supraclavicular lymph nodes swollen child

supraclavicular lymph nodes swollen child2020/09/28

In most cases, a careful history and physical examination will identify a readily diagnosable cause of the lymphadenopathy, such as upper respiratory tract infection, pharyngitis, periodontal disease, conjunctivitis, lymphadenitis, tinea, insect bites, recent immunization, cat-scratch disease or dermatitis, and no further assessment is necessary (see the diagnostic branch of the algorithm). If you notice strange bruising or if your child is bleeding unusually from the nose and mouth or experiencing weight loss, visit your doctor. Our understanding of the epidemiology of lymphadenopathy in family practice is limited by the scarcity of relevant literature. It is the final common pathway of the lymphatic system as it joins the central venous system. Sensitivity of fine-needle aspiration in children is usually greater than 90%1416 and specificity is approximately 85%.16 However, in one series, 76% of the children required general anesthesia; a cytopathologist who has experience with neck lesions in children is essential.16 Occasionally, fine-needle aspiration does not provide sufficient tissue or adequate evaluation of lymph node architecture, and an open biopsy is needed to determine the diagnosis. Dr. Iannelli has cared for children for more than 20 years. A hard, irregular mass, or a firm or rubbery mass that is immobile or fixed to the deep tissues of the neck may indicate malignancy. This is about the size of a quarter. Finding a lump on the collarbone can be concerning. Conversely, the presence of abnormally enlarged lymph nodes . In children, lymph nodes larger than 2 cm in diameter (along with an abnormal chest radiograph and the absence of ear, nose and throat symptoms) were predictive of granulomatous diseases (i.e., tuberculosis, cat-scratch disease or sarcoidosis) or cancer (predominantly lymphomas).11 These studies were performed in referral centers, and conclusions may not apply in primary care settings. When biopsy is deferred, the physician should explain to the patient the rationale for waiting. Suppurant nodes may be fluctuant. Common causes of lymphadenopathy in children include: The lymph nodes may also enlarge due to an allergic response. The search included systematic reviews, meta-analyses, consensus development conferences, and guidelines. Copyright 2023 American Academy of Family Physicians. If Epstein-Barr virus antibodies are absent, other causes of the mononucleosis syndrome should be considered. Patients with unexplained localized lymphadenopathy who have constitutional symptoms or signs, risk factors for malignancy or lymphadenopathy that persists for three to four weeks should undergo a biopsy. When the cause of the lymphadenopathy remains unexplained, a three- to four-week observation period is appropriate when the clinical setting indicates a high probability of benign disease. Thyroglossal duct cysts are often located over the hyoid bone and elevate with tongue protrusion or swallowing, whereas dermoid cysts typically move with the overlying skin.6 Malignant anterior neck masses are usually caused by thyroid cancer. Concern for airway involvement or malignancy should prompt immediate referral or imaging. Lymphadenopathy can be especially prominent in the nodes closest to the site of infection. Patients should be cautioned to remain alert for the reappearance of the nodes because lymphomatous nodes have been known to temporarily regress. Your lymph nodes, also called lymph glands, play a vital role in your body's ability to fight off infections. Ent doc decided he wanted to do an excisional biopsy of one of the nodes to be sure. The body has approximately 600 lymph nodes, but only those in the submandibular, axillary or inguinal regions may normally be palpable in healthy people.1 Lymphadenopathy refers to nodes that are abnormal in either size, consistency or number. The supraclavicular lymph nodes (often shortened to the supraclavicular nodes) are a paired group of lymph nodes located on each side in the hollow superior to the clavicle, close to the sternoclavicular joint. Most are in the neck. Occasionally, if lymphoma is suspected, the FNA may not be enough to make the diagnosis and an open or surgical biopsy will be recommended so the lymph node or a piece of it is removed in the operating room. Copyright 2023 American Academy of Family Physicians. If fine-needle aspiration is warranted for deep neck masses, ultrasonographic guidance can help. In primary care settings, patients 40 years of age and older with unexplained lymphadenopathy have about a 4 percent risk of cancer versus a 0.4 percent risk in patients younger than age 40.4. Matting. Increased size of one or more lymph nodes. Usually, the patient or caregiver is anxious for a diagnosis and an intervention. The most common symptoms associated with lymphadenopathy are the symptoms of the primary condition (such as infection or cancer). Lymph nodes get inflamed when there is some sort of trauma, an infection, or a tumor mass in or near the lymph node. Swollen nodes caused by cancer require treatment for the cancer. Swollen lymph nodes are sometimes referred to as swollen glands. The presence of the typical syndrome and positive results on a heterophilic antibody test (Monospot test) confirms the diagnosis. John Carew, MD, is board-certified in otolaryngology-head and neck surgery. The supraclavicular lymph nodes on the left side are called Virchow's nodes. Search dates: August 25, 2011, and December 2, 2013. It may also turn red, and the child may also have a fever. Data Sources: A PubMed search was completed in Clinical Queries using the key term pediatric neck mass. Lymphadenopathy of the right supraclavicular node is associated with cancer in the mediastinum, lungs or esophagus. Don't look for lymph nodes, because you can always find some. supraclavicular lymph nodes swollen after covid shot. Current suggested algorithms are based on expert opinion.17 Observation is recommended initially in children with cervical lymphadenitis that is bilateral, whose lymph nodes are smaller than 3 cm and are not erythematous or exquisitely tender.18 An empiric course of antibiotics should be considered for patients with cervical lymphadenitis if they have systemic symptoms (e.g., fever, chills), unilateral lymphadenopathy, or erythema and tenderness, or if their lymph nodes are larger than 2 to 3 cm.18 If an antibiotic is prescribed, a 10-day course of oral cephalexin (Keflex), amoxicillin/clavulanate (Augmentin), or clindamycin is recommended based on expert opinion, because the most common organisms are Staphylococcus aureus and group A streptococcus.11 Empiric antibiotic therapy with observation for four weeks is acceptable for presumed reactive lymphadenopathy.11 Figure 3 is an algorithm for the treatment of a child presenting with a neck mass. The location of the neck mass provides many clues to the diagnosis. scalp infection. ADVERTISEMENT: Supporters see fewer/no ads. How can I treat swollen glands in my neck? In primary care patients with unexplained lymphadenopathy, approximately three fourths of patients will present with localized lymphadenopathy and one fourth with generalized lymphadenopathy (Figure 1).2,3. Lack of response to initial antibiotics should prompt consideration of intravenous antibiotic therapy, referral for possible incision and drainage, or further workup. 2013;60(4):923-36. doi:10.1016/j.pcl.2013.04.005. An upper respiratory tract infection preceding the onset of the mass suggests possible reactive lymphadenopathy or a secondary infection of a congenital cyst. If malignancy is suspected (accompanying type B symptoms; hard, firm, or rubbery consistency; fixed mass; supraclavicular mass; lymph node larger than 2 cm in diameter; persistent enlargement for more than two weeks; no decrease in size after four to six weeks; absence of inflammation; ulceration; failure to respond to antibiotic therapy; or a thyroid mass), the patient should be referred to a head and neck surgeon for urgent evaluation and possible biopsy. Many things can cause cervical lymph node swelling, including: bronchitis. For lymphadenopathy that's caused by a bacterial infection, antibiotics will often be prescribed to help the infection resolve. Thank you so much for replying I am trying my best to keep it together for my wife and daughter and not letting my other kids notice I am worried about something. This content is owned by the AAFP. The presence of certain characteristic clinical syndromes may help the physician determine a suspected cause of lymphadenopathy. If the mass persists for six weeks, or enlarges after initial antibiotic therapy, a neoplastic lesion must be considered. Palpation of the lymph nodes provides information about the possible presence of a malignant or inflammatory process and the localization or generalization of that process. Homecare measures such as warm or cold compresses and getting . Most often, it's the node that drains the tonsil. By and large, children have weak immune systems and are prone to infections. Swollen lymph nodes are rarely caused by cancer. Lymph nodes in the neck are about half an inch to one-inch in size and appear the same on both sides. Causes ofswollen lymph nodes in kids may include the following: Lymph nodes can swell up when they themselves get infected. Vascular malformations present at birth and grow with the child, whereas hemangiomas develop a few weeks after birth and have a rapid growth phase. Lymph nodes are an important part of a body that help fight against infections and illnesses. Third, are there epidemiologic clues (Table 1) such as occupational exposures, recent travel or high-risk behaviors that suggest specific disorders? Verywell Health's content is for informational and educational purposes only. Nodes larger than four centimetres are serious, and medical intervention may be required. This occurs because lymphadenopathy is typically a response to a condition in the body, and the lymph nodes that become the most swollen are generally located near the primary condition. Lymph Node Exam Findings Size Insignificant if < 2cm In axilla and inguinal, insignificant if < 3cm In the supraclaviclar fossa > 1cm is significant Consistency Antibiotic therapy for suspected bacterial lymphadenitis should target Staphylococcus aureus and group A streptococcus. . We took her to the pharmacy initially and they thought it might be a cyst due to the location and size. The presence or absence of tenderness does not reliably differentiate benign from malignant nodes.4. The ent doc didnt seem to concerned because they werent huge but i was scared. Many young children temporarily develop swollen glands when they have an infection. And if your child has cancer, treatment may include surgery, chemotherapy, and radiation. Such assertions overestimate the probability of malignancy in patients with lymphadenopathy because they exclude the 97 percent of patients with lymphadenopathy who do not undergo a biopsy. A mass present since birth or discovered during the neonatal period is usually benign and developmental. Non-Hodgkin lymphoma may grow in lymph nodes under the skin (on the sides of the neck, in the underarm area, above the collar bone, or in the groin area). So what I'd say is focus on the positive outcome, stay away from Google as it only made me worse, reading medical journals etc. Reference article, Radiopaedia.org (Accessed on 18 Apr 2023) https://doi.org/10.53347/rID-15432, Case 1: right supraclavicular nodal metastases, Case 2: right supraclavicular necrotic metastases, View Stefano Pacifici's current disclosures, View Yuranga Weerakkody's current disclosures, see full revision history and disclosures, superior longitudinal muscle of the tongue, inferior longitudinal muscle of the tongue, levator labii superioris alaeque nasalis muscle, superficial layer of the deep cervical fascia, ostiomeatal narrowing due to variant anatomy. Acute infections with cytomegalovirus and Toxoplasma may be identified with IgM serology for those organisms. In children, enlarged lymph nodes that are rubbery, firm, immobile, or that persist for longer than six weeks or that enlarge during a course of antibiotics should be considered for biopsy. It can be quite large; over 1 inch (25 mm) across. Lymphoma, a cancer, may be the cause of supraclavicular lymph node swelling. An Overview of Axillary Lymphadenopathy (Swollen Lymph Nodes in the Armpit). Excision is recommended to confirm the diagnosis and to prevent future problems (e.g., potential growth, secondary infection).1 Patients with suppurative lymphadenitis or a neck abscess that does not respond to oral antibiotic therapy should be referred for intravenous antibiotics, possible incision and drainage, or further workup. But they can be tender or painful. Your child's healthcare provider will perform more diagnostic tests in these circumstances: The treatment for lymphadenopathy depends on the cause. [1] It leads to an appreciable mass that can be recognized clinically, called Troisier sign. Lymphadenopathy may be the only clinical finding or one of several nonspecific findings, and the discovery of swollen lymph nodes will often raise the specter of serious illness such as lymphoma, acquired immunodeficiency syndrome or metastatic cancer. In general, lymph nodes greater than 1 cm in diameter are considered to be abnormal. Inflammatory neck masses can be the result of reactive lymphadenopathy, infectious lymphadenitis (viral, staphylococcal, and mycobacterial infections; cat-scratch disease), or Kawasaki disease. If your daughter is otherwise well, with no major symptoms apart from this swelling I would take some comfortfrom my experience and see that it does happen and in all fairness not one of the doctors apart from my GP were too worried, they said it's pretty common after infections or something that's happened way before for a childto have node that is stubborn and won't settle down, thatin some cases may never fully reduce and be sortof scarred without any effect other than it's being a little larger than normal. Malignancies associated with supraclavicular lymph nodes are as follows (Note: supraclavicular lymphadenitis is an ominous sign of malignancy): Intrathoracic and intra-abdominal malignancies (Note: left-sided supraclavicular sentinel node or the Virchow node is highly suggestive of an occult abdominal neoplasm.) Over a week ago my 8 year old daughternoticed a lump on the left hand side ofher neck. Rajasekaran K, Krakovitz P. Enlarged neck lymph nodes in children. Specific to the right supraclavicular lymph node is the drainage of the mid-section of the chest, esophagus and lungs. The lymph nodes are filled with white blood cells. Generalized lymphadenopathy may be related to a viral infection, autoimmune disorder, or disseminated diseases. Location. Usually, there is nothing to worry if a child has enlarged lymph nodes. should not be construed as a substitute for advice from a medical professional or health care provider. A new, rapidly growing mass is usually inflammatory. The most helpful findings are rash, mucous membrane lesions, hepatomegaly, splenomegaly or arthritis (Table 4). 2000;174 (3): 837-44. Very firm, rubbery nodes suggest lymphoma. Lymph nodes are present throughout the body. While anyone with a suspicious lump should see a doctor, there are many simple causes of a lump in this area, including swollen lymph nodes from . If lymph nodes are detected, the following five characteristics should be noted and described: Size. Node gets 1 inch (2.5 cm) or larger in size. ear infection. Enlargement of the lymph nodes that persists for at least three months in at least two extrainguinal sites is defined as persistent generalized lymphadenopathy and is common in patients in the early stages of HIV infection. Certain lymph nodes, especially the supraclavicular, epitrochlear, and popliteal glands, are rarely swollen, even in children. Enlarged lymph nodes. Bacterial and viral throat infections, respiratory infections, tooth decay, ear infections, and various autoimmune conditions can cause swollen lymph nodes in children. Certain lymph nodes, especially the supraclavicular, epitrochlear, and popliteal glands, are rarely swollen, even in children. Supraclavicular lymphadenopathy Axillary lymphadenopathy Inguinal lymphadenopathy Cervical lymphadenopathy Epitrochlear lymphadenopathy Other localized lymphadenopathy DIAGNOSTIC TESTS CBC and ESR/CRP Lactate dehydrogenase Cultures and serology Tuberculin skin test Chest radiograph Ultrasonography Trial of antibiotic therapy Lymph node biopsy You, the reader, assume full responsibility for how you choose to use it. 2002;222 (1): 245-51. elevators, retractors and evertors of the upper lip, depressors, retractors and evertors of the lower lip, embryological development of the head and neck. Consistency. They are often first noticed by the child, parent, or a health care provider. Your In contrast, the prevalence of malignancy in lymph node biopsies performed in referral centers is 40 to 60 percent,5 a statistic that has made its way into many textbooks (e.g., In those more than 30 years of age, however, lymphadenopathy is due to a benign process only 40 percent of the time6). Lymphocyte activity against the microbes results in swelling of the lymph nodes. Of 2,556 patients in the study who presented with unexplained lymphadenopathy to their family physicians, 256 (10 percent) were referred to a subspecialist and 82 (3.2 percent) required a biopsy, but only 29 (1.1 percent) had a malignancy. Detection and diagnosis of nonpalpable supraclavicular lymph nodes in lung cancer at CT and US. By Vincent Iannelli, MD I was still not convinced so asked the ENT for another opinion there and then, she got the most senior specialist to pop in who said the same thing and said he wouldarrange an ultrasound just to "put my mindat ease"and "put it to bed". If the lymphadenopathy is localized, the decision about when to biopsy is more difficult. This causesswollen lymph nodes in childrens neck on one sideand is quite large, measuring to about one inch. After the infection is gone, the nodes slowly return to normal size. Developmental masses may present later in life, either with superimposed infection or with growth over time. It is normal to notice small lymph nodes in children; however, if they get bigger, it is a sign of an infection. Can Swollen Lymph Nodes Be a Symptom of Breast Cancer? Check for errors and try again. Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Supraclavicular lymph node metastasis has been reported to be more common in patients with lung and breast tumors (18.7% and 18.6%, respectively) [ 1, 2 ]. I'm waiting for the ENT appointment for my 8 year old daughter who has a large left supraclavicular swelling. your doctor. Lymphadenopathy may cause symptoms due to pressure on nearby structures. Computed tomography with intravenous contrast media is recommended for evaluating a malignancy or a suspected retropharyngeal or deep neck abscess. Pain/Tenderness. An enlarged node can be the first sign of gastric cancerand is often called Virchow's node, because the association between left supraclavicular lymphadenopathy and gastric cancer was first described by the German pathologist Rudolf Virchow (1821-1902). Sometimes the body is not able to effectively fight an infection, or the immune system is impaired. If your child has allergies or an autoimmune condition, you and your child's pediatrician will have to discuss a long-term plan to minimize the recurrence of symptoms. strep throat. We waited for the scan a few weeks and that was a grim wait, but we went and they couldn't give use results right away,but I asked their opinion and again the radiologist said it looked ok to him but he needed to wait for the the main consultant to look and write us back. Read our. Rarely, lymph nodes can enlarge due to cancer. If possible, the physician should not select inguinal and axillary nodes for biopsy, since they frequently show only reactive hyperplasia. Laboratory studies may be indicated if there is concern about a systemic disease or to confirm a diagnosis suspected from the history and physical examination. When, after the initial evaluation and after exploration of the diagnostic and suggestive branches of the algorithm (Figure 2), a cause for the lymphadenopathy remains unexplained, the physician must decide whether to pursue a specific diagnosis. We took her to the pharmacy initially and they thought it might be a cyst due to the location and size. The enlarged nodes are often seen or felt as lumps under the skin and are not usually painful. The classic cause is tularemia, acquired by contact with an infected rabbit or tick; more common causes include streptococcal infection (e.g., impetigo), cat-scratch disease and Lyme disease. When indicated, ultrasonography is the preferred initial imaging study for most children with a neck mass. I'm going to cling to your story and stop googling as I'm driving myself mad with worry. [] In children with inguinal adenopathy or abdominal complaints, ultrasonography or CT scanning of the abdomen (or both) may be indicated. Lymph fluid includes white blood cells and proteins to help fight infections. This would be considered a red flag to healthcare providers that further investigations are needed. Ultrasonography is the preferred imaging study for a developmental or palpable mass. Localized adenopathy should prompt a search for an adjacent precipitating lesion and an examination of other nodal areas to rule out generalized lymphadenopathy. I cryed for weeks untill he told me he could cope with that but not me crying all the time .. so I turned it around and learned everything I could to keep him healthy .. though I nearly lost him twice to hypos Once I took it on, we all coped better it's like my cancer now it's looking it square in the eye, and getting ready to fight it all the way .. then my lad panicked over me till we got that in control too .. you'll always find someone here to chat too .. we know how scary the weight is so if you need to yell or vent or just chat .. this is the place Chrissie x, my son 9 years old is going through the same. Male patient have suffered more (60%) from malignant disease than that of female patient (40%). They filter the lymph fluid coming from certain parts of the body. Lymph nodes are described by their location and include: Along with their location, the distribution of swollen lymph nodes can help your child's healthcare provider determine the cause of the swelling. Neck masses in children typically fall into one of three categories: developmental, inflammatory/reactive, or neoplastic (Table 1). Patients with a benign clinical history, an unremarkable physical examination and no constitutional symptoms should be reexamined in three to four weeks to see if the lymph nodes have regressed or disappeared. When a lymph node rapidly increases in size, its capsule stretches and causes pain. When lymph nodes become infected, it's usually because an infection started somewhere else in your body. The information is intended to provide a framework for the approach to the evaluation of peripheral lymphadenopathy in children and to supplement clinical judgment in the absence of research that directly addresses how children with unexplained lymphadenopathy should be evaluated. If your swollen lymph nodes are a result of certain conditions, such as lupus or rheumatoid arthritis, treatment is directed at the underlying condition. The lymph nodes are part of the body's lymphatic system, which includes lymph fluid, lymph vessels, the tonsils, the thymus gland, and the spleen. If your child has a sore throat, fever, and the lymph nodes continue to grow or do not go away for weeks, take your child to a doctor. An over all extremely scary time and the relief was unbelievable, I hope this puts some people's minds at ease. I know what it's like with our babies .. when my lad was young he got diagnosed type one diabetic and his life changed from that day .. but you know, we have to hold it together for our babies .. that's what we do .. panic inside but look calm outside for them and fingers crossed for a good result try to keep busy as poss there's far more have these tests and it turns out something else Chrissie x. The algorithm in Figure 2 provides a diagnostic framework for the evaluation of lymphadenopathy. Axillary lymphadenopathy can cause tenderness under the arms, with increased pain when a child moves their arms. Enlarged cervical lymph nodes can cause neck pain and may make it uncomfortable to lie down. Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Swollen lymph nodes often do not cause symptoms. Refer urgently children or young people: with one or more of the following (particularly if there is no evidence of local infection): non-tender, firm or hard lymph nodes ; lymph nodes greater than 2 cm in size; lymph nodes progressively enlarging ; other features of general ill-health, fever or weight loss Application of a prediction rule to select which patients presenting with lymphadenopathy should undergo a lymph node biopsy. (2008) ISBN:0443066841. Lymphadenopathy in children Lymphadenopathy (or 'swollen glands') is very common in children. 2. Pain is usually the result of an inflammatory process or suppuration, but pain may also result from hemorrhage into the necrotic center of a malignant node. Supraclavicular lymph nodes or those in the posterior triangle (behind or lateral to the sternocleidomastoid muscle) have a higher incidence of malignancy than lymph nodes in the anterior triangle (anterior or medial to the sternocleidomastoid muscle).2 Generalized or multiple anatomic sites of lymphadenopathy increase the chance of malignancy.7,8. Supraclavicular nodes of any size at any age . Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Sometimeslow-gradeinfections can take place during shaving of the legs. Common benign neoplastic lesions include pilomatrixomas, lipomas, fibromas, neurofibromas, and salivary gland tumors. Churchill Livingstone. In other cases, the diagnosis is less clear. Findings from this Dutch study revealed a 0.6 percent annual incidence of unexplained lymphadenopathy in the general population. Associated symptoms, such as persistent or unexplained fever, unintentional weight loss, fatigue, and night sweats can be signs of a serious condition. Congenital neck masses are excised to prevent potential growth and secondary infection of the lesion. Please don't over Google things, I have two masteresdegrees so can churn through academic journals and looking at medical journals I had convinced myself of the worst, so please take time away and trust the process. Large lymph nodes and supraclavicular nodes are potential indicators of serious pathology. As the infection is treated and resolves, these lymph nodes eventually revert back to . The supraclavicular lymph nodes (often shortened to the supraclavicular nodes) are a paired group of lymph nodes located on each side in the hollow superior to the clavicle, close to the sternoclavicular joint. Moreover, since younger children have an average of six to eight upper respiratory tract infections per year, it may seem like your child's lymph nodes are always enlarged. Epstein-Barr virus infection may be confirmed by repeating the Monospot test in seven to 10 days. Cancer. Most malignant neck masses in children are asymptomatic and are not painful.4 However, acute infection in a necrotic, malignant lymph node can also occur. Only one node is involved. They are tiny filters that are responsible for catching the virus and bacteriathat infect the body, after which the white blood cells come in and destroy them. Author disclosure: No relevant financial affiliations. A complete blood count with differential is recommended in patients with a history and physical examination suggestive of infection or malignancy; however, good evidence to support the value of routine complete blood count is lacking. Imaging-based nodal classification for evaluation of neck metastatic adenopathy. After completing this article, readers should be able to: Examining the lymph nodes is an important aspect of the general physical examination of both well and ill children and adolescents. Lymphadenitis Lymph nodes can swell up when they themselves get infected. If they have a bacterial infection, antibiotics may be prescribed, whereas painkillers may be prescribed for tenderness and pain. Viral infections are generally not treated with medications and they resolve on their own. Normal lymph nodes are smaller than inch or 12 mm. It is a sign of the nodes doing their job and fighting off infections that the child may have as in the case of mesenteric adenitis, where there are swollen lymph nodes in the stomach that go away on their own with time. But, there is no need to worry. Sometimes lymphadenopathy is monitored as part of the surveillance for assessing the effectiveness of cancer treatment. Swollen lymph nodes alone cannot be spread to others. This is when the body's immune system overreacts to a harmless substance, such as pollen or pet dander. Schmitt Pediatric Guidelines LLC. This syndrome involves the combination of conjunctivitis and associated preauricular nodes. This would be considered a red flag to healthcare providers that further investigations are needed. This reaction is normal. Enlarged lymph nodes in different parts of the body may be caused due to different infections. We waited a few weeks and got that appointment, we went in the she was scanned quickly, they could give me results there and then but did say that the radiologist thought it look normal.

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