Lymphadenopathy

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Lymphadenopathy Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Lymphadenopathy from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

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Electrocardiogram

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Shyam Patel [2];Associate Editor(s)-in-Chief: Amandeep Singh M.D.[3], Raviteja Guddeti, M.B.B.S. [4] Ogechukwu Hannah Nnabude, MD

Synonyms and keywords: Lymph nodes enlarged; Enlarged lymph nodes; Lymphadenitis; Swollen lymph nodes; Swollen/enlarged lymph nodes
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Overview

Lymphadenopathy, also called adenopathy, refers to any disease process that involves lymph nodes that are abnormal in consistency and size. This condition has multiple causes, the most common of which include neoplasia, autoimmune diseases, and infection. Lymphadenitis refers to lymphadenopathies that are due to inflammatory processes. It is characterized by nodal swelling, pain, skin changes, fever, edema, and/or purulent collections. [1]


Historical Perspective

Classification

Pathophysiology

Causes

Lymph node enlargement can be of viral, bacterial, malignant, protozoan origin and can even be caused by live vaccines [2] Examples of infections that can cause lymph node enlargement include:

  • Viral infections such as Epstein-Barr Virus and cytomegalovirus which cause infectious mononucleosis, [3] and CMV mononucleosis respectively.[4] as well HHV8 [5] and HIV.[6]
  • Yersinia pestis, which causes the bubonic plague, causes lymph node swelling so large that it can be seen under the skin. These lymph nodes are called buboes and may become necrotic. [7]
  • Other bacterial infections such as cat-scratch disease, [8] cutaneous anthrax, [9] and tuberculous lymphadenitis [10]
  • Protozoal infections including African sleeping sickness, [11] Chagas' Disease, [12] and toxoplasmosis. [13]

Examples of malignancies that cause lymphadenopathy are:

  • Primary: Hodgkin lymphoma [14] and non-Hodgkin lymphoma give lymphadenopathy in all or a few lymph nodes.[15]
  • Secondary: metastasis, Virchow's Node, neuroblastoma, [16] and chronic lymphocytic leukemia.[17]

Autoimmune causes include: systemic lupus erythematosus [18] and rheumatoid arthritis may have a generalized lymphadenopathy.[15]


Differentiating Lymphadenopathy from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic criteria | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X-Ray Findings | Ultrasound | CT-Scan Findings | MRI Findings | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

References

  1. Gosche JR, Vick L (2006). "Acute, subacute, and chronic cervical lymphadenitis in children". Semin Pediatr Surg. 15 (2): 99–106. doi:10.1053/j.sempedsurg.2006.02.007. PMC 7111159 Check |pmc= value (help). PMID 16616313.
  2. (2015) Reorganized text. JAMA Otolaryngol Head Neck Surg 141 (5):428. DOI:10.1001/jamaoto.2015.0540 PMID: 25996397
  3. Weiss LM, O'Malley D (2013). "Benign lymphadenopathies". Mod Pathol. 26 Suppl 1: S88–96. doi:10.1038/modpathol.2012.176. PMID 23281438.
  4. Sinha AK, Lovett M, Pillay G (1970). "Cytomegalovirus infection with Lymphadenopathy". Br Med J. 3 (5715): 163. doi:10.1136/bmj.3.5715.163. PMC 1702272. PMID 4317237.
  5. O'Leary J, Kennedy M, Howells D, Silva I, Uhlmann V, Luttich K; et al. (2000). "Cellular localisation of HHV-8 in Castleman's disease: is there a link with lymph node vascularity?". Mol Pathol. 53 (2): 69–76. doi:10.1136/mp.53.2.69. PMC 1186908. PMID 10889905.
  6. Oksenhendler E, Duarte M, Soulier J, Cacoub P, Welker Y, Cadranel J; et al. (1996). "Multicentric Castleman's disease in HIV infection: a clinical and pathological study of 20 patients". AIDS. 10 (1): 61–7. PMID 8924253.
  7. Butler T (2009). "Plague into the 21st century". Clin Infect Dis. 49 (5): 736–42. doi:10.1086/604718. PMID 19606935.
  8. Klotz SA, Ianas V, Elliott SP (2011). "Cat-scratch Disease". Am Fam Physician. 83 (2): 152–5. PMID 21243990.
  9. Sweeney DA, Hicks CW, Cui X, Li Y, Eichacker PQ (2011). "Anthrax infection". Am J Respir Crit Care Med. 184 (12): 1333–41. doi:10.1164/rccm.201102-0209CI. PMC 3361358. PMID 21852539.
  10. Fontanilla JM, Barnes A, von Reyn CF (2011). "Current diagnosis and management of peripheral tuberculous lymphadenitis". Clin Infect Dis. 53 (6): 555–62. doi:10.1093/cid/cir454. PMID 21865192.
  11. Kennedy PG (2013) Clinical features, diagnosis, and treatment of human African trypanosomiasis (sleeping sickness). Lancet Neurol 12 (2):186-94. DOI:10.1016/S1474-4422(12)70296-X PMID: 23260189
  12. Salazar Schettino PM, Bucio Torres M, Cabrera Bravo M, Ruiz Hernández AL (2011). "[Chagas disease in Mexico. Report of two acute cases]". Gac Med Mex. 147 (1): 63–9. PMID 21412398.
  13. Montoya JG, Liesenfeld O (2004). "Toxoplasmosis". Lancet. 363 (9425): 1965–76. doi:10.1016/S0140-6736(04)16412-X. PMID 15194258.
  14. Glass, C (September 2008). "Role of the Primary Care Physician in Hodgkin Lymphoma". American Family Physician. 78 (5): 615–622. PMID 18788239.
  15. 15.0 15.1 Status and anamnesis, Anders Albinsson. Page 12
  16. Colon, NC; Chung, DH (2011). "Neuroblastoma". Advances in Pediatrics. 58 (1): 297–311. doi:10.1016/j.yapd.2011.03.011. PMC 3668791. PMID 21736987.
  17. Sagatys, EM; Zhang, L (January 2011). "Clinical and laboratory prognostic indicators in chronic lymphocytic leukemia". Cancer Control. 19 (1): 18–25. doi:10.1177/107327481201900103. PMID 22143059.
  18. Melikoglu, MA; Melikoglu, M (October–December 2008). "The clinical importance of lymphadenopathy in systemic lupus erythematosus" (PDF). Acta Reumatologia Portuguesa. 33 (4): 402–406. PMID 19107085.



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