Cervical nodes smaller than 2 cm in diameter are unlikely to be associated with malignancy in a child who has no other signs or symptoms, but a chest radiograph, an abdominal ultrasound examination and a full blood count may be useful to exclude malignancy in suspicious cases. The pathologic features of myocarditis depend on the cause and the immune response, but cell death and fibrosis may result. The clinical picture may also vary depending on the etiology and extent of the inflammation. Sudden death is possible. The diagnosis depends on suspicion and evidence of cardiac malfunction.
Management is directed at maintaining cardiac function, treating the cause and minimizing sequelae.
Many cases require bed rest and monitoring for arrhythmias and development of cardiac failure. Pituitary tumors may present as a local mass effect, excessive hormone production or deficiency of pituitary-controlled hormones. Headache is relatively uncommon even with large tumors, but other mass effects, especially on the optic pathways, can occur, depending on the size and location of the tumor. The most common hormonal excess is prolactin, leading to galactorrhea and menstrual disturbances in women and loss of libido in men. Acromegaly and Cushing's syndrome are much less common and may present initially with subtle clinical signs and symptoms.