This presents as irregular lumps in a child's abdomen, sometimes with ascites, and with little tendency to obstruct. His mesenteric nodes are large, and not very mobile. They may be so large that you can feel them through his abdominal wall. They are matted together, and firm to hard, with characteristic pale yellow areas of caseation on their cut surfaces.
Often you can be fairly certain of the diagnosis. If many lymph nodes are involved, biopsy one from his neck, axilla, or groin. Non-specific adenitis is common in the groin, so only biopsy an unusually large one. You may see enlarged nodes in a chest X-ray. If you cannot establish the diagnosis in any other way, you may have to do a laparotomy and take a node for section. Lymphoma is the important differential diagnosis (32.3 and 32.4).