknotenvergrößerung - Lymphadenopathie

Key words

Lymphadenitis colli - differential diagnosis of childhood Lymphadenopathy - cervical mass

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