소아 경부 림프절증의 원인 질환과 임상 양상의 분석
Etiologies and Clinical Characteristics of Cervical Lymphadenopathy in Children
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목 적 : 경부 림프절 비대를 주소로 내원한 환아들을 대상으로 임상 양상과 원인 질환을 분석하고 올바른 접근법을 찾는데 도움이 되고자 하였다. 방 법 : 경부 림프절비대를 주소로 입원한 18세 이하 환아 240명의 의무기록을 후향적으로 검토하여 진단과 병력, 임상양상 및 검사 소견을 알아보았다. 결 과 : 임상적인 림프절염(52.1%), 농양(15%), 괴사성 림프절염(7.9%), 반응성 증식(5.4%), 결핵성 림프절염(4.2%), 가와사끼병 (2.9%), 악성 질환(2.5%)이 발견되었다. 농양은 2주 이하의 발열(69.4%)을 동반한 급성 병변(94.1%)을, 결핵성 림프절염은 열이 동반되지 않았고(90%) 만성 병변(62.5%)을 보였다. 악성 질환, 괴사성 림프절염은 환아의 나이가 많았고 전신 증상이 동반되는(40%, 37.5%) 만성 병변(100%, 62.5%)으로 나타나는 경우가 많았으며 후자는 백혈구 감소증(57.9%)을 보이는 경우가 많았고 다양한 발열 기간을 보였다. 결 론 : 본 연구에서는 경부 림프절증의 원인으로 임상적인 림프절염(52.1%), 농양(15%), 괴사성 림프절염(7.9%), 반응성 증식(5.4%), 결핵성 림프절염(4.2%), 가와사끼병 (2.9%), 악성 질환(2.5%)이 발견되었다. 즉, 경부 림프절증은 대부분 흔한 감염성 질환에 의한 양성 경과를 보이나 다른 원인 질환들이 드물지 않았다. 이를 임상적으로 구분해 낼 수 있는 기준은 없으나 이들은 나이, 발열 기간, 병변 지속 기간, 동반 증상이나 질환, 백혈구 수와 같은 임상 양상 및 검사 소견에서 서로 차이를 보일 수 있다. 따라서 소아의 경부 림프절증에 접근할 때는 병력 및 진찰, 임상양상과 검사 소견의 조합에 주의를 기울이고 특히 장기간 지속되는 환아에서는 양성 결과를 얻었다고 하여도 충분한 설명과 추적 관찰이 필요함을 잘 숙지하고 있어야 할 것으로 생각된다.
Abstract
Purpose : This study was performed to investigate clinical characteristics and the etiology of cervical lymphadenopathy in children. Methods : A clinical review of 240 cases of children under the age of 18 who were admitted with cervical lymphadenopathy from January 2002 to December 2007. Results : Cervical lymphadenopathy was diagnosed as follows : clinically diagnosed lymphadenitis (52.1%), abscess (15%), necrotizing lymphadenitis (7.9%), reactive hyperplasia (5.4 %), tuberculous lymphadenitis (4.2%), Kawasaki disease (2.9%) and malignancy (2.5%). Abscess was presented as an acute lesion (94.1%) with less than 2 weeks of fever (69.4 %) and tuberculous lymphadenitis was presented as a chronic lesion (62.5%) without fever (90%). Malignant disease (100%) and necrotizing lymphadenitis (62.5%) were found in chronic lesion of older children with systemic symptoms (40% and 37.5%, respectively). Leukopenia (57.9%) with various duration of fever occured in case of necrotizing lymphadenitis. Conclusion : Clinically diagnosed lymphadenitis (52.1%), abscess (15%), necrotizing lymphadenitis (7.9%), reactive hyperplasia (5.4%), tuberculous lymphadenitis (4.2%), Kawasaki disease (2.9%) and malignancy (2.5%) were found in cervical lymphadenopathy. Although cervical lymphadenopathy was commonly caused by a benign infectious process, a more serious disease was not rare, which may have different clinical characteristics including age, duration of fever and disease, previous or accompanying symptoms, or white cell counts. Meticulous combination of clinical characteristics, history, physical examination and workup as well as follow-up may be the most important for the proper approach on cervical lymphadenopathy in children.
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