A four-year old girl presents to the accident and emergency department with a history of being generally unwell for the preceding week and on examination is found to have cervical lymphadenopathy. In addition to a volley of tests, a Lactate Dehydrogenase (LDH) was requested by a registrar who had read that this was a predictor of malignancy which came back as 1,750. Should this be seen as suggestive of underlying malignancy?

Report by:

Tauseef Mehrali (SHO), Birmingham Children’s Hospital

How often have you seen a child with a neck full of lymph nodes, sent an LDH and been concerned about lymphoma? It’s a frequent occurrence in my clinical practise (although I am a Paeds Oncologists in between Archimedes topics). And I do fret about them - but should I be? (At a rough guess, my pre-test probability of lymphoma is about 75%; probably a fair bit higher than the ED experience.) What do the rest of you do, or think?