Hodgkin's lymphoma differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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.





Differential Diagnosis

The following conditions must be considered in the differential diagnosis of Hodgkin's lymphoma: DDx [1][2][3][4][5][6][7]
  • Sarcoidosis DDx
  • Lymphocytic lymphoma DDx
  • Miliary tuberculosis DDx
  • Infectious mononucleosis DDx
  • Thoracic aortic aneurysm DDx
  • Substernal goiter DDx
  • Thymoma DDx
  • Actinomycosis DDx
  • Chronic lymphocytic leukemia DDx
  • Superior vena cava syndrome DDx
  • Unicentric Castleman disease DDx
  • Adult Still disease DDx
  • Small cell lung carcinoma DDx
  • Malignant histiocytosis DDx


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Mahshid Mir, M.D. [3]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

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


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4] Mahshid Mir, M.D. [5]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

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


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [6] Mahshid Mir, M.D. [7]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

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


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [8] Mahshid Mir, M.D. [9]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

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


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [10] Mahshid Mir, M.D. [11]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

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


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [12] Mahshid Mir, M.D. [13]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

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


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [14] Mahshid Mir, M.D. [15]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

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


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [16] Mahshid Mir, M.D. [17]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

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


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [18] Mahshid Mir, M.D. [19]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

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)


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [20] Mahshid Mir, M.D. [21]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

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


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [22] Mahshid Mir, M.D. [23]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

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


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [24] Mahshid Mir, M.D. [25]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Radiographic features
  • Mediastinal mass, adenopathy, or widening on chest radiography


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [26] Mahshid Mir, M.D. [27]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

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


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [28] Mahshid Mir, M.D. [29]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

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)


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [30] Mahshid Mir, M.D. [31]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

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

  1. ↑ Ferri, Fred (2011). Ferri's differential diagnosis: a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323076999.
  2. ↑ Siegenthaler, Walter (2007). Differential diagnosis in internal medicine: from symptom to diagnosis. Stuttgart New York: Thieme. ISBN 978-1588905512.
  3. ↑ Mesko, Dusan (2002). Differential diagnosis by laboratory medicine: a quick reference for physicians. Berlin New York: Springer-Verlag. ISBN 978-3540430575.
  4. ↑ Reeder and Felson's gamuts in radiology: comprehensive lists of roentgen differential diagnosis. Place of publication not identified: Springer. 2014. ISBN 978-1475781229.
  5. ↑ Burgener, Francis (2008). Differential diagnosis in conventional radiology. Stuttgart New York: Thieme. ISBN 978-1588902757.
  6. ↑ Gattuso, Paolo (2015). Differential diagnosis in surgical pathology. Philadelphia, PA: Saunders/Elsevier. ISBN 978-1455770137.
  7. ↑ "DXplain".
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