Lymphadenopathy resident survival guide: Difference between revisions
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==Do's== | ==Do's== | ||
*[[Patients]] with [[immunodeficiency]] should have a wide differential diagnosis considering [[non-Hodgkin's lymphoma]] and [[Kaposi sarcoma]].<ref name="pmid12484692">{{cite journal |vauthors=Bazemore AW, Smucker DR |title=Lymphadenopathy and malignancy |journal=Am Fam Physician |volume=66 |issue=11 |pages=2103–10 |date=December 2002 |pmid=12484692 |doi= |url=}}</ref> | *[[Patients]] with [[immunodeficiency]] should have a wide differential diagnosis considering [[non-Hodgkin's lymphoma]] and [[Kaposi sarcoma]].<ref name="pmid12484692">{{cite journal |vauthors=Bazemore AW, Smucker DR |title=Lymphadenopathy and malignancy |journal=Am Fam Physician |volume=66 |issue=11 |pages=2103–10 |date=December 2002 |pmid=12484692 |doi= |url=}}</ref> | ||
*Remember that [[lymphadenopathy]] involving [[supraclavicular lymph nodes|supraclavicular L.N]] poses the highest risk of [[malignancy]] (90% among [[patients]] >40 years of [[age]]) and 25% among < 40 years old. <ref name="pmid3049914">{{cite journal |vauthors=Fijten GH, Blijham GH |title=Unexplained lymphadenopathy in family practice. An evaluation of the probability of malignant causes and the effectiveness of physicians' workup |journal=J Fam Pract |volume=27 |issue=4 |pages=373–6 |date=October 1988 |pmid=3049914 |doi=10.1080/09503158808416945 |url=}}</ref> | |||
==Don'ts== | ==Don'ts== | ||
*[[Physical examination]] should never be missed as a finding may change the course of differential [[diagnosis]]. Missing the [[physical exam]] may lead to unnecessary investigations and delays.<ref name="pmid22750769">{{cite journal |vauthors=Garg PK, Jain BK, Dubey IB, Sharma AK |title=Generalized lymphadenopathy: physical examination revisited |journal=Ann Saudi Med |volume=33 |issue=3 |pages=298–300 |date=2013 |pmid=22750769 |pmc=6078537 |doi=10.5144/0256-4947.2012.01.7.1525 |url=}}</ref> | *[[Physical examination]] should never be missed as a finding may change the course of differential [[diagnosis]]. Missing the [[physical exam]] may lead to unnecessary investigations and delays.<ref name="pmid22750769">{{cite journal |vauthors=Garg PK, Jain BK, Dubey IB, Sharma AK |title=Generalized lymphadenopathy: physical examination revisited |journal=Ann Saudi Med |volume=33 |issue=3 |pages=298–300 |date=2013 |pmid=22750769 |pmc=6078537 |doi=10.5144/0256-4947.2012.01.7.1525 |url=}}</ref> | ||
Revision as of 20:31, 21 August 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: , Javaria Anwer M.D.[2]
Overview
Lymphadenopathy (LAD) is used to describe abnormal size, consistency, and the number of lymph nodes. Under normal conditions, lymph nodes may not be palpated. The lymph nodes maybe central or peripheral located deep in the subcutaneous tissue. Common causes of lymphadenopathy include infectious and non-infectious. A thorough physical exam is important to establish a differential diagnosis.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
- Infectious mediastinal lymphadenopathy[1]
Common Causes
The American Academy of Family Physicians (AAFP) and many research articles utilize a pneumonic CHICAGO to include all causes of lymphadenopathy based on etiology.[2][3] The causes may also be remembered based on the location of lymph nodes.
- Cancers:
- Hypersensitivity :
- Serum sickness, immunization reactions, graft-vs-host disease, silicone allergy, and drug allergy (such as sulfonamides, allopurinol, carbamazepine, etc).
- Infections:
- Fungal, Protozoan, Rickettsial (Typhus), Helminthes.
- Bacterial: Tiberculosis, syphilis (primary and secondary), chancroid, staphylococcus or streptococcal skin infections.
- Viral: IM, CMV, HIV,lymphadenitis post vaccination, adenovirus, herpes zoster, and hepatitis (infectious), and melioidosis.
- Chlamydial (lymphogranuloma venereum), protozoan (toxoplasmosis), mycotic (histoplasmosis, coccidioidomycosis, helminthic (filariasis, and rickettsial (typhus).
- Connective tissue disorders:
- Atypical lymphoproliferative disorders :
- Granulomatous:
- Others:
- Rosai Dorfman disease, Kikuchi disease, pseudotumor of L.N, transformation of germinal centers, and vascular transformation of sinuses.
- For more detailed information in the causes of lymphadenopathy, click here.
Diagnosis
Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Do's
- Patients with immunodeficiency should have a wide differential diagnosis considering non-Hodgkin's lymphoma and Kaposi sarcoma.[4]
- Remember that lymphadenopathy involving supraclavicular L.N poses the highest risk of malignancy (90% among patients >40 years of age) and 25% among < 40 years old. [5]
Don'ts
- Physical examination should never be missed as a finding may change the course of differential diagnosis. Missing the physical exam may lead to unnecessary investigations and delays.[6]
- Needle aspiration biopsy or excisional biopsy is the gold standard for the tissue diagnosis and evaluation for lymphadenopathy.[7]
References
- ↑ Hiraishi Y, Goto Y, Ohishi N, Nagase T (May 2013). "Infectious mediastinal lymphadenopathy after repeated transbronchial needle aspiration". BMJ Case Rep. 2013. doi:10.1136/bcr-2012-007998. PMC 3669807. PMID 23723103.
- ↑ "Tips From Other Journals - American Family Physician".
- ↑ Habermann TM, Steensma DP (July 2000). "Lymphadenopathy". Mayo Clin. Proc. 75 (7): 723–32. doi:10.4065/75.7.723. PMID 10907389.
- ↑ Bazemore AW, Smucker DR (December 2002). "Lymphadenopathy and malignancy". Am Fam Physician. 66 (11): 2103–10. PMID 12484692.
- ↑ Fijten GH, Blijham GH (October 1988). "Unexplained lymphadenopathy in family practice. An evaluation of the probability of malignant causes and the effectiveness of physicians' workup". J Fam Pract. 27 (4): 373–6. doi:10.1080/09503158808416945. PMID 3049914.
- ↑ Garg PK, Jain BK, Dubey IB, Sharma AK (2013). "Generalized lymphadenopathy: physical examination revisited". Ann Saudi Med. 33 (3): 298–300. doi:10.5144/0256-4947.2012.01.7.1525. PMC 6078537. PMID 22750769.
- ↑ Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A (March 2014). "Peripheral lymphadenopathy: approach and diagnostic tools". Iran J Med Sci. 39 (2 Suppl): 158–70. PMC 3993046. PMID 24753638.