Lymphadenopathy

From Anvita Health Wiki

Contents 1 More Specific Terms 2 Etiology 3 Clinical-manifestations 4 Laboratory 5 Radiology 6 Differential-diagnosis 7 Management 8 More General Terms 9 Additional Terms 10 References

More Specific Terms

• hilar lymphadenopathy
• lymphadenitis
• sinus histiocytosis
• sinus histiocytosis with massive lymphadenopathy; Rosai-Dorfman disease
• unilateral tonsillar enlargement

Etiology

• lymphocyte proliferation & hyperplasia of non lymphoid cells in response to antigen exposure. Size of the lymph node increases; the nodal architecture is preserved.
• entrapment of malignant cells* within lymph nodes results in malignant cells taking residence in lymph nodes, proliferating & causing nodal enlargement with destruction of nodal architecture.
• see causes of lymphadenopathy
  

• * < 1% of lymphadenopathy in primary care due to malignancy; risk increases with age & chronicity

Clinical-manifestations

• size: a lymph node larger than 1 cm in diameter is considered enlarged.
• location: see differential diagnosis
• consistency

• infection

• tender
• asymmetric
• matted
• may have inflamed, red overlying skin

• lymphoma:

• large
• symmetric
• firm
• mobile;
• non tender
• rubbery

• metastatic tumor

• fixed
• hard
• discrete
• non tender

• temporal course

• constant
• intermittent

• associated signs/symptoms:

• cough
• fever
• weight loss
• night sweats
• pruritis
• fatigue
• arthralgia
• myalgia
• hepatomegaly
• splenomegaly
• abdominal masses

Laboratory

• malignancy suspected

• lymph node biopsy

• histologic examination
• culture
• antigenic typing
• chromosomal analysis
• molecular studies

• infection suspected

• complete blood count ( CBC)
• peripheral blood smear
• markers of inflammation

• erythrocyte sedimentation rate (ESR)
• serum C-reactive protein ( CRP)

• tuberculin skin test ( PPD)
• coccidioidomycosis serology if indicated
• serum protein electrophoresis
• heterophile antibodies
• serum transaminases
• antibodies to Toxoplasmosis
• HIV testing

Radiology

• chest X-ray
• ultrasound
• computed tomography ( CT)

Differential-diagnosis

• cysts
• abscess

Management

• infection

• empiric treatment with antibiotics for no more than 1-2 weeks
• observation for 15-30 days after appropriate treatment

• other specifically directed therapy
• 50% of lymph node biopsies are non diagnostic
• 25% of patients with non- diagnostic biopsies develop disease in 1 year

More General Terms

• lymphoid tissue disease
• sign/symptom

Additional Terms

• causes of lymphadenopathy
• lymph node

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 603-604
2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
3. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 324

lymphadenopathy