Asymmetrical Shoulder: A Possible Sign of Supraclavicular Lymphadenitis in Children

We report a rare case of pediatric supraclavicular pyogenic lymphadenitis presenting with an "asymmetrical shoulder" in a five-year-old boy. The boy developed right neck and shoulder pain following the resolution of cellulitis at the site of insect bites on his right forearm. Despite the absence of visible inflammation in the shoulder or proximal lymph nodes, short tau inversion recovery magnetic resonance imaging (STIR-MRI) revealed an enlarged supraclavicular lymph node with surrounding edema. He fully recovered following intravenous antibiotic treatment. This case highlights that lymphadenitis in remote drainage sites, such as the supraclavicular nodes, may develop even after the resolution of distal cellulitis at the primary site. Notably, in the present case, inflammation was absent in the anatomically proximal lymph nodes (such as those at the elbow or subclavicular lymph nodes) and appeared only in the supraclavicular region. Lastly, the asymmetrical shoulder appearance may serve as a valuable clinical sign of the underlying lymphadenitis. We also discuss key considerations when encountering supraclavicular lymphadenitis, which carries a high risk of malignancy at all ages.