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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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| '''For patient information on this page, click [[Lymphadenopathy (patient information)|here]]'''
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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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| {|style="width:80%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| [[Erythroderma]], [[Infantile papular acrodermatitis]], [[Melanoma]], [[Merkel cell carcinoma]], [[Mycosis fungoides]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| [[Allopurinol]], [[Atenolol ]], [[Captopril]], [[Carbamazepine ]], [[Cephalosporins]], [[Gold]], [[Hydralazine]], [[Penicillin]], [[Phenytoin]], [[Phenytoin]], [[Primidone]], [[Pyrimethamine]], [[Quinidine]], [[Sulfonamides]], [[Sulindac]], [[Yaws]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| [[Hyperthyroidism]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| [[Hepatitis A]], [[Hepatitis B]], [[Mesenteric adenitis]], [[Stomach cancer]], [[Tang Hsi Ryu syndrome]], [[Whipple's disease]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| [[Familial alphalipoprotein deficiency]], [[Familial hemophagocytic lymphohistiocytosis]], [[Familial histiocytic reticulosis]], [[X-linked agammaglobulinaemia]], [[X-linked lymphoproliferative syndrome]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| [[Acute lymphoblastic leukemia]], [[Acute lymphocytic leukemia]], [[Adult T cell leukemia]], [[Autoimmune lymphoproliferative syndrome type 1]], [[Castleman's disease]], [[Chronic lymphocytic leukemia]], [[Cutaneous T cell lymphoma]], [[Familial hemophagocytic lymphohistiocytosis]], [[Familial histiocytic reticulosis]], [[Faisalabad histiocytosis]], [[Gamma heavy chain disease]], [[Hairy cell leukaemia]], [[Hemoblastosis]], [[Hemophagocytic reticulosis]], [[Histiocytosis X]], [[Hodgkin's Lymphoma]], [[Hyperimmunoglobulinemia D and periodic fever syndrome]], [[Large granular lymphocyte leukemia]], [[Leukemia]], [[Lipogranulomatosis]], [[Lymphangioma]], [[Lymphoma]], [[Macroglobulinemia]], [[Myeloproliferative disorder]], [[Non-Hodgkin's Lymphoma]], [[Primary autoimmune haemolytic anaemia]], [[Plasma cell leukemia]], [[Reticuloendotheliosis]], [[Sinus histiocytosis]], [[Systemic mastocytosis]], [[Waldenström macroglobulinaemia]], [[X-linked agammaglobulinaemia]], [[X-linked lymphoproliferative syndrome]], [[WT limb blood syndrome]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| '''Bacteria''':
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| [[Anthrax]], [[Borrelia burgdorferi]], [[Bortonneuse fever]], [[Brucellosis]], [[Cat scratch disease]], [[Congenital tuberculosis]], [[Erysipelas]], [[Granuloma inguinale]], [[Lepromatous leprosy]], [[Listeriosis]], [[Lymphogranuloma venereum]], [[Mastitis]], [[Moraxella catarrhalis]], [[Mycobacterium avium-intracellulare]], [[Mycobacterium chelonei]], [[Pinta]], [[Plague]], [[Rat-bite fever]], [[Rickettsiae]], [[Scrub typhus]], [[Sennetsu fever]], [[Septicaemia]], [[Spotted fevers]], [[Streptococcal tonsillitis]], [[Syphilis]], [[Three-day fever]], [[Tuberculosis]], [[Tularemia]], [[Typhus fever]], [[Vincent's angina]], [[Yersinia pestis]]
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| '''Virus''':
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| [[AIDS]], [[Cowpox]], [[Coxsackie virus]], [[Cytomegalovirus infection]], [[Dengue]], [[German Measles]]/[[Rubella]], [[Hepatitis A]], [[Hepatitis B]], [[Herpes simplex]], [[Infectious mononucleosis]], [[Influenza]], [[Lassa fever]], [[Measles]], [[Mumps]], [[Smallpox]], [[Varicella]], [[Western equine encephalitis]]
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| '''Fungal''':
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| [[Coccidioidomycosis]], [[Blastomycosis]], [[Histoplasmosis]], [[Sporotrichosis]]
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| '''Parasitic''':
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| [[African Sleeping sickness]], [[Chagas' disease]], [[Congenital Toxoplasmosis]], [[Filaria]], [[Lymphatic filariasis]], [[Onchocerciasis]], [[Opisthorchiasis]], [[Paracoccidioidomycosis]], [[Rhabditida Infections]], [[Toxoplasmosis]], [[Trypanosomiasis]], [[Visceral leishmaniasis]] /[[Kala-azar]], [[Wuchereria bancrofti]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| [[Juvenile chronic arthritis]], [[WT limb blood syndrome]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| [[Tang Hsi Ryu syndrome]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| [[Apo A-I deficiency]], [[Sphingomyelinase deficiency]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| [[Acute lymphoblastic leukemia]], [[Acute lymphocytic leukemia]], [[Adult T cell leukemia]], [[Breast cancer]], [[Colorectal cancer]], [[Chronic lymphocytic leukemia]], [[Hemangiopericytoma]], [[Lip cancer]], [[Malignant lymphoma]], [[Melanoma]], [[Metastasis]], [[Non-Hodgkin's Lymphoma]], [[Pancoast tumor]], [[Pseudolymphoma]], [[Rhabdomyosarcoma]], [[Stomach cancer]], [[Cutaneous T cell lymphoma]], [[Hairy cell leukaemia]], [[Hodgkin's Lymphoma]], [[Large granular lymphocyte leukemia]], [[Lymphoma]], [[Plasma cell leukemia]], [[Merkel cell carcinoma]], [[Mycosis fungoides]], [[WT limb blood syndrome]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| [[Extrinsic allergic alveolitis]], [[Pneumoconiosis]], [[Sarcoidosis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| [[Angioimmunoblastic lymphadenopathy]], [[Angioimmunoblastic with dysproteinemia lymphadenopathy]], [[Autoimmune lymphoproliferative syndrome type 1]], [[Caspase-8 deficiency]], [[Chediak-Higashi syndrome]], [[Churg-Strauss syndrome]], [[Common Variable Immunodeficiency]], [[Extrinsic allergic alveolitis]], [[Griscelli disease]], [[Primary autoimmune haemolytic anaemia]], [[Rheumatoid arthritis]], [[Serum sickness]], [[Siccardi syndrome]], [[Still's Disease]], [[Systemic lupus erythematosus]]/[[SLE]], [[Sarcoidosis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| [[Amyloidosis]], [[Aphthous stomatitis]], [[Bejel]], [[Black widow spider envenomation]], [[Cystic hygroma]], [[Gingivostomatitis]], [[Idiopathic]], [[Radiotherapy]], [[Snake bite]] (Viperidae), [[Spider bite]], [[Vaccination]]
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| |-
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| |}
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| ===Causes in Alphabetical Order<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]]<ref name="pmid21901632">{{cite journal |author=Blum JA, Neumayr AL, Hatz CF |title=Human African trypanosomiasis in endemic populations and travellers |journal=Eur. J. Clin. Microbiol. Infect. Dis. |volume=31 |issue=6 |pages=905–13 |year=2012 |month=June |pmid=21901632 |doi=10.1007/s10096-011-1403-y |url=}}</ref>
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| *[[AIDS]]<ref name="pmid22716315">{{cite journal |author=Beukes CA, Thiart J |title=The incidence of human herpes virus-8 expression in lymph node biopsies from human immunodeficiency virus-positive patients |journal=Histopathology |volume= |issue= |pages= |year=2012 |month=April |pmid=22716315 |doi=10.1111/j.1365-2559.2012.04291.x |url=}}</ref>
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| *[[Amyloidosis]]
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| *[[Angioimmunoblastic lymphadenopathy]]<ref name="pmid21821991">{{cite journal |author=Mitsuhashi K, Shiseki M, Ishiyama M, ''et al.'' |title=[Angioimmunoblastic T-cell lymphoma with marked polyclonal plasmacytosis in peripheral blood and bone marrow mimicking plasma cell leukemia] |language=Japanese |journal=Rinsho Ketsueki |volume=52 |issue=7 |pages=563–9 |year=2011 |month=July |pmid=21821991 |doi= |url=}}</ref>
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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]]<ref name="pmid22271127">{{cite journal |author=Simonelli S, Gianazza E, Mombelli G, ''et al.'' |title=Severe high-density lipoprotein deficiency associated with autoantibodies against lecithin:cholesterol acyltransferase in non-Hodgkin lymphoma |journal=Arch. Intern. Med. |volume=172 |issue=2 |pages=179–81 |year=2012 |month=January |pmid=22271127 |doi=10.1001/archinternmed.2011.661 |url=}}</ref>
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| *[[Autoimmune lymphoproliferative syndrome]] type 1<ref name="pmid22752343">{{cite journal |author=Simesen de Bielke MG, Yancoski J, Rocco C, ''et al.'' |title=A Missense Mutation in the Extracellular Domain of Fas: The Most Common Change in Argentinean Patients with Autoimmune Lymphoproliferative Syndrome Represents a Founder Effect |journal=J Clin Immunol |volume= |issue= |pages= |year=2012 |month=July |pmid=22752343 |doi=10.1007/s10875-012-9731-y |url=}}</ref>
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| *[[Bejel]]
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| *[[Black widow spider envenomation]]
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| *[[Borrelia burgdorferi]]
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| *[[Boutonneuse fever]]<ref name="pmid22511280">{{cite journal |author=Schleenvoigt BT, Keller P, Stallmach A, Pletz MW |title=[African tick bite fever--rickettsiosis after holiday in South Africa] |language=German |journal=Dtsch. Med. Wochenschr. |volume=137 |issue=17 |pages=891–3 |year=2012 |month=April |pmid=22511280 |doi=10.1055/s-0032-1304902 |url=}}</ref>
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| *[[Breast cancer]]
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| *[[Brucellosis]]<ref name="pmid22812616">{{cite journal |author=Roushan MR, Amiri MJ |title=Update on Childhood Brucellosis |journal=Recent Pat Antiinfect Drug Discov |volume= |issue= |pages= |year=2012 |month=July |pmid=22812616 |doi= |url=}}</ref>
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| *[[Caspase-8 deficiency]]
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| *[[Castleman's disease]]<ref name="pmid22791417">{{cite journal |author=Dispenzieri A, Armitage JO, Loe MJ, ''et al.'' |title=The clinical spectrum of Castleman's disease |journal=Am J Hematol |volume= |issue= |pages= |year=2012 |month=June |pmid=22791417 |doi=10.1002/ajh.23291 |url=}}</ref>
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| *[[Cat scratch disease]]<ref name="pmid22358366">{{cite journal |author=Chondrogiannis K, Vezakis A, Derpapas M, Melemeni A, Fragulidis G |title=Seronegative cat-scratch disease diagnosed by PCR detection of Bartonella henselae DNA in lymph node samples |journal=Braz J Infect Dis |volume=16 |issue=1 |pages=96–9 |year=2012 |pmid=22358366 |doi= |url=}}</ref>
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| *[[Chagas' disease]]
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| *[[Chediak-Higashi syndrome]]<ref name="pmid22223973">{{cite journal |author=Reddy RR, Babu BM, Venkateshwaramma B, Hymavathi Ch |title=Silvery hair syndrome in two cousins: Chediak-Higashi syndrome vs Griscelli syndrome, with rare associations |journal=Int J Trichology |volume=3 |issue=2 |pages=107–11 |year=2011 |month=July |pmid=22223973 |pmc=3250006 |doi=10.4103/0974-7753.90825 |url=}}</ref><ref name="pmid22147054">{{cite journal |author=Fantinato GT, Cestari Sda C, Afonso JP, Sousa LS, Enokihara MM |title=Do you know this syndrome? Chediak-Higashi syndrome |journal=An Bras Dermatol |volume=86 |issue=5 |pages=1029 |year=2011 |pmid=22147054 |doi= |url=}}</ref>
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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]]<ref name="pmid22826712">{{cite journal |author=Warnatz K, Voll RE |title=Pathogenesis of autoimmunity in common variable immunodeficiency |journal=Front Immunol |volume=3 |issue= |pages=210 |year=2012 |pmid=22826712 |pmc=3399211 |doi=10.3389/fimmu.2012.00210 |url=}}</ref>
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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]]<ref name="pmid22768436">{{cite journal |author=Goyal T, Varshney A |title=A rare presentation of erythrodermic mycosis fungoides |journal=Cutis |volume=89 |issue=5 |pages=229–32, 236 |year=2012 |month=May |pmid=22768436 |doi= |url=}}</ref>
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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]]<ref name="pmid22223973">{{cite journal |author=Reddy RR, Babu BM, Venkateshwaramma B, Hymavathi Ch |title=Silvery hair syndrome in two cousins: Chediak-Higashi syndrome vs Griscelli syndrome, with rare associations |journal=Int J Trichology |volume=3 |issue=2 |pages=107–11 |year=2011 |month=July |pmid=22223973 |pmc=3250006 |doi=10.4103/0974-7753.90825 |url=}}</ref>
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| *[[Hairy cell leukaemia]]
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| {{ColBreak}}
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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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|
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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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|
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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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|
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| *[[Mucocutaneous leishmaniasis]]
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|
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| *[[Mumps]]
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| *[[Mycobacterium avium-intracellulare]]
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|
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| *[[Mycobacterium chelonei]]
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|
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| *[[Mycosis fungoides]]<ref name="pmid22768436">{{cite journal |author=Goyal T, Varshney A |title=A rare presentation of erythrodermic mycosis fungoides |journal=Cutis |volume=89 |issue=5 |pages=229–32, 236 |year=2012 |month=May |pmid=22768436 |doi= |url=}}</ref>
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| *[[Myeloproliferative disorder]]
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|
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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]]
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| {{ColBreak}}
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| *[[Autoimmune haemolytic anaemia]]
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| *[[Protozoa]]
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| *[[Pseudolymphoma]]
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| *[[Radiotherapy]]
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| *[[Rat-bite fever]]
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| *[[Reticuloendotheliosis]]
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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 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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| *[[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]]
| | ==[[Lymphadenopathy differential diagnosis|Differentiating Lymphadenopathy from other Diseases]]== |
| | ==[[Epidemiology and Demographics]]== |
|
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|
| *[[Yaws]]
| | ==Laboratory Evaluation of Lymphadenopathy== |
|
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| *[[Yersinia pestis]]
| | ==Diagnostic Radiological Testing== |
|
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| {{EndMultiCol}}
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| ===Bihilar lymphadenopathy=== | | ==Treatment== |
| 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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|
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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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|
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| ==Differentiating from other diseases==
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|
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| ==Epidemiology and Demogaphics==
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| The estimated incidence of [[lymphadenopathy]] in children in the United States ranges from 35% - 45%.
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|
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| It is more common in the pediatric population.
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|
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| Race and gender have no predilection in lymphadenopathy incidence.
| |
|
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| ==Risk factors==
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|
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| ==Natural History, Complications and Prognosis==
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| ===Natural History===
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| The natural course of lymphadenopathy depends on the underlying cause. Lymphadenopathy due to infectious causes subsides once the infection is controlled.
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|
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| ===Complications===
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| * Mediastinal lymphadenopathy causes pressure symptoms like:
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| ** [[Superior vena cava syndrome]]
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| ** Tracheal and bronchial obstruction
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| ** [[Dysphagia]]
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| ** [[Hemoptysis]]
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| * [[Uric acid nephropathy]]
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| * [[Hyperkalemia]]
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| * [[Hypercalcemia]]
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| * [[Hypocalcemia]]
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| * [[Hyperphosphatemia]]
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| * [[Renal failure]]
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|
| |
| ===Prognosis===
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| Prognosis of lymphadenopathy depends entirely on the underlying etiology. Cancerous causes of lymphadenopathy have a poor prognosis compared to the infectious causes.
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|
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| ==Diagnosis==
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| ===Symptoms===
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| Lymphadenopathy can present as
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| * Lump in the neck (e.g in [[tumors]], [[sarcoidosis]]).
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| * Red, tender skin over lymph node.
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| * Swollen, tender, or hard lymph nodes.
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|
| |
| ===Physical Examination===
| |
| 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.
| |
| ====Palpating Anterior Cervical Lymph Nodes====
| |
| 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.
| |
| # 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).
| |
| # 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).
| |
|
| |
| 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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|
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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.
| |
|
| |
| ===Case Studies in Physical Examination===
| |
| (Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)
| |
|
| |
| <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.
| |
| 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.
| |
| </gallery>
| |
| </div>
| |
|
| |
| ===Laboratory Findings===
| |
|
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|
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| ===Imaging===
| |
| ====Chest X Ray====
| |
| 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]].
| |
|
| |
| <div align="left">
| |
| <gallery heights="175" widths="175">
| |
| Image:Sarcoidosis_Lymphadenopathy.jpg|Sarcoidosis bilateral hilar lymphadenopathy, non-caseating granulomas<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages</ref>
| |
| </gallery>
| |
| </div>
| |
|
| |
|
| |
| ====CT====
| |
| [[Image:Sarcoidosis-CT.jpeg.jpeg|thumb|left|[[CT]] scan of the chest showing lymphadenopathy in the mediastinum due to [[sarcoidosis]].]]{{clr}}
| |
|
| |
| ====Biopsy====
| |
| The test is used to diagnose cancer or an infection:
| |
|
| |
| * When the doctor feels swollen glands and they do not go away
| |
| * When lymph nodes are present on a [[CT]] or [[MRI]] scan
| |
| * For some patients with [[breast cancer]] or [[melanoma]], to see if the cancer has spread (sentinel lymph node biopsy)
| |
|
| |
| [[Image:Dermatopathic lymphadenopathy.JPG|left|200px|[[Micrograph]] of [[dermatopathic lymphadenopathy]], a type of lymphadenopathy. [[H&E stain]]]]
| |
| {{Clr}}
| |
|
| |
|
| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
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| [[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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