Lymphadenopathy and Splenomegaly

Lymphadenopathy and splenomegaly are benign and malignant processes that can produce common findings in children and it is important to distinguish between the two so that appropriate management can be undertaken. Lymphadenopathy might be caused by proliferation of cells intrinsic to the node, such as lymphocytes, plasma cells, monocytes or histiocytes or by infiltration of cells extrinsic to the node, such as neutrophils and malignant cells. Lymphadenopathy is also a presenting sign of malignancies such as leukemia, lymphoma, or neuroblastoma and it is important to be able to differentiate benign from malignant lymphadenopathy. Splenomegaly can be caused by diseases that result in hyperplasia of the lymphoid and reticuloendothelial systems, infiltrative disorders, hematologic disorders and conditions that cause distention of the sinusoids whenever there is increased pressure in the portal or splenic veins. The significance of splenomegaly depends on the underlying disease. In children, a palpable spleen may occasionally be due to visceroptosis rather than true splenomegaly. This distinction is important to make so that extensive investigations for the cause of splenomegaly are not undertaken unnecessarily.