Lymphadenopathy overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2],Raviteja Guddeti, M.B.B.S. [3]
Overview
Lymphadenopathy (also known as "enlarged lymph nodes") refers to lymph nodes which are abnormal in size, number or consistency. Common causes of lymphadenopathy are infection, autoimmune disease, or malignancy. Lymphadenopathy may be classified according to distribution into 2 groups: generalized lymphadenopathy and localized lymphadenopathy. The pathogenesis of lymphadenopathy is characterized by the inflammation of lymph nodes. This process is primarily due to an elevated rate of trafficking of lymphocytes into the node from the blood, exceeding the rate of outflow from the node. Lymph nodes may also be enlarged secondarily as a result of the activation and proliferation of antigen-specific T and B cells (clonal expansion). Lymphadenopathy is very common, the estimated incidence of lymphadenopathy among children in the United States ranges from 35%- 45%. Patients of all age groups may develop lymphadenopathy. Lymphadenopathy is more commonly observed among children. Common complications of lymphadenopathy, may include: abscess formation, superior vena cava syndrome, and intestinal obstruction. Diagnostic criteria for malignant lymphadenopathy, may include: node > 2 cm, node that is draining, hard, or fixed to underlying tissue, atypical location (e.g. supraclavicular node), associated risk factors (e.g. HIV or TB), fever and/or weight loss, and splenomegaly. On the other hand, diagnostic criteria for benign lymphadenopathy, may include: node < 1 cm, node that is mobile, soft-or tender, and is not fixed to underlying tissue, typical location (e.g. supraclavicular node), no associated risk factors, and palpable and painful enlargement. Laboratory findings consistent with the diagnosis of lymphadenopathy may include elevated lactate dehydrogenase (LDH), mild neutropenia, and leukocytosis. There is no treatment for lymphadenopathy; the mainstay of therapy is treating the underlying condition.
Diagnosis
Positron emission tomography (PET) is used to evaluate clinically diagnosed lymphadenopathy.
Classification
Lymphadenopathy may be classified according to distribution into 2 groups localized lymphadenopathy and generalized lymphadenopathy.
Causes
Differentiating Lymphadenopathy from Other Diseases
- Lymphadenopathy must be differentiated from syphilis, which may present as fever, myalgias, weight loss, and lymph node enlargement.[1]
Epidemiology and Demographics
The estimated incidence of lymphadenopathy in children in the United States ranges from 35%- 45%. It is more common in the pediatric population. Race and gender have no predilection in lymphadenopathy incidence.
Risk Factors
Common risk factors in the development of lymphadenopathy may be occupational, environmental, genetic, and viral.
Screening
There is insufficient evidence to recommend routine screening for lymphadenopathy
Natural History, Complications, and Prognosis
Diagnosis
Diagnostic Criteria
Malignant Lymphadenopathy
- Node > 2 cm
- Node that is draining, hard, or fixed to underlying tissue
- Atypical location (e.g. supraclavicular node)
- Risk factors (e.g. HIV or TB)
- Fever and/or weight loss
- Splenomegaly
Benign Lymphadenopathy
- Node < 1 cm
- Node that is mobile, soft-or tender, and is not fixed to underlying tissue
- Common location (e.g. supraclavicular node)
- No associated risk factors
- Palpable and painful enlargement
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
The medical therapy depends upon the underlying cause. Appropriate antibiotics are given for infective causes. Glucocorticoids for autoimmune conditions like sarcoidosis, and chemotherapy and radiation for malignant causes.[2]
Surgery
Surgery is not the first-line treatment option for patients with lymphadenopathy. Surgery is usually reserved for patients with either malignancy and an indication of biopsy. It involves removal or aspiration of lymph nodes. They are dissected when the cancer is in an advanced stage.
Primary Prevention
Good general health and hygiene are helpful in the prevention of any infection.
Secondary Prevention
Effective measures for the secondary prevention of lymphadenopathy include sentinel lymph node biopsy and early treatment if metastasis is detected.
References
- ↑ Deschenes J, Seamone CD, Baines MG (1992). "Acquired ocular syphilis: diagnosis and treatment". Ann Ophthalmol. 24 (4): 134–8. PMID 1590633.
- ↑ Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A (2014). "Peripheral lymphadenopathy: approach and diagnostic tools". Iran J Med Sci. 39 (2 Suppl): 158–70. PMC 3993046. PMID 24753638.