|
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| Line 4: |
Line 4: |
| ==Overview== | | ==Overview== |
| Hodgkin's lymphoma must be differentiated from [[sarcoidosis]], [[lymphocytic lymphoma]], [[miliary tuberculosis]], [[infectious mononucleosis]], [[thoracic aortic aneurysm]], substernal goiter, [[thymoma]], [[actinomycosis]], [[chronic lymphocytic leukemia]], [[superior vena cava syndrome]], unicentric castleman disease, adult still disease, [[small cell lung carcinoma]], and [[malignant histiocytosis]]. | | Hodgkin's lymphoma must be differentiated from [[sarcoidosis]], [[lymphocytic lymphoma]], [[miliary tuberculosis]], [[infectious mononucleosis]], [[thoracic aortic aneurysm]], substernal goiter, [[thymoma]], [[actinomycosis]], [[chronic lymphocytic leukemia]], [[superior vena cava syndrome]], unicentric castleman disease, adult still disease, [[small cell lung carcinoma]], and [[malignant histiocytosis]]. |
| ==Differential Diagnosis==
| |
| {{ddx0|Hodgkin's lymphoma}}
| |
| {{ddx1|Sarcoidosis}}
| |
| {{ddx1|Lymphocytic lymphoma}}
| |
| {{ddx1|Miliary tuberculosis}}
| |
| {{ddx1|Infectious mononucleosis}}
| |
| {{ddx1|Thoracic aortic aneurysm}}
| |
| {{ddx1|Substernal goiter}}
| |
| {{ddx1|Thymoma}}
| |
| {{ddx1|Actinomycosis}}
| |
| {{ddx1|Chronic lymphocytic leukemia}}
| |
| {{ddx1|Superior vena cava syndrome}}
| |
| {{ddx1|Unicentric Castleman disease}}
| |
| {{ddx1|Adult Still disease}}
| |
| {{ddx1|Small cell lung carcinoma}}
| |
| {{ddx1|Malignant histiocytosis}}
| |
|
| |
|
| ----
| |
|
| |
| {{ddx|Hodgkin's lymphoma}}
| |
|
| |
| =====Clinical manifestations=====
| |
| * Mental nerve neuropathy
| |
| * Alcohol intolerance
| |
| * Exfoliative dermatitis
| |
| * Epitrochlear lymph node enlargement
| |
| * Inguinal lymph node enlargement
| |
| * Hepatomegaly
| |
| * Liver mass
| |
| * Superior vena cava obstruction
| |
| * Inferior vena cava obstruction
| |
| * Femoral lymph node enlargement
| |
| * Popliteal lymph node enlargement
| |
| * Pemberton sign positive
| |
| * Pel-Ebstein fever
| |
| * Chylous ascites
| |
| * Axillary lymph node enlargement
| |
| * Erythema multiforme
| |
| * Erythema nodosum
| |
| * Hepatosplenomegaly
| |
| * Mesenteric lymph node enlargement
| |
| * Paraplegia
| |
| * Pruritus
| |
| * Spinal cord compression
| |
| * Spleen enlargement
| |
| * Urinary tract obstruction
| |
| * Generalized diffuse lymph node enlargement
| |
| * Airway compression or obstruction
| |
| * Cryptococcosis
| |
| * Bone pain
| |
| * Cervical lymph node enlargement
| |
| * Recurrent fever
| |
| * Recurrent infection
| |
| * Fixed lymph node
| |
| * Neck mass
| |
| * Night sweats
| |
| * Malaise
| |
| * Supraclavicular lymph node enlargement
| |
| * Sweating increase
| |
| * Fever unknown origin
| |
| * Remittent fever
| |
| * Painless lymphadenopathy
| |
| * Regional lymph node enlargement
| |
|
| |
| =====Laboratory abnormalities=====
| |
| * Nucleated red cells
| |
| * Hypogammaglobulinemia
| |
| * Pancytopenia
| |
| * Lymphocytes decreased
| |
| * Granulomas on biopsy
| |
|
| |
| =====Radiographic features=====
| |
| * Retroperitoneal lymph node enlargement
| |
| * Biliary tract dilatation on abdominal ultrasound
| |
| * Bone lesion
| |
| * Mediastinal mass,adenopathy, or widening on chest xray
| |
| * Middle mediastinal mass on chest xray
| |
| * Mediastinal lymph node enlargement
| |
| * Anterior mediastinal mass on chest radiograph
| |
| * Increased uptake on abdomen gallium scan
| |
| * Ivory vertebra
| |
| * Increased uptake on mediastinum gallium scan
| |
|
| |
| ----
| |
|
| |
| {{ddx|Sarcoidosis}}
| |
|
| |
| =====Clinical manifestations=====
| |
| * Corneal deposit
| |
| * Corneal opacity
| |
| * Parotid gland swelling
| |
| * Polyneuropathy
| |
| * Cranial nerve paralysis
| |
| * Airway compression or obstruction
| |
| * Retinal granuloma
| |
| * Erythema nodosum
| |
| * Uveitis
| |
| * Ankle pain
| |
| * Facial paralysis
| |
| * Salivary gland swelling
| |
| * Massive splenomegaly
| |
| * Cryptococcosis
| |
| * Generalized rash, papules (elevated, <0.5cm)
| |
| * Iridocyclitis
| |
| * Iritis
| |
| * Dry cough
| |
| * Night sweats
| |
| * Spleen enlargement
| |
| * Bilateral uveitis
| |
| * Generalized diffuse lymph node enlargement
| |
| * Polyarthritis
| |
|
| |
| =====Laboratory abnormalities=====
| |
| * Hypercalcemia
| |
| * Increased lymphocytes in pleural effusion
| |
| * Decreased Lymphocytes
| |
| * Hypercalciuria
| |
| * Mild-moderate elevation of alkaline phosphatase
| |
| * PFT's: restrictive defect
| |
| * PFT's: diffusion capacity decreased
| |
| * Elevated serum angiotensin-converting enzyme
| |
| * Increased vitamin D, 1,25-dihydroxy
| |
|
| |
| =====Radiographic features=====
| |
| * Heart conduction abnormality on electrocardiographic
| |
| * Atrioventricular block
| |
| * Retroperitoneal lymph node enlargement
| |
| * Lung cyst on chest radiography
| |
| * Interstitial infiltrate ( incl. reticulonodular )on chest radiography
| |
| * Increased mediastinal uptake on gallium scan
| |
| * Increased lung uptake on gallium scan
| |
| * Mediastinal lymph node enlargement
| |
| * Bone marrow granulomas
| |
| * Mediastinal mass, adenopathy, or widening on chest radiography
| |
| * Granulomas on biopsy
| |
| * Hilar lymph node enlargement on chest radiography
| |
|
| |
| ----
| |
|
| |
| {{ddx|Lymphocytic lymphoma}}
| |
|
| |
| =====Clinical manifestations=====
| |
| * Mental nerve neuropathy
| |
| * Exfoliative dermatitis
| |
| * Lower extremity paralysis
| |
| * Gout
| |
| * Esophageal candidiasis
| |
| * Abdominal mass
| |
| * Biliary tract obstruction
| |
| * Breast mass
| |
| * Epitrochlear lymph node enlargement
| |
| * Erythema multiforme
| |
| * Erythema nodosum
| |
| * Esophageal obstruction
| |
| * Facial edema
| |
| * Gastric obstruction
| |
| * Thyroid nodule
| |
| * Hepatosplenomegaly
| |
| * Intestinal obstruction
| |
| * Intussusception
| |
| * Liver mass
| |
| * Mesenteric lymph node enlargement
| |
| * Mucous membrane bleeding
| |
| * Night sweats
| |
| * Paraplegia
| |
| * Pruritus
| |
| * Anergy
| |
| * Spinal cord compression
| |
| * Stool clay color
| |
| * Stool color yellow
| |
| * Superior vena cava obstruction
| |
| * Supraclavicular lymph node enlargement
| |
| * Testicular mass
| |
| * Urinary tract obstruction
| |
| * Inferior vena cava obstruction
| |
| * Generalized diffuse lymph node enlargement
| |
| * Massive splenomegaly
| |
| * Femoral lymph node enlargement
| |
| * Popliteal lymph node enlargement
| |
| * Airway compression or obstruction
| |
| * Cryptococcosis
| |
| * Recurrent infection
| |
| * Fixed lymph node
| |
| * Neck mass
| |
| * Spleen enlargement
| |
| * Fever unknown origin
| |
| * Regional lymph node enlargement
| |
| * Painless lymphadenopathy
| |
| * Cancer
| |
| * Lymphoma
| |
| * Non-Hodgkin lymphoma
| |
|
| |
| =====Laboratory abnormalities=====
| |
| * Extreme hypercalcemia (>14 mg/dl)
| |
| * Prolonged bleeding time
| |
| * Markedly increased ESR
| |
| * Hypogammaglobulinemia
| |
| * Pancytopenia
| |
| * Lymphocytes decreased
| |
| * Pleural effusion (Exudate)
| |
| * Bone marrow plasma cells increased
| |
| * Lymphocytes increased in pleural effusion
| |
| * Pleural effusion (Chylous)
| |
| * Malignant ascites
| |
| * Cryoglobulinemia
| |
| * Vitamin D, 1,25-dihydroxy increased
| |
|
| |
| =====Radiographic features=====
| |
| * Bladder mass or abnormal shape on IVP
| |
| * Bone destruction
| |
| * Kidney mass
| |
| * Mediastinal lymph node enlargement
| |
| * Bone lesion
| |
| * Retroperitoneal lymph node enlargement
| |
| * Mediastinal mass, adenopathy, or widening on chest radiography
| |
| * Anterior mediastinal mass on chest radiography
| |
| * Biliary tract dilatation on abdominal ultrasound
| |
| * Increased mediastinal uptake on gallium scan
| |
| * Increased abdominal uptake on gallium scan
| |
|
| |
| ----
| |
|
| |
| {{ddx|Miliary tuberculosis}}
| |
|
| |
| =====Clinical manifestations=====
| |
| * Prison inmate
| |
| * Retinal granuloma
| |
| * Erythema nodosum
| |
| * Travel history (Haiti)
| |
| * Immunosuppressive therapy
| |
| * Severe weight loss
| |
| * Corticosteroid use
| |
| * Pleuritic chest pain
| |
| * Progressive dyspnea
| |
| * Fever unknown origin
| |
| * Retinitis
| |
| * Tuberculosis exposure
| |
|
| |
| =====Laboratory abnormalities=====
| |
| * Pancytopenia
| |
| * PPD positive
| |
| * Nucleated red cells
| |
| * Bone marrow granulomas
| |
| * AFB smear positive
| |
| * Granulomas on biopsy
| |
|
| |
| =====Radiographic features=====
| |
| * Increased abdominal uptake on gallium scan
| |
| * Multiple hypodense liver lesions on abdominal CT
| |
| * Multiple non-calcified pulmonary nodules on chest radiography
| |
|
| |
| ----
| |
|
| |
| {{ddx|Infectious mononucleosis}}
| |
|
| |
| =====Clinical manifestations=====
| |
| * Optic neuritis
| |
| * Epitrochlear lymph node enlargement
| |
| * Periorbital edema
| |
| * Pharyngeal petechia
| |
| * Spleen enlargement
| |
| * Spleen palpable
| |
| * Tonsillitis
| |
| * Left upper quadrant abdominal tenderness
| |
| * Axillary lymph node enlargement
| |
| * Inguinal lymph node enlargement
| |
| * Pesenteric lymph node enlargement
| |
| * Pharyngeal exudate
| |
| * Pharyngeal erythema
| |
| * Spleen tenderness
| |
| * Tonsillar exudate
| |
| * Generalized diffuse lymph node enlargement
| |
| * Cervical lymph node enlargement
| |
| * Pharyngeal swelling
| |
| * Sore throat
| |
|
| |
| =====Laboratory abnormalities=====
| |
| * Marked elevationSGPT (ALT)
| |
| * SGPT (ALT) elevated
| |
| * Lymphocytes increased
| |
| * Atypical lymphocytes increased
| |
| * Heterophile antibody positive
| |
| * Monocytes increased
| |
| * Epstein-Barr virus titre positive
| |
|
| |
| ----
| |
|
| |
| {{ddx|Thoracic aortic aneurysm}}
| |
|
| |
| =====Clinical manifestations=====
| |
| * Cocaine use
| |
| * Turner syndrome
| |
| * Pemberton sign positive
| |
| * Marfan syndrome
| |
| * Aortic valve regurgitation
| |
| * Superior vena cava obstruction
| |
| * Ascending aortic dilation
| |
|
| |
| =====Radiographic features=====
| |
| * Anterior mediastinal mass on chest radiography
| |
| * Middle mediastinal mass on chest radiography
| |
| * Posterior mediastinal mass on chest radiography
| |
| * Aorta prominent or enlarged on chest radiography
| |
|
| |
| ----
| |
|
| |
| {{ddx|Substernal goiter}}
| |
|
| |
| =====Clinical manifestations=====
| |
| * Upper extremity edema
| |
| * Chest mass
| |
| * Neck mass
| |
| * Thyroid enlargement
| |
| * Tracheal compression
| |
| * Pemberton sign positive
| |
|
| |
| =====Laboratory abnormalities=====
| |
| * TSH elevated
| |
|
| |
| =====Radiographic features=====
| |
| * Mediastinal mass, adenopathy, or widening on chest radiograph
| |
|
| |
| ----
| |
|
| |
| {{ddx|Thymoma}}
| |
|
| |
| =====Clinical manifestations=====
| |
| * Bulbar palsy
| |
| * Facial candida infection
| |
| * Facial cyanosis
| |
| * Jugular venous distention
| |
| * Mouth candida infection
| |
| * Superior vena cava obstruction
| |
| * Diplopia
| |
| * Pemberton sign positive
| |
|
| |
| =====Laboratory abnormalities=====
| |
| * Pancytopenia
| |
| * Antistriational antibodies
| |
|
| |
| =====Radiographic features=====
| |
| * Mediastinal mass, adenopathy, or widening on chest radiograph
| |
| * Anterior mediastinal mass on chest radiograph
| |
|
| |
| ----
| |
|
| |
| {{ddx|Actinomycosis}}
| |
|
| |
| =====Clinical manifestations=====
| |
| * Tongue mass
| |
| * Trismus
| |
| * Pericardial constriction
| |
| * Pharyngeal swelling
| |
| * Pharyngeal tenderness
| |
| * Abdominal fistula
| |
| * Bronchial fistula
| |
| * Empyema
| |
| * Lung abscess
| |
| * Right lower quadrant abdominal mass
| |
| * Chest wall suppuration
| |
| * Gingival fistula
| |
| * Chest wall fistula
| |
| * Gingival swelling
| |
| * Gingival tenderness
| |
| * Jaw induration
| |
| * Mandibular swelling
| |
|
| |
| =====Laboratory abnormalities=====
| |
| * Branching Gram-positive bacilli on Gram stain
| |
| * Sulfur granule
| |
|
| |
| =====Radiographic features=====
| |
| * Mediastinal mass, adenopathy, or widening on chest radiography
| |
| * Intracardiac mass on echocardiogram
| |
| * Hepatic cyst(s)
| |
|
| |
| ----
| |
|
| |
| {{ddx|Chronic lymphocytic leukemia}}
| |
|
| |
| =====Clinical manifestations=====
| |
| * Skin infiltration
| |
| * Sternal tenderness
| |
| * Lymph node firmness
| |
|
| |
| =====Laboratory abnormalities=====
| |
| * Hemolysis
| |
| * Prolonged bleeding time
| |
| * Monoclonal gammopathy
| |
| * Cryoglobulinemia
| |
| * Marked increase of leukocytes
| |
| * Clonal B-lymphocytes on flow cytometry
| |
| * Lymphocytes increased
| |
|
| |
| =====Radiographic features=====
| |
| * Mediastinal mass, adenopathy, or widening on chest radiography
| |
|
| |
| The following findings (if present) would make this disease less likely:
| |
| * Left shift
| |
| * Metamyelocytes increased
| |
|
| |
| ----
| |
|
| |
| {{ddx|Superior vena cava syndrome}}
| |
|
| |
| =====Clinical manifestations=====
| |
| * Stridor
| |
| * Facial erythema
| |
| * Forehead vein distention
| |
| * Lymphoma
| |
| * Tracheal displacement
| |
| * Chest vein distention
| |
| * Facial cyanosis
| |
| * Collateral circulation increase
| |
| * Conjunctival edema
| |
| * Conjunctival vein distention
| |
| * Upper extremity edema
| |
| * Upper extremity erythema
| |
| * Head edema
| |
| * Jugular venous distention with inspiration
| |
| * Lung tumor
| |
| * Extremity cyanosis
| |
| * Upper extremity vein distention
| |
| * Facial edema
| |
| * Neck edema
| |
| * Jugular venous distention
| |
| * Lung cancer
| |
| * Upper extremity cyanosis
| |
| * Facial vein distention
| |
| * Superior vena cava obstruction
| |
|
| |
| =====Radiographic features=====
| |
| * Mediastinal lymph node enlargement
| |
| * Non-calcified pulmonary nodule (< 4 cm) on chest radiography
| |
| * Mediastinal mass, adenopathy, or widening on chest radiography
| |
|
| |
| The following findings (if present) would exclude this disease:
| |
| * hepatojugular reflux
| |
|
| |
| ----
| |
|
| |
| {{ddx|Unicentric Castleman disease}}
| |
|
| |
| =====Radiographic features=====
| |
| * Mediastinal mass, adenopathy, or widening on chest radiography
| |
|
| |
| ----
| |
|
| |
| {{ddx|Adult Still disease}}
| |
|
| |
| =====Clinical manifestations=====
| |
| * Ankylosis
| |
| * Hepatosplenomegaly
| |
| * Severe weight loss
| |
| * Recurrent fever
| |
| * Night sweats
| |
| * Wrist pain
| |
| * Generalized diffuse lymph node enlargement
| |
| * Fever unknown origin
| |
| * Remittent fever
| |
| * High grade fever
| |
| * Polyarticular
| |
| * Evanescent rash
| |
|
| |
| =====Laboratory abnormalities=====
| |
| * Leukocytes, marked increase
| |
| * ESR markedly increased
| |
| * Serum ferritin greatly increased
| |
|
| |
| The following findings (if present) would make this disease less likely:
| |
| * monoarticular
| |
|
| |
| The following findings (if present) would exclude this disease:
| |
| * asymptomatic
| |
|
| |
| ----
| |
|
| |
| {{ddx|Small cell lung carcinoma}}
| |
|
| |
| =====Clinical manifestations=====
| |
| * Acanthosis nigricans
| |
| * Axillary lymph node enlargement
| |
| * Axillary lymph node pain
| |
| * Dysphagia
| |
| * Esophageal obstruction
| |
| * Heart tamponade
| |
| * Pericardial effusion
| |
| * Lower rib tenderness
| |
| * Tracheal displacement
| |
| * Hoarseness
| |
| * Digital clubbing
| |
| * Airway compression or obstruction
| |
| * Pemberton sign positive
| |
| * Velvet palms
| |
| * Horner syndrome
| |
| * Superior vena cava obstruction
| |
| * Bone pain
| |
| * Spinal cord compression
| |
| * Supraclavicular lymph node enlargement
| |
| * Intracranial metastatic tumor
| |
| * Acute symmetrical peripheral neuropathy
| |
| * Hemoptysis
| |
| * Right supraclavicular lymph node enlargement
| |
| * Tobacco smoking
| |
|
| |
| =====Laboratory abnormalities=====
| |
| * Bone destruction
| |
| * Unilateral diaphragm elevation on chest radiography
| |
| * Non-calcified pulmonary nodule (< 4 cm) on chest radiography
| |
| * Mediastinal mass, adenopathy, or widening on chest radiography
| |
| * Pleural effusion
| |
| * Pleural effusion (bloody)
| |
| * Non-calcified pulmonary mass (>= 4 cm)on chest radiography
| |
| * Hyponatremia
| |
| * Bone marrow tumor cells
| |
| * Serum calcitonin increased
| |
| * Hilar lymph node enlargement on chest radiography
| |
|
| |
| =====Radiographic features=====
| |
| * Normal on chest radiography
| |
| * Normal on chest CT (contrast enhanced)
| |
|
| |
| ----
| |
|
| |
| {{ddx|Malignant histiocytosis}}
| |
|
| |
| =====Clinical manifestations=====
| |
| * Tendon xanthoma
| |
| * Xanthoma
| |
| * Tuberous xanthoma
| |
| * Planar xanthoma
| |
| * Palmar planar xanthoma
| |
| * Hepatosplenomegaly
| |
| * Spleen enlargement
| |
| * Panniculitis
| |
| * Generalized diffuse lymph node enlargement
| |
|
| |
| =====Laboratory abnormalities=====
| |
| * ESR markedly increased
| |
| * Serum ferritin greatly increased
| |
| * ESR mildly or moderately increased
| |
| * C-reactive protein elevated
| |
|
| |
|
| ==References== | | ==References== |