more advanced in their course (patients then present with violaceous skin discoloration), fevers, or preceding URIs Triage Considerations As with other deep neck infections, care should be taken in triage to assess the patency of the airway Patients with cervical adenitis may present with evidence of partial upper airway obstruction or respiratory distress, though that is rare Patients who appear toxic, have high fever, malaise, or dehydration should be aggressively resuscitated Surgical consultation should be obtained when drainage is believed to be necessary Initial Assessment The diagnosis of cervical adenitis should be suspected in any patient that presents to the ED with fever, neck swelling, and tenderness A thorough evaluation of the number of nodes involved and their size is helpful Infected nodes seen in lymphadenitis are often unilateral, warm, and tender to palpation Erythema and warmth over the affected node should raise the possibility of an overlying cellulitis The affected node(s) may also be fluctuant, which is common when lymphadenitis is complicated by the development of a neck abscess The provider should also perform an oral examination, looking for dental caries or other evidence of poor dentition Management and Diagnostic Testing Laboratory studies may be helpful in patients who are ill appearing or have persistent symptoms A complete blood count (CBC), and inflammatory markers such as C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR), can show evidence of acute infection Blood culture can potentially identify a pathogen to guide therapy, though only systemically ill patients warrant evaluation for associated bacteremia Imaging can also be helpful, particularly in identifying suppuration/abscess in the context of lymphadenitis Ultrasound is an appropriate first choice, for its safety profile, lack of radiation, and accuracy in diagnosing abscesses CT is also useful in diagnosis and management, particularly in patients who are anticipated to require drainage in the operating room ( e-Fig 118.1 ) CT may show evidence of deeper infection or loculations that could change the surgical approach Cervical adenitis does not usually occur following a brief, uncomplicated viral infection of the upper respiratory tract Instead, these tender and enlarged nodes occur more often as a result of bacterial infection of the head and neck Infections