Child with persistent Lymphadenopathy

[worriedmommy315]

Thankyou in advance for any advice.
I'm writing regarding my son who is almost 4 years old. He has had some health issues since birth, was born prematurely, shortly after coming home from the NICU he contracted RSV and ended up spending 6 weeks in the PICU with complications. Came home at 2 months old with chronic lung disease. By 18 months old his respiratory problems were almost completely resolved, but he continued to have lowered immunity and was always on antibiotics for various infections. At 2 1/2 years old he started to have severe eczema and frequent episodes of fever and fatigue. At this time he also developed a very enlarged cervical lymph node under his jaw on the right side of his neck. His doctor ordered blood work, which came back normal. Tests for Mono were negative. We were sent to an ENT who wanted to moniter the growth of the lymph node for one month and then make a decision to biopsy or not. This was last december, 2006. Our health insurance changed january '07 and so did our docters, so we were not able to go back to that ENT. I read that enlarged lymph nodes in children can stay that way for several months, so I decided to wait before I went ahead with further medical testing. Several months later he was unable to catch his breath after running around outside and I brought him into Urgent Care. The docter on call noted the very large lymph node and ordered blood work and a chest xray. Both came back normal. We were referred to another ENT.
This ENT said he is concerned by the size (golf ball sized) and consistency (quite hard) but didn't seem to believe me that it has now been that way for a full year. He had us make an appointment for an ultrasound, which will be on January 2nd, 2008.
My question is... WHAT could cause a lymph node to be this enlarged for THIS long in a preschool aged child? Does the fact that it has been this way for a year rule out anything serious? It has never decreased in size, and has gradually increased.
For the past three weeks he has had a persistent cough and fevers almost every night. We've had a cold going through everyone in our house (we have three other children) but he has been hit the hardest and cannot seem to recover from it.
I have attached two pictures so you can see the size and location. The node goes from right under his right ear to the middle of his throat. I also included a view of the left side (no visible nodes) for comparison.
http://share.shutterfly.com/action/welcome?sid=8CZuXLhwxatAc&notag=1

Again, thankyou so much for any advice or information.

[Dennis MD]

Hi.
I understand what you are going through.
Your son gone through a lot in his young age.
Lymph nodes serve like a filter, trapping microorganisms and even cancer cells, resulting in enlargement.
Chronic infections can cause enlarged lymph nodes in the neck.  An example would be tuberculosis.  
An acute infection like upper respiratory tract infection can bring about an increase in size of a previously enlarged lymph node.
Lymphoma is also one of the considerations for an enlarged lymph nodes.  The involvement could be a single site in the neck, or several sites in the body.  The lymph nodes are non-tender and hard.
I do agree with ENT consult for proper evaluation and management.
Wish you all well.

[petulka]

Hi!
I am really not an expert on lymph nodes, and am dealing with one big one on my neck right now too.
I can not give an advice about the node, but I can give you an advice where to look for some ideas. I posted on this website few times, and not so many people really answer. The only two that always helped me are Dean and Riley. You should go to www.askwaltstollmd.com
He is a great doctor with many  answers. Go on bulletin board on his site. Dozens of people there share their troubles every day and try to help each other.