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| | [[File:ImageLymphadenopathy.jpg|300px|thumb|right|Lymphadenopathy]] |
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| __NOTOC__ | | __NOTOC__ |
| {{Infobox_Disease | | | {{Lymphadenopathy}} |
| Name = Lymphadenopathy |
| | {{CMG}},{{shyam}};{{AE}} {{ADS}}, {{RT}} [[Ogechukwu Hannah Nnabude, MD]] |
| ICD10 = {{ICD10|I|88||i|80}}, {{ICD10|L|04||l|00}}, {{ICD10|R|59|1|r|50}} |
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| ICD9 = {{ICD9|289.1}}-{{ICD9|289.3}}, {{ICD9|683}}, {{ICD9|785.6}} |
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| ICDO = |
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| Image = Lymphadenopathy 001.jpg|
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| Caption = Lymphadenopathy|
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| OMIM = |
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| MedlinePlus = |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| DiseasesDB = 22225 |
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| MeshID = D008206 |
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| }}
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| {{SI}}
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| {{CMG}}; {{AE}} {{RT}}
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| '''''Synonyms and keywords:''''' Lymph nodes enlarged, enlarged lymph nodes, lymphadenitis, swollen/enlarged lymph nodes
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| | {{SK}} Lymph nodes enlarged; Enlarged lymph nodes; Lymphadenitis; Swollen lymph nodes; Swollen/enlarged lymph nodes<br> |
| | '''For patient information, click [[Xyz (patient information)|here]]''' |
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| ==Overview== | | ==Overview== |
| '''Lymphadenopathy''' is a term meaning "disease of the [[lymph nodes]]." It is, however, almost synonymously used with "swollen/enlarged lymph nodes". When the infection is of the lymph nodes themselves, it is called '''lymphadenitis''', but when the infection is of the lymph channels, it is called '''[[lymphangitis]]'''.
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| ==Classification==
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| Depending upon the involvement of the lymph nodes, lymphadenopathy is classified as 3 types.
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| * '''Localized lymphadenopathy''' : due to localized spot of [[infection]] e.g. an infected spot on the scalp will cause lymph nodes in the neck on that same side to swell up
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| * [[Generalized lymphadenopathy]] : due to generalized infection all over the body e.g. [[influenza]]
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| ** [[Persistent generalized lymphadenopathy]] (PGL) : persisting for a long time, possibly without an apparent cause
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| * [[Dermatopathic lymphadenopathy]] : lymphadenopathy associated with skin disease.[[Tangier disease]] (ABCA1 deficiency) may also cause this.
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| ==Pathophysiology== | | ==[[Lymphadenopathy classification|Classification]]== |
| * If an [[infection]] remains untreated, the center of the node may become necrotic, resulting in the accumulation of fluid and debris within the structure. This is known as an abscess and feels a bit like a tensely filled balloon or grape (a.k.a. fluctuance). Knowledge of which nodes drain specific areas will help search efficiently. Following infection, lymph nodes occasionally remain permanently enlarged, though they should be non-tender, small (less the 1 cm), have a rubbery consistency. It is common, for example, to find small, palpable nodes in the submandibular/tonsilar region of otherwise healthy individuals. This likely represents sequelae of past pharyngitis or dental infections.
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| * [[Malignancies]] may also involve the lymph nodes, either primarily (e.g. [[lymphoma]]) or as a site of metastasis. In either case, these nodes are generally firm, non-tender, matted (i.e. stuck to each other), fixed (i.e. not freely mobile but rather stuck down to underlying tissue), and increase in size over time. The location of the lymph node may help to determine the site of malignancy. Diffuse, bilateral involvement suggests a systemic malignancy (e.g. lymphoma) while those limited to a specific anatomic region are more likely associated with a local problem. Enlargement of nodes located only on the right side of the neck in the anterior cervical chain, for example, would be consistent with a [[squamous cell carcinoma]], frequently associated with an intra-oral primary cancer.
| | ==[[Lymphadenopathy pathophysiology|Pathophysiology]]== |
| * Diffuse upper airway infections (e.g. [[mononucleosis]]), systemic infections (e.g. [[tuberculosis]]) and inflammatory processes (e.g. [[sarcoidosis]]) can also cause lymphadenopathy (i.e. lymph node enlargement). This can be either symmetric or asymmetric.
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| ===Microscopic pathology=== | | ==Histopathology== |
| ===Patterns of Benign (Reactive) Lymphadenopathy===
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| There are three distinct patterns of benign lymphadenopathy:
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| * Follicular hyperplasia. Seen in infections, autoimmune disorders, and nonspecific reactions.
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| * Paracortical hyperplasia. Seen in viral infections, skin diseases, and nonspecific reactions.
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| * Sinus histiocytosis. Seen in lymph nodes draining limbs, inflammatory lesions, and malignancies.
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| ==Causes== | | ==Causes== |
| ===Common Causes===
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| * Acute [[infection]]s (e.g. [[bacterial]], or [[virus|viral]])
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| * Chronic infections (e.g [[tuberculous lymphadenitis]], [[cat-scratch disease]]). Infectious [[mononucleosis]] is an acute viral infection, the hallmark of which is marked enlargement of the [[cervical lymph nodes]].
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| *[[Toxoplasmosis]], a [[parasitic disease]], gives a generalized lymphadenopathy<ref name=Status/>
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| * [[Hodgkin lymphoma]], [[non-Hodgkin lymphoma]], [[hairy cell leukemia]], give lymphadenopathy in all or a few lymph nodes <ref name=Status> Status and anamnesis, Anders Albinsson. Page 12 </ref>
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| * [[Metastasis]]
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| * [[Sarcoidosis]]
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| * [[Systemic lupus erythematosus]] ([[SLE]])
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| * [[Rheumatoid arthritis]]
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| * [[AIDS]]. Generalized lymphadenopathy is an early sign of infection with [[human immunodeficiency virus]] (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS). "Lymphadenopathy syndrome" has been used to describe the first symptomatic stage of [[HIV]] progression, preceding [[AIDS-related complex]] and full-blown [[AIDS]].<ref>{{cite web|url=http://www.aproposinc.com/hap/types.htm|title=Understanding and Preventing AIDS: A Book for Everyone|author=Chris Jennings|year=1993}}</ref>
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| ===Causes by Organ System===
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| ===Causes in Alphabetical Order===
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| <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
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| {{MultiCol}}
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| *[[Acute lymphoblastic leukemia]]
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| *[[Acute lymphocytic leukemia]]
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| *Adult [[T cell leukemia]]
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| *[[African Sleeping sickness]]
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| *[[AIDS]]
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| *[[Amyloidosis]]
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| *[[Angioimmunoblastic lymphadenopathy]]
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| *[[Angioimmunoblastic with dysproteinemia lymphadenopathy]]
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| *[[Anthrax]]
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| *[[Aphthous stomatitis]]
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| *[[Apo A-I deficiency]]
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| *[[Autoimmune lymphoproliferative syndrome type 1]]
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| *[[Bartonella]]
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| *[[Bejel]]
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| *[[Black widow spider envenomation]]
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| *[[Borrelia burgdorferi]]
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| *[[Bortonneuse fever]]
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| *[[Breast cancer]]
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| *[[Brucellosis]]
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| *[[Caspase-8 deficiency]]
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| *[[Castleman's disease]]
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| *[[Cat scratch disease]]
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| *[[Chagas' disease]]
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| *[[Chediak-Higashi syndrome]]
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| *[[Chronic lymphocytic leukemia]]
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| *[[Churg-Strauss syndrome]]
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| *[[Coccidioidomycosis]]
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| *[[Colorectal cancer]]
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| *[[Common Variable Immunodeficiency]]
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| *[[Congenital Toxoplasmosis]]
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| *[[Congenital tuberculosis]]
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| *[[Cowpox]]
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| *[[Coxsackie virus]] infections
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| *[[Cutaneous leishmaniasis]]
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| *[[Cutaneous T cell lymphoma]]
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| *[[Cystic hygroma]]
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| *[[Cytomegalovirus infection]]
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| *[[Dengue]]
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| *[[Drug reaction]]
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| *[[Erysipelas]]
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| *[[Erythroderma]]
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| *[[Extrinsic allergic alveolitis]]
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| *[[Faisalabad histiocytosis]]
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| *[[Familial alphalipoprotein deficiency]]
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| *[[Familial hemophagocytic lymphohistiocytosis]]
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| *[[Familial histiocytic reticulosis]]
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| *[[Filaria]]
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| *[[Fungal blastomycosis]]
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| *[[Gamma heavy chain disease]]
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| *[[German Measles]]
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| *[[Gingivostomatitis]]
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| *[[Granuloma inguinale]]
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| *[[Griscelli disease]]
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| *[[Hairy cell leukaemia]]
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| *[[Hemangiopericytoma]]
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| *[[Hemoblastosis]]
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| *[[Hemophagocytic reticulosis]]
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| *[[Hepatitis A]]
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| *[[Hepatitis B]]
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| *[[Herpes simplex]]
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| *[[Histiocytosis X]]
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| *[[Histoplasmosis]]
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| *[[Hodgkin's Lymphoma]]
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| *[[Hyperimmunoglobulinemia D and periodic fever syndrome]]
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| *[[Hyperthyroidism]]
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| *[[Idiopathic]]
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| *[[Infantile papular acrodermatitis]]
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| *[[Infectious mononucleosis]]
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| *[[Influenza]]
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| *[[Juvenile chronic arthritis]]
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| *[[Large granular lymphocyte leukemia]]
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| *[[Lassa fever]]
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| *[[Leishmaniasis]]
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| *[[Lepromatous leprosy]]
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| *[[Leukemia]]
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| *[[Lip cancer]]
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| *[[Lipogranulomatosis]]
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| *[[Listeriosis]]
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| *[[Lymphangioma]]
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| *[[Lymphatic filariasis]]
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| *[[Lymphogranuloma venereum]]
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| *[[Lymphoma]]
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| *[[Macroglobulinemia]]
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| *[[Malignant lymphoma]]
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| *[[Metastasis]]
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| *[[Mastitis]]
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| *[[Measles]]
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| *[[Melanoma]]
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| *[[Merkel cell carcinoma]]
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| *[[Mesenteric adenitis]]
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| *[[Moraxella catarrhalis]]
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| *[[Mucocutaneous leishmaniasis]]
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| *[[Mumps]]
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| *[[Mycobacterium avium-intracellulare]]
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| *[[Mycobacterium chelonei]]
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| *[[Mycosis fungoides]]
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| *[[Myeloproliferative disorder]]
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| *[[Non-Hodgkin's Lymphoma]]
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| *[[Onchocerciasis]]
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| *[[Opisthorchiasis]]
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| *[[Pancoast tumor]]
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| *[[Paracoccidioidomycosis]]
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| *[[Penicillium marneffei]]
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| *[[Phenytoin]]
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| *[[Pinta]]
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| *[[Plague]]
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| *[[Plasma cell leukemia]]
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| *[[Pneumoconiosis]]
| | ==[[Lymphadenopathy differential diagnosis|Differentiating Lymphadenopathy from other Diseases]]== |
| | ==[[Epidemiology and Demographics]]== |
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| {{ColBreak}}
| | ==Laboratory Evaluation of Lymphadenopathy== |
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| *[[Primary autoimmune haemolytic anaemia]]
| | ==Diagnostic Radiological Testing== |
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| *[[Protozoa]]
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| *[[Pseudolymphoma]]
| | ==Treatment== |
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| *[[Radiotherapy]]
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| *[[Rat-bite fever]]
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| *[[Reticuloendotheliosis]]
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| *[[Rhabditida Infections]]
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| *[[Rhabdomyosarcoma]]
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| *[[Rheumatoid arthritis]]
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| *[[Rickettsiae]]
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| *[[Rubella]]
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| *[[Sarcoidosis]]
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| *[[Scrub typhus]]
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| *[[Secondary deposits from a local malignancy]]
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| *[[Secondary syphilis]]
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| *[[Sennetsu fever]]
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| *[[Septicaemia]]
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| *[[Serum sickness]]
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| *[[Siccardi syndrome]]
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| *[[Sinus histiocytosis]]
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| *[[SLE]]
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| *[[Smallpox]]
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| *[[Snake bite (Viperidae)]]
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| *[[Sphingomyelinase deficiency]]
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| *[[Spider bite]]
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| *[[Sporotrichosis]]
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| *[[Spotted fevers]]
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| *[[Sexually transmitted diseases]]
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| *[[Still's Disease]] - Juvenile-Onset
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| *[[Stomach cancer]]
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| *[[Streptococcal tonsillitis]]
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| *[[Syphilis]]
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| *[[Systemic lupus erythematosus]]
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| *[[Systemic mastocytosis]]
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| *[[Tang Hsi Ryu syndrome]]
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| *[[Three-day fever]]
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| *[[Toxoplasmosis]]
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| *[[Trypanosomiasis]]
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| *[[Tuberculosis]]
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| *[[Tularemia]]
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| *[[Typhoid vaccination]]
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| *[[Typhus fever]]
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| *[[Vaccination]]
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| *[[Varicella]]
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| *[[Vincent's angina]]
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| *[[Visceral leishmaniasis /Kala-azar]]
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| *[[Waldenström macroglobulinaemia]]
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| *[[Western equine encephalitis]]
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| *[[Whipple's disease]]
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| *[[WT limb blood syndrome]]
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| *[[Wuchereria bancrofti]]
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| *[[X-linked agammaglobulinaemia]]
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| *[[X-linked lymphoproliferative syndrome]]
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| *[[Yaws]]
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| *[[Yersinia pestis]]
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| {{EndMultiCol}}
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| ===Bihilar lymphadenopathy===
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| The causes can divide into the four commonest:
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| *[[Tuberculosis]]
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| *[[Sarcoidosis]]
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| *[[Lymphoma]]
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| *Other malignancies
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| Less common causes include:
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| *[[Churg-Strauss syndrome]]
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| *[[Human Immunodeficiency Virus]]
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| *[[Extrinsic allergic alveolitis]]
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| *[[Pneumoconiosis]]
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| ==Differentiating from other diseases==
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| ==Epidemiology and Demogaphics==
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| ==Risk factors==
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| ==Natural History, Complications, Prognosis==
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| ==Diagnosis==
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| ===Symptoms===
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| ===Physical examination===
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| The major lymph node groups are located along the anterior and posterior aspects of the neck and on the underside of the jaw. If the nodes are quite big, you may be able to see them bulging under the skin, particularly if the enlargement is asymmetric (i.e. it will be more obvious if one side is larger then the other). To palpate, use the pads of all four fingertips as these are the most sensitive parts of your hands. Examine both sides of the head simultaneously, walking your fingers down the area in question while applying steady, gentle pressure. The major groups of lymph nodes as well as the structures that they drain, are listed below. The description of drainage pathways are rough approximations as there is frequently a fair amount of variability and overlap.
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| ====Palpating Anterior Cervical Lymph Nodes====
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| Nodes are generally examined in the following order:
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| # Anterior Cervical (both superficial and deep): Nodes that lie both on top of and beneath the sternocleidomastoid muscles (SCM) on either side of the neck, from the angle of the jaw to the top of the clavicle. This muscle allows the head to turn to the right and left. The right SCM turns the head to the left and vice versa. They can be easily identified by asking the patient to turn their head into your hand while you provide resistance. Drainage: The internal structures of the throat as well as part of the posterior pharynx, tonsils, and thyroid gland.
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| # Posterior Cervical: Extend in a line posterior to the SCMs but in front of the trapezius, from the level of the mastoid bone to the clavicle. Drainage: The skin on the back of the head. Also frequently enlarged during upper respiratory infections (e.g. mononucleosis).
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| # Tonsillar: Located just below the angle of the mandible. Drainage: The tonsilar and posterior pharyngeal regions.
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| # Sub-Mandibular: Along the underside of the jaw on either side. Drainage: The structures in the floor of the mouth.
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| # Sub-Mental: Just below the chin. Drainage: The teeth and intra-oral cavity.
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| # Supra-clavicular: In the hollow above the clavicle, just lateral to where it joins the sternum. Drainage: Part of the throacic cavity, abdomen.
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| A number of other lymph node groups exist. However, palpation of these areas is limited to those situations when a problem is identified in that specific region (e.g. the pre-auricular nodes, located in front of the ears, may become inflamed during infections of the external canal of the ear).
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| Lymph nodes are part of the immune system. As such, they are most readily palpable when fighting infections. Infections can either originate from the organs that they drain or primarily within the lymph node itself, referred to as lymphadenitis. Infected lymph nodes tend to be:
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| * Firm, tender, enlarged and warm. Inflammation can spread to the overlying skin, causing it to appear reddened.
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| Malignancies may also involve the lymph nodes, either primarily (e.g. lymphoma) or as a site of metastasis. In either case, these nodes are generally:
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| * Firm, non-tender, matted (i.e. stuck to each other), fixed (i.e. not freely mobile but rather stuck down to underlying tissue), and increase in size over time.
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| ===Case Studies in Physical Examination===
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| (Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:head_scc1.jpg|Cervical Adenopathy: Massive right side cervical adenopathy and facial assymetry due to metastatic, intraoral squamous cell cancer.
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| Image:head_scc2.jpg|Cervical Adenopathy: Massive right side cervical adenopathy and facial assymetry due to metastatic, intraoral squamous cell cancer.
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| Image:head_cervical_ln.jpg|Cervical Adenopathy: Large right anterior cervical lymph node.
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| Image:head_cneck_adenop1.jpg|Cervical Adenopathy: Multiple right sided cervical lymph nodes.
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| </gallery>
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| </div>
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| ===Lab findings===
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| ===Imaging===
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| ====Chest X Ray====
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| Bihilar lymphadenopathy is a [[radiography|radiographic]] term that describes the enlargement of [[mediastinal]] [[lymph]] nodes. It is easily and most commonly identified by a [[chest x-ray]].
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Sarcoidosis_Lymphadenopathy.jpg|Sarcoidosis bilateral hilar lymphadenopathy, non-caseating granulomas<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages</ref>
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| </gallery>
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| </div>
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| ====CT====
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| [[Image:Sarcoidosis-CT.jpeg.jpeg|thumb|left|[[CT]] scan of the chest showing lymphadenopathy in the mediastinum due to [[sarcoidosis]].]]{{clr}}
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| ====Biopsy====
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| [[Image:Dermatopathic lymphadenopathy.JPG|left|200px|[[Micrograph]] of [[dermatopathic lymphadenopathy]], a type of lymphadenopathy. [[H&E stain]]]]
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| {{Clr}}
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
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| | [[Category: Oncology]] |
| [[Category:Inflammations]] | | [[Category:Inflammations]] |
| [[Category:Dermatology]] | | [[Category:Dermatology]] |
| [[Category:Signs and symptoms]] | | [[Category:Medical signs]] |
| [[Category:Infectious disease]] | | [[Category: Signs and symptoms]] |
| [[Category:Hematology]]
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| [[Category:Oncology]]
| | [[Category: Physical examination]] |
| [[Category:Physical examination]] | | |
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| <br>
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| [[de:Lymphadenopathie]]
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| [[fr:Adénopathie]]
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| [[he:לימפדנופתיה]]
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| [[id:Limfadenopati]]
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| [[lt:Limfadenitas]]
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| [[pt:Linfadenopatia]]
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| [[ru:Лимфаденопатия]]
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