Lymphadenopathy
Lymphadenopathy | |
Lymphadenopathy | |
ICD-10 | I88, L04, R59.1 |
ICD-9 | 289.1-289.3, 683, 785.6 |
DiseasesDB | 22225 |
MeSH | D008206 |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Synonyms and keywords: Lymph nodes enlarged, enlarged lymph nodes, lymphadenitis
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.
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. Nodes are generally examined in the following order:
Pathophysiology
Causes
Differentiating from other diseases
Epidemiology and Demogaphics
Risk factors
Natural history, Complications, Prognosis
Diagnosis
Symptoms
Physical examination
Lab findings
Imaging
Treatment
Lymphadenopathy associated conditions
Enlarged lymph nodes are a common symptom in a number of infectious and cancerous diseases. It is a recognized symptom of many diseases, which include:
- reactive: acute infection (e.g. bacterial, or viral), or chronic infections (tuberculous lymphadenitis, cat-scratch disease).
- Infectious mononucleosis is an acute viral infection, the hallmark of which is marked enlargement of the cervical lymph nodes.
- it is also a symptom of cutaneous anthrax, measles and Human African trypanosomiasis, the latter two giving lymphadenopathy in lymph nodes in the neck
- toxoplasmosis, a parasitic disease, gives a generalized lymphadenopathy[1]
- tumoral:
- Primary: Hodgkin lymphoma, non-Hodgkin lymphoma, hairy cell leukemia, give lymphadenopathy in all or a few lymph nodes [1]
- Secondary: metastasis, Virchow's Node, Neuroblastoma
- autoimmune etiology: sarcoidosis, systemic lupus erythematosus, rheumatoid arthritis all giving a generalized lymphadenopathy.[1]
- immunocompromised etiology: 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.[2]
Diagnosis
Patterns of Benign (Reactive) Lymphadenopathy
There are three distinct patterns of benign lymphadenopathy:
- Follicular hyperplasia. Seen in infections, autoimmune disorders, and nonspecific reactions.
- Paracortical hyperplasia. Seen in viral infections, skin diseases, and nonspecific reactions.
- Sinus histiocytosis. Seen in lymph nodes draining limbs, inflammatory lesions, and malignancies.
Bihilar lymphadenopathy
Bihilar lymphadenopathy is a radiographic term that describes the enlargement of mediastinal lymph nodes. It is easily and most commonly identified by a chest x-ray. The causes can divide into the four commonest:
- Tuberculosis
- Sarcoidosis
- Lymphoma
- Other malignancies
Less common causes include:
Physical Examination
Chest X Ray
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Sarcoidosis bilateral hilar lymphadenopathy, non-caseating granulomas [3]
Diagnostic Findings
(Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)
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Cervical Adenopathy: Massive right side cervical adenopathy and facial assymetry due to metastatic, intraoral squamous cell cancer.
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Cervical Adenopathy: Massive right side cervical adenopathy and facial assymetry due to metastatic, intraoral squamous cell cancer.
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Cervical Adenopathy: Large right anterior cervical lymph node.
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Cervical Adenopathy: Multiple right sided cervical lymph nodes.
Differential Diagnosis of Causes of Lymphadenopathy
In alphabetical order. [4] [5]
- A. catarrhalis
- Anthrax
- Aphthous stomatitis
- Breast Cancer
- Brucellosis
- Cat scratch fever
- Erysipelas
- German Measles
- Hemoblastosis
- Histoblastosis
- Hodgkin's Lymphoma
- Idiopathic
- Infectious mononucleosis
- Influenza
- Listeriosis
- Leukemia
- Lymphangitis
- Lymphatic leukemia
- Mastitis
- Measles
- Metastatic tumor
- Mumps
- Pancoast tumor
- Reticulosis
- Streptococcal tonsillitis
- Systemic Lupus Erythematosus
- Three-day fever
- Toxoplasmosis
- Tuberculosis
- Tularemia
- Vaccination
- Varicella
- Vincent's angina
- Waldenstrom's Syndrome
References
- ↑ 1.0 1.1 1.2 Status and anamnesis, Anders Albinsson. Page 12
- ↑ Chris Jennings (1993). "Understanding and Preventing AIDS: A Book for Everyone".
- ↑ http://picasaweb.google.com/mcmumbi/USMLEIIImages
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
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