Neck Swelling
                                =============
þ Things to consider:
 - bilateral: likely systemic
 - kids with fever and bilateral enlarged nodes:
  + common, especially in 1-2 year olds, who may have nodes all 
    the time. Not to worry.
  + swollen nodes with tonsillitis: ignore unless very tender.
  + bilateral swollen nodes without tonsillitis
   - Mono syndrome:
    + EBV > CMV > toxoplasmosis > HIV > lymphoma, leukemia 
      (especially if sentinel node supraclavicular, or if hard 
      and matted)
    + Monospot more likely to be negative early in younger kids 
      or earlier in disease
    + CBC for leukemia or atypical lymphocytes, ? consider EBV 
      titres
 - unilateral:
  + ages 1-5: acute unilateral lymphadenitis, may form abscess, 
    mostly staph, occasionally strep, often fluctuant
  + reactive nodes begin regressing by 2 weeks.
  + Differential in kids:
   - 40-50% "reactive" on biopsy
   - Atypical reactive viral node (most common)
   - Subacute bacterial adenitis
   - Cat scratch fever (B.heneselae)
    + Bartonella henselae
    + facial nontender papule, fades; 1-2 weeks later, node 
       develops, then peaks at 2-3 weeks (slightly tender), 
       resolves in 2-3 months. Usually 4-6 cm. Only about 1/10 
       red or fluctuant, may have mild systemic sx, don't need bx 
       if good history. Can do serology, aspirate for pleomorphic 
       gram - organisms + silver stain. Self-resolving in 3 
       months. Azithromycin might cause faster resolution, still 
       lasts 1-2 months.
   - Atypical mycobacteria
     + mycobacterium avium-intracellulare (MAC)
     + need skinny-needle bx
     + Rx: excise it, though will go away in 9-12 months anyway, 
       PPD + in 85%.
     + (regular TB rare as cause of single cervical node)
   - Malignancy (e.g., Hodgkin's lymphoma)

þ Branchial Cleft Cyst
 - anterior neck, close to larynx
 - 95% 2nd anterior to SCM, can treat like infected node
 - 5% 1st, posterior
 
þ Cystic Hygroma
 - lymphatic malformation
 - 60% in head neck, may be front or back
 - cosmetic, infection, airway compromise
 
þ Thyroglossal Duct Cystic
 - remnant of thyroid tract from tongue
 - midline, near hyoid
 - moves up with tongue protrusion
 - may get infected
 
þ Oculoglandular syndrome
 - inflamed eye, swollen node: usually adenovirus, but don't see 
   much node formation with bacterial conjunctivitis
 
þ Preuricular Swelling
 - Parotitis
 - First branchial cleft cyst