Pediatric Case: Submental Lymphadenopathy with Associated Ocular Symptoms

Case at a Glance

A 7-year-old female presented with a progressively enlarging submental mass over several days, accompanied by localized tenderness with neck movement and development of unilateral conjunctival symptoms.

Patient's Story

The patient's mother reported that her daughter initially complained of pain in the submental region (directly under the chin) approximately one week prior to presentation. Initial palpation revealed no obvious abnormalities. Over the subsequent 3-4 days, a palpable mass became evident in the same location. The patient described pain that was specifically triggered by neck flexion, extension, and lateral movement. She denied sore throat, fever, or systemic symptoms. Notably, she developed what appeared to be conjunctival irritation or possible nasolacrimal duct obstruction on one side during the same timeframe.

Initial Assessment

Physical examination revealed a mobile, firm mass in the submental triangle region. The lesion was tender to palpation and caused discomfort with neck range of motion. The patient appeared otherwise well with no signs of systemic illness. Unilateral ocular symptoms were noted, suggesting possible regional lymphatic involvement or concurrent upper respiratory process.

The Diagnostic Journey

The clinical presentation suggested reactive lymphadenopathy in the submental lymph node chain. The submental nodes typically drain the central lower lip, floor of mouth, tip of tongue, and central mandibular region. The association with ocular symptoms raised consideration of a viral upper respiratory infection or other inflammatory process affecting the regional lymphatic drainage.

Final Diagnosis

Reactive submental lymphadenopathy, likely secondary to viral upper respiratory infection with associated conjunctival involvement

Treatment Plan

Conservative management with observation, symptomatic pain relief as needed, and close follow-up. Pediatric consultation recommended for further evaluation and monitoring of lymph node size and characteristics over time.

Outcome and Follow-up

Patient scheduled for pediatric follow-up within 24-48 hours for formal evaluation. Parents advised to monitor for fever, increasing size of mass, or development of additional symptoms and to seek immediate care if concerning changes occur.