• <2 cm, no infection, no distal node, no worrisome features, no obvious cause → observation for 10-14 days
  • If no regression → abx. Bx after 4 weeks if not regressed
• ≥2 cm, no infection, no worrisome feature → CBC, ESR/CRP, CXR (r/o mediastinal masses or hilar adenopathy)
• Worrisome features: systemic sx (fever >1 wk, night sweats, weight loss >10%), supraclavicular nodes, generalized lymphadenopathy, fixed non-tender nodes without other sx, matted nodes, lymph nodes >1 cm in neonatal period, lymph nodes ≥2 cm do not respond to 2 wks abx, abnormal CXR, abnormal CBC, persistent/rising ESR/CRP despite abx
• CXR indications
  • Generalized lymphadenopathy
  • Supraclavicular lymphadenopathy
  • Cervical or inguinal adenopathy ≥ 2 cm without signs or symptoms of infxn or signs of infection but did not respond to trial of abx
• Excisional biopsy indications
  • Suspicion of malignancy
  • Suspicion of TB or non-TB mycobacterial lymphadenitis
  • Persistent (>4 wks without decreasing in size)
  • Enlarging adenopathy with an uncertain diagnosis