Pediatric emergency medicine trisk 2687 2687

Lymphoma Typical presentation Potential complications at diagnosis and considerations for ED management Hodgkin disease Painless, hard adenopathy: neck and supraclavicular common AMM common, with or without symptoms Pleural effusions uncommon May have “B” symptoms Fevers Night sweats Weight loss (at least 10% weight loss) Superior vena cava (SVC) syndrome Tracheal obstruction Lymphoblastic lymphoma Painless, hard adenopathy at any site Respiratory symptoms from rapidly growing mediastinal mass, often with pleural effusions (Tlineage, advanced stage) GI tract involvement rare Tumor lysis syndrome (TLS) SVC syndrome Tracheal obstruction Pleural effusions Burkitt lymphoma Single site of enlarged lymphoid tissue (low stage) Incidental finding on appendectomy Asymmetric enlarged tonsil Lead point for intussusception in >3 yrs A single, painless enlarged node Painless, hard adenopathy with rapid growth (usually advanced stage) Rapid assessment for TLS: High risk of severe tumor lysis, even prior to treatment (advanced stage) First dose rasburicase in ED if uric acid >8 and low risk for G6PD deficiency Urgent consultation with oncology Admission to center with available pediatric dialysis