What would you do if 5 year old male presented with this lump?

[u/Ok_Sherbert1801]

I brought my son (5M) to a&e with these swollen nodes above the collarbone. They told me he has a virus and sent me home with Keflex antibiotics for 10 days and to come back in 6 weeks. I told them Im concerned it’s a lymphoma as the location is very odd to me but they assured me his blood test was fine so he doesn’t have lymphoma. No X-ray or further tests were done bar physically examination. The doctor I saw before going a&e put in his letter that there was minimum 7 nodes, they were rubbery and matted and the largest was 4cm.

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[u/FaulerHund]

Despite the people downvoting, if that genuinely is an enlarged supraclavicular lymph node, then yes, it absolutely warrants further evaluation, because that is a very atypical location for a benign enlarged node. See a pediatrician urgently

[u/Immer_Susse → u/FaulerHund]

May I ask why they sent Keflex for a virus?

[u/Ok_Sherbert1801 → u/Immer_Susse]

They told me they don’t know what’s wrong with him and that it may be a virus from months ago ‘lingering’ and prescribed Keflex

[u/Double-Package8270 → u/Ok_Sherbert1801]

An antibiotic for a viral infection though?

[u/Ok_Sherbert1801 → u/Double-Package8270]

Yeah, I know! Everything they did confused me!

[u/Double-Package8270 → u/Ok_Sherbert1801]

That's very odd. Was your son seen by doctors at that A+E visit? For a doctor to prescribe antibiotics for a suspected viral infection, and dismiss supraclavicular lymphadenopathy I'd be very concerned about their competence.

[u/Ok_Sherbert1801 → u/Double-Package8270]

Yes! There were 2 doctors and 2 nurses seeing him the first time! I said to them im worried about lymphoma because of the location of the affected nodes. The second time he was sent home in respiratory distress. I had to lie and say there was a family history of leukimia for them to take me seriously.

[u/sharraleigh → u/Ok_Sherbert1801]

That is completely absurd and I do not understand why people like these go into the profession if they don't even seem to care. Having to lie to be taken seriously is beyond ridiculous!

[u/Ghitit → u/Ok_Sherbert1801]

I'd find another hospital to use for emergency if I were in your boots.

They've been screaming at us for years to not ask for antibiotics for a viral infection telling us that anitbiotics become less effective if used for non bacterial infections.

I'm just a mom and I've known this for thirty years.

Those docs seem t obe prescribing just to shut you up because they don't know what the lump is.

[u/Ok_Sherbert1801 → u/Ghitit]

Also unfortunately have to go to that hospital 4 days a week

[u/Ghitit → u/Ok_Sherbert1801]

Very unfortunate.

[u/Noturaveragefriend → u/Ok_Sherbert1801]

Please try to find a pediatric emergency room near you. Idk how it is in the UK but typically “university” hospitals that work are better and have more specialists.

[u/Ok_Sherbert1801 → u/Noturaveragefriend]

He’s already been and diagnosed with lymphoma

[u/Ok_Sherbert1801 → u/Ghitit]

Yes, Thats exactly what I thought but the fact they had absolutely no idea what was wrong and just threw antibiotics at us is wild. I wish I pushed it more at the time. He ended up near death

[u/avadacadavera → u/Ok_Sherbert1801]

It had to have been for lymphadenitis. That antibiotic would be appropriate for an infected lymph node. Maybe they said it may have started with a virus, or maybe they were attributing another symptom or symptoms to a virus?

[u/Ok_Sherbert1801 → u/avadacadavera]

They said to me that lymph nodes swell from infections and that the virus must not have completely cleared. They said they might stay like that for up to 6 months

[u/Ok_Sherbert1801 → u/FaulerHund]

I’ve already been to the hospital and he has been diagnosed with lymphoma after 4 hospital visits and no one doing an X-ray. Im looking for opinions on wether or not the doctors should have done more in the beginning

[u/FaulerHund → u/Ok_Sherbert1801]

Yeah. They should have.

[u/Ok_Sherbert1801 → u/FaulerHund]

2 weeks of being ignored and he ended up in ICU for a week

[u/Raspberry__Beret → u/Ok_Sherbert1801]

Hi - my daughter is 19 she went 4 months without being diagnosed with HL - four visits to the doctors surgery… and she was very symptomatic, ticked off just about every one on the list…

[u/ratpH1nk → u/Ok_Sherbert1801]

Oh. I am sorry /u/Ok_Sherbert1801

Good luck

[u/ijustwanttobeanon → u/Ok_Sherbert1801]

I’m SO sorry. Wish I could give you a hug. I’m so tired of doctors acting like moms are nucking futz (not all of them, let me just say, so I don’t offend anyone. I know some moms really are overly intense and I know not all docs are apathetic. I’ve been proven time and time again that they are in our area, however, and I’m absolutely jaded and pissed off and not playing when it comes to my kids’ health)

[u/Brilliant_Ranger_543 → u/Ok_Sherbert1801]

I'm raging on you and your sons behalf. Please, please report this.

[u/LatrodectusGeometric → u/Ok_Sherbert1801]

If this is what it looked like in the beginning? Maybe, yes.

[u/Ok_Sherbert1801 → u/LatrodectusGeometric]

Yes, this was the very first day and they literally popped up out of nowhere. They got much bigger than this after

[u/costalunakayy → u/Ok_Sherbert1801]

NAD but wanted to offer a hug ❤️

[u/endosurgery → u/FaulerHund]

As a surgeon, I agree. I would have monitored close with follow up with me personally to ensure no resolution with time. If there was no improvement in two weeks I would have done US and likely lymph node biopsy. Just my algorithm in these situations.

[u/ratpH1nk → u/FaulerHund]

Agree concerning for potential lymphoma!

[u/No-Discipline7291 → u/FaulerHund]

Out of curiosity, would a normal cbc imply it’s very early in the disease course?

[u/NeandertalsRUs → u/No-Discipline7291]

For lymphoma the cancer is often confined to the lymph nodes and isn’t in the blood like leukemia, so CBC isn’t often abnormal. The real tell for labs are the electrolytes, uric acid, and LDH.

[u/No-Discipline7291 → u/NeandertalsRUs]

Appreciate the response!

[u/Incorrect_Username_]

If they don’t have some overwhelming story that sounds like they are acutely ill with a virus… I don’t know how you ignore this.

Even if they do have that story, that is a fairly enlarged supraclavicular node. I’d be uneasy writing that off

They need some testing, specifically I’d want to rule out lymphoma

What are the symptoms? Any bruising, weight loss, night sweats, fatigue etc?

[u/Ok_Sherbert1801 → u/Incorrect_Username_]

He was diagnosed with lymphoma after my fourth visit to a&e when they finally did a scan. He couldn’t breathe and had a huge chest mass. I told them each visit that I was concerned about lymphoma and my third visit his breathing was 45 breaths per minute and they sent me home. He was in ICU for a week

[u/My_2Cents_666 → u/Ok_Sherbert1801]

NAD. I am furious on your behalf. Just wow. I would file a complaint with every doctor who was involved.

[u/sharraleigh → u/Ok_Sherbert1801]

Is there some way you could lodge a complaint? I would hate for someone else to be similarly dismissed by these incompetent people in the future. They need to know how badly they messed up and something needs to be done to fix the issue. I'm sorry this happened to your son, he deserved better.

[u/Ok_Sherbert1801 → u/Incorrect_Username_]

Also the only other symptom he had at the first hospital visit was fatigue. I went back a week later and he had laboured breathing and said his bones all hurt. They sent him home that day too and the nurse told me to not come back unless it’s an actual emergency

[u/Kiloblaster → u/Ok_Sherbert1801]

The fatigue and hurting bones is literally something out of a medical school board exam question. There is no excuse for this.

[u/gldngrlee → u/Ok_Sherbert1801]

Please send her a letter with a picture of your child. She needs to pin it up and see his face daily to remember the importance of her words. Damn, sorry OP.

[u/miyog]

I’m an internal medicine physician and only deal with adults but what the HELL. A+E, so this is in the UK? Absolutely wild. Keflex for a viral infection what the hell. I’m sorry. They suck.

[u/Ok_Sherbert1801 → u/miyog]

It was so large and literally appeared in a few minutes. Yes UK. Im very angry with everyone involved, he ended up so much sicker than he should have

[u/Jhzaeth → u/Ok_Sherbert1801]

Just jumping in here to say that I’m a doctor in the UK and I recommend you file a complaint.

It’s not as important as supporting your son and taking care of yourself, of course, but it would go some way towards relieving you of these feelings and trying to force some accountability to reduce the chance of this happening again in the future.

I’m really sorry you’ve had to go through all this and had to advocate for yourself so hard.

[u/Xertahal → u/Jhzaeth]

Well, even if de Dx and even Tx was off compared to Dx, we are not 10 days intervalle short for treating both lymphoma or abdominal malignancy with supraclacivular lymphnodes metastasis. It’s certain it’s suboptimal. But even if the initial Dx was off, follow-up would have catch the case. I would take it easy before saying all of this. Moreover, we don’t have the whole picture lf what the A&E had during initial presentation.

[u/kxnnie → u/Ok_Sherbert1801]

i am a lymphoma survivor and see other lymphoma patients’ pre-diagnosis lumps all the time because we post them and compare them with eachother lol - this is such a common lymphoma spot and it’s also the spot where enlarged lymph nodes are apparently the most suspicious, according to my doctor (supraclavicular nodes). hang in there 🩷🩷 i’m sorry they dismissed you and your son like that, when i was diagnosed i wanted to go to every doctor who dismissed me and yell at them.

[u/Ok_Sherbert1801 → u/kxnnie]

Thank you and hope you’re doing good now. Im just glad to see people agree with me because I’ve been holding a lot of anger and didn’t know it I was right or wrong to be mad

[u/kxnnie → u/Ok_Sherbert1801]

you’re absolutely right! the downside of this cancer is that you can look “healthy” and your labs can look “good” so imaging may not be warranted in the eyes of some doctors if you only have vague symptoms. that being said, not everyone with lymphoma has B symptoms and i can imagine a 5 year old doesn’t know how to articulate themselves well enough sometimes to express those vague symptoms. maybe write a strongly worded letter to all the doctors/nurses who dismissed you as a cathartic exercise for yourself and then assess how you feel after that 😅 - and thank you for the well wishes 🩷 6 years cancer free, and before you know it that will be your little one too!!

[u/Raspberry__Beret → u/Ok_Sherbert1801]

You have every right to be angry - I was furious, and then you go such a roller coaster of emotions. I hope you are doing ok - sending you a big hug. I wrote to my local mp and he contacted the health secretary- I was asking for more awareness of symptoms and earlier blood tests.

[u/NeandertalsRUs]

I may be biased because I’m in pediatric hematology/oncology but that would have gotten him a chest xray, targeted labs, and an urgent appointment with ENT for a biopsy. Supraclavicular lymphadenopathy is a major red flag for lymphoma. Just to be complete though if the airway isn’t compromised lymphoma doesn’t require hospital admission to be worked up, but at the very least he should have gotten a chest xray to assess for the presence of any masses in the chest and a very good history because that is lymphoma unless proven otherwise.

[u/Ok_Sherbert1801 → u/NeandertalsRUs]

It was T-Cell Lymphoblastic Lymphoma. Im not a doctor but as soon as I saw that I knew it was that. It literally appeared out of nowhere

[u/NeandertalsRUs → u/Ok_Sherbert1801]

Thankfully the prognosis of that is overall excellent in kids but I’m sorry, I may be biased because I see this regularly but I think that’s a major miss.

[u/Ok_Sherbert1801 → u/NeandertalsRUs]

Yeah he’s doing great and treatment is going really well, Im just really mad at the doctors and want to know if my anger is justified.

[u/NeandertalsRUs → u/Ok_Sherbert1801]

Yes I believe it is.

[u/Immer_Susse → u/Ok_Sherbert1801]

I believe your anger is justified.

[u/uniqc0rn]

Was he screened for Tuberculosis? This is a typical presentation for primary complex TB or Lymphoma.

The A&E doctor is wild! Why give antibiotics if they thought it was viral. Doesn’t make sense.

[u/Ok_Sherbert1801 → u/uniqc0rn]

They asked me if anyone in my family had been near any African tribes recently or anyone with a long term cough, felt his stomach, asked when he was sick last which was several months ago and then said that basically his body probably didn’t fully get rid of that last virus and prescribed keflex. I was very unhappy leaving but the doctor reassured me and said come back in 6 weeks. So odd

[u/Spare-Locksmith-2162 → u/Ok_Sherbert1801]

Keflex doesn't kill viruses. It kills bacteria.

[u/shotcaller77]

It’s viral. Here’s some antibiotics 🤦

I would be concerned enough to further investigate this, given the presentation as well as your legitimate concern.

[u/Ok_Sherbert1801 → u/shotcaller77]

He was diagnosed with lymphoma

[u/Upbeat_Anything_1927 → u/Ok_Sherbert1801]

Oh mama 😢 im so sorry

[u/shotcaller77 → u/Ok_Sherbert1801]

Im sorry to hear that. I hope he can get a swift treatment. Fortunately, many lymphomas are curable. 🙏♥️

[u/secret_tiger101]

Bloods + ultrasound. In practice direct same day referral to paediatrics

[u/roguewhispers]

Holy shit. Now im just ortho, and everyone knows all the jokes about us, but even I know that virchoves nodes should ALWAYS be suspected for cancer and further testing is warranted. This is incredibly negligent. Cherry on top with the keflex for a viral infection. Report this to the proper authorities, or the system will never improve.