a case of shotty lymph node reported with a size of 3 to 4 mm, which was soft on touch and can move and the lymph nodes on the right side of neck were less than 1 cm. In case of epitrochlear node, the size of the lymph node allowed is 0.5 cm and in case of inguinal nodes, the size of the lymph node allowed is 1.5 cm. But the size may vary with the severity and type of lymph node associated. The most common size of lymph nodes seen are 1 cm and it is considered normal. Sometimes the associated cause is treated to treat the shotty lymph nodes. These shotty lymph nodes may form with a little soft compression and may disappear by itself. and it is most of the time asymptomatic showing no symptoms and malignancy. The permanent lymph nodes are usually smaller in size i.e. Most often the lymph node enlargement becomes permanent and they may be painless, and may not tender and soft like temporary shotty lymph nodes. This swelling of lymph nodes due to any infection is known as lymphadenitis but the rarest cause behind it is cancer. The swelling in the lymph nodes occur as a result of viral or bacterial infection in body. This normally occurs in the lower neck region, in the armpits, near chin and the groin. immune system which are small bean shaped covered in a capsule which comprise of several connective tissues and it helps in the defense mechanism of body against foreign invasive particles like bacteria, viruses and other pathogens as it contains macrophages and lymphocytes in it. Lymph nodes are the component of lymphatic system i.e. For urgent queries, please call switchboard, and ask to speak to the on call Paediatrics Team via the PAU Telephone.As the name indicates that shotty means short lymph nodes, which get swollen and enlarged. If possible, please arrange FBC, blood film, LFTs, ESR, consider Monospot (if aged > 5 years and clinical suspicion of acute EBV), consider ASOT/CMV/EBV serology if thought to be relevant.įor cases where there is clinical uncertainty or you would like to discuss the patient, please contact paediatrics via Kinesis. Unexplained axillary, epitrochlear or supraclavicular lymph nodes of more than 1cm diameter.Unexplained inguinal lymphadenopathy more than 1.5cm in diameter.Cervical lymphadenopathy more than 2cm in diameter and increasing in size or present for more than 2 weeks.The following would be indications for referral to rapid access clinic (which is currently accessed by ERS and marked as ‘urgent’) The child is very likely to need further investigations including a blood test. If there are any acute concerns as listed above, then refer in to acute paediatrics via the GP referral phone. If no response to oral antibiotics, systemic illness, fluctuant mass or more than 5cm then refer to acute paediatrics on-call for consideration of admission for IV (intravenous) antibiotics. If the child is well, consider treating with co-amoxiclav orally. Suspect bacterial lymphadenitis if there is a short history of infection and lymph node is red and/or tender. It is normal for the lymph nodes to get bigger and smaller in future with intercurrent infections. Lymph nodes are likely to slowly decrease over time, though this may take 2-4 weeks.
In cases of reactive lymphadenopathy, please reassure the child and family that this is a normal response to infection. Most enlarged lymph nodes require no management or further referral unless there are any red flags.
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