Which physical findings are characteristic of pediatric acute lymphoblastic leukemia (ALL)?

Updated: Jan 03, 2019
  • Author: Vikramjit S Kanwar, MBBS, MBA, MRCP(UK), FAAP; Chief Editor: Jennifer Reikes Willert, MD  more...
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Answer

Physical findings in children with acute lymphoblastic leukemia (ALL) reflect bone marrow infiltration, as well as extramedullary disease. Patients commonly present with pallor caused by anemia and petechiae and bruising secondary to thrombocytopenia. Leukemic infiltration may manifest as lymphadenopathy and hepatosplenomegaly. If it involves the central nervous system (CNS), papilledema, nuchal rigidity, and cranial nerve palsy is sometimes found. Testicular examination in males is critical; leukemic infiltration usually manifests as unilateral painless testicular enlargement.

The presence of stridor is cause for concern and may signify a mediastinal mass, found in half of patients with T-lineage ALL, with a risk of imminent respiratory arrest. Attempts to lay the patient flat or perform intubation should be avoided, and the patient should commence steroid therapy and be transferred to the PICU for close observation while workup is underway.


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