Sandbox: Lymphadenopathy: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
 
(29 intermediate revisions by the same user not shown)
Line 6: Line 6:
   
   
==Overview==
==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]].<ref name="!">{{cite journal|last=King|first=D|last2=Ramachandra|first2=J|last3=Yeomanson|first3=D|title=Lymphadenopathy in children: refer or reassure?|journal=Archives of Disease in Childhood: Education and Practice Edition|date=2 January 2014|pmid=24385291|doi=10.1136/archdischild-2013-304443|volume=99|pages=101–110}}</ref>  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%.<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref> Patients of all age groups may develop lymphadenopathy. Lymphadenopathy is more commonly observed among children. Common complications of lymphadenopathy, may include: [[Abscess|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 AIDS|HIV]] or [[Tuberculosis|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.


==Classification==
==Classification==
*Lymphadenopathy may be classified according to distribution into 2 groups:
*Lymphadenopathy may be classified according to distribution into 2 groups:<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref>
:*Generalized lymphadenopathy
:*Generalized lymphadenopathy
:*Localized lymphadenopathy
:*Localized lymphadenopathy


==Pathophysiology==
==Pathophysiology==
*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.  
*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.<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref>
*The inmune response between the antigen and lymphocyte that leads to cellular proliferation and enlargement of the lymph nodes.  
*The inmune response between the antigen and lymphocyte that leads to cellular proliferation and enlargement of the lymph nodes.  
*Lymph nodes may also be enlarged secondarily as a result of the activation and proliferation of antigen-specific T and B cells (clonal expansion).  
*Lymph nodes may also be enlarged secondarily as a result of the activation and proliferation of antigen-specific T and B cells (clonal expansion).  
Line 21: Line 21:
:*Soft greasy yellow areas within capsule
:*Soft greasy yellow areas within capsule
*On microscopic histopathological analysis, characteristic findings of lymphadenopathy will depend on the aetiology.  
*On microscopic histopathological analysis, characteristic findings of lymphadenopathy will depend on the aetiology.  
*Common findings, include:
*Common findings, include:<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref>
'''Non-specific reactive follicular hyperplasia (NSRFH)'''
'''Non-specific reactive follicular hyperplasia (NSRFH)'''
:*Large spaced cortical follicles
:*Large spaced cortical follicles
Line 47: Line 47:


==Causes==
==Causes==
*Common causes of lymphadenopathy, include:  
*Common causes of lymphadenopathy, include:<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref>
:*'''Infections''' (acute suppurative)
:*'''Infections''' (acute suppurative)
::*Fungal
::*Fungal
::*Mycobacterial
::*Mycobacterial
::*Viral
::*Viral
::*Protozoal (e.g. toxoplasma)
::*Protozoal (e.g. [[Toxoplasmosis|toxoplasma]])
::*Bacterial (e.g. chlamydia, rickettsia, bartonella)
::*Bacterial (e.g. [[chlamydia]], [[Rickettsia rickettsii infection|rickettsia]], [[bartonella]])
:*'''Reactive'''
:*'''Reactive'''
::*Follicular hyperplasia
::*Follicular hyperplasia
Line 66: Line 66:
==Epidemiology and Demographics==
==Epidemiology and Demographics==
* Lymphadenopathy is very common.  
* Lymphadenopathy is very common.  
* The prevalence of lymphadenopathy is approximately [number or range] per 100,000 individuals worldwide.
*The estimated incidence of lymphadenopathy among children in the United States ranges from 35%- 45%.<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref>
*The estimated incidence of lymphadenopathy among children in the United States ranges from 35%- 45%.
===Age===
===Age===
*Patients of all age groups may develop lymphadenopathy.
*Patients of all age groups may develop lymphadenopathy.
Line 76: Line 75:
   
   
===Race===
===Race===
*There is no racial predilection for lymphadenopathy.
*There is no racial predilection for lymphadenopathy.<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref>


==Risk Factors==
==Risk Factors==
*The most common risk factors in the development of lymphadenopathy, include:
*The most common risk factors in the development of lymphadenopathy, include:
:*Idiopathic
:*Local soft-tissue infections
:*Local soft-tissue infections
:*Upper respiratory tract infection
:*[[Upper respiratory tract infection]]
:*Foreign travel


== Natural History, Complications and Prognosis==
== Natural History, Complications and Prognosis==
*Patients with lymphadenopathy may be symptomatic or asymptomatic, depending on the aetiology.  
*Patients with lymphadenopathy may be symptomatic or asymptomatic, depending on the aetiology.<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref> 
*Early clinical features include palpable tenderness, pain, and fever.  
*Early clinical features include palpable tenderness, pain, and fever.  
*Common complications of lymphadenopathy, include:
*Common complications of lymphadenopathy, include:
Line 107: Line 106:
* [[Fistulas]] (seen in lymphadenitis that is due to [[tuberculosis]])
* [[Fistulas]] (seen in lymphadenitis that is due to [[tuberculosis]])
* [[Sepsis]]  
* [[Sepsis]]  
Prognosis will depend on the aetiology of the underlying disease.
*Prognosis will depend on the aetiology of the underlying disease.


== Diagnosis ==
== Diagnosis ==
Line 115: Line 114:
:*Node that is draining, hard, or fixed to underlying tissue
:*Node that is draining, hard, or fixed to underlying tissue
:*Atypical location (e.g. supraclavicular node)  
:*Atypical location (e.g. supraclavicular node)  
:*Risk factors (e.g. HIV or TB)
:*Risk factors (e.g. [[HIV AIDS|HIV]] or [[TB]])
:*Fever and/or weight loss
:*Fever and/or weight loss
:*Splenomegaly
:*[[Splenomegaly]]


====Benign Lymphadenopathy====  
====Benign Lymphadenopathy====  
Line 127: Line 126:


=== Symptoms ===
=== Symptoms ===
*Symptoms of lymphadenopathy may include the following:
*Symptoms of lymphadenopathy may include the following:<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref>
:*'''Constitutional symptoms'''
:*'''Constitutional symptoms'''
::*Fever
::*[[Fever]]
::*Weight loss
::*[[Weight loss]]
::*Fatigue  
::*[[Fatigue]]
::*Night sweats
::*[[Night sweats]]
:* [[Malaise]]
:* [[Malaise]]
:* [[Nausea]] and [[vomiting]]
:* [[Nausea]] and [[vomiting]]
:* [[Cachexia]]
:* [[Cachexia]]
*A directed history should be obtained to ascertain:
*A directed history should be obtained to ascertain:<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref>
:*Use of drugs causing lymphadenopathy
:*Use of drugs causing lymphadenopathy
:*Travel to endemic areas
:*Travel to endemic areas
Line 159: Line 158:
===Head===
===Head===
====Palpating Anterior Cervical Lymph Nodes====
====Palpating Anterior Cervical Lymph Nodes====
Lymph nodes should be examined in the following order:  
Lymph nodes should be examined in the following order:<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref> 
*Anterior Cervical  
*Anterior Cervical  
*Posterior Cervical
*Posterior Cervical
Line 179: Line 178:
<gallery heights="175" widths="175">
<gallery heights="175" widths="175">
Image:head_scc1.jpg|'''Cervical adenopathy''': massive right side cervical adenopathy and facial asymmetry due to metastatic, intraoral squamous cell cancer. Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.
Image:head_scc1.jpg|'''Cervical adenopathy''': massive right side cervical adenopathy and facial asymmetry due to metastatic, intraoral squamous cell cancer. Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.
Image:head_scc2.jpg|'''Cervical adenopathy''': massive right side cervical adenopathy and facial asymmetry due to metastatic, intraoral squamous cell cancer.  Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.I
Image:head_scc2.jpg|'''Cervical adenopathy''': massive right side cervical adenopathy and facial asymmetry due to metastatic, intraoral squamous cell cancer.  Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.
Image:head_cervical_ln.jpg|'''Cervical adenopathy''': large right anterior cervical lymph node.  Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.
Image:head_cervical_ln.jpg|'''Cervical adenopathy''': large right anterior cervical lymph node.  Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.
Image: Lymphadenopathy 001.jpg| '''Cervical lymphadenopathy'''. Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.
Image: Lymphadenopathy 001.jpg| '''Cervical lymphadenopathy'''. Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.
Line 187: Line 186:


=== Laboratory Findings ===
=== Laboratory Findings ===
*Laboratory findings consistent with the diagnosis of lymphadenopathy, include:  
*Laboratory findings consistent with the diagnosis of lymphadenopathy, may include:<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref>
'''Complete Blood Count'''
:*Elevated lactate dehydrogenase (LDH)
:*Mild neutropenia
:*Leukocytosis
:*Elevated markers of inflammation and acute phase reactants (e.g. ESR, C-reactive protein, ferritin)


===Imaging Findings===
===Imaging Findings===
'''Ultrasonography'''
*On ultrasound, characteristic findings of lymphadenopathy, include:<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref><ref name="radio">Lymph node enlargment. Radiopedia.  http://radiopaedia.org/articles/lymph-node-enlargement Accessed on May 9, 2016 </ref>
:*Round, hypoechoic mass (less than 1 cm)
:*Extent of lymph node involvement
'''CT'''
*On CT, characteristic findings of lymphadenopathy, include:<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref><ref name="radio">Lymph node enlargment. Radiopedia.  http://radiopaedia.org/articles/lymph-node-enlargement Accessed on May 9, 2016 </ref>
:*Most nodes: 10 mm in short-axis
:*Sub-mental and sub-mandibular: 15 mm
:*Retropharyngeal: 8 mm
:*Loss of fatty hilum
:*Focal necrosis
:*Cystic necrotic nodes
:*Long-to-short axis ratio (>2cm - usually benign)
*The upper limit in size of a normal node varies with location.


== Treatment ==
== Treatment ==
*There is no treatment for lymphadenopathy; the mainstay of therapy is treating the underlying condition.
*There is no treatment for lymphadenopathy; the mainstay of therapy is treating the underlying condition.<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref>
*For instance, infectious lymphadenopathy responds well to prompt treatment with antibiotics, and usually leads to a complete recovery. However, it may take months, for swelling to disappear. The amount of time to recovery depends on the cause.


==References==
==References==

Latest revision as of 19:23, 9 May 2016

WikiDoc Resources for Sandbox: Lymphadenopathy

Articles

Most recent articles on Sandbox: Lymphadenopathy

Most cited articles on Sandbox: Lymphadenopathy

Review articles on Sandbox: Lymphadenopathy

Articles on Sandbox: Lymphadenopathy in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Sandbox: Lymphadenopathy

Images of Sandbox: Lymphadenopathy

Photos of Sandbox: Lymphadenopathy

Podcasts & MP3s on Sandbox: Lymphadenopathy

Videos on Sandbox: Lymphadenopathy

Evidence Based Medicine

Cochrane Collaboration on Sandbox: Lymphadenopathy

Bandolier on Sandbox: Lymphadenopathy

TRIP on Sandbox: Lymphadenopathy

Clinical Trials

Ongoing Trials on Sandbox: Lymphadenopathy at Clinical Trials.gov

Trial results on Sandbox: Lymphadenopathy

Clinical Trials on Sandbox: Lymphadenopathy at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Sandbox: Lymphadenopathy

NICE Guidance on Sandbox: Lymphadenopathy

NHS PRODIGY Guidance

FDA on Sandbox: Lymphadenopathy

CDC on Sandbox: Lymphadenopathy

Books

Books on Sandbox: Lymphadenopathy

News

Sandbox: Lymphadenopathy in the news

Be alerted to news on Sandbox: Lymphadenopathy

News trends on Sandbox: Lymphadenopathy

Commentary

Blogs on Sandbox: Lymphadenopathy

Definitions

Definitions of Sandbox: Lymphadenopathy

Patient Resources / Community

Patient resources on Sandbox: Lymphadenopathy

Discussion groups on Sandbox: Lymphadenopathy

Patient Handouts on Sandbox: Lymphadenopathy

Directions to Hospitals Treating Sandbox: Lymphadenopathy

Risk calculators and risk factors for Sandbox: Lymphadenopathy

Healthcare Provider Resources

Symptoms of Sandbox: Lymphadenopathy

Causes & Risk Factors for Sandbox: Lymphadenopathy

Diagnostic studies for Sandbox: Lymphadenopathy

Treatment of Sandbox: Lymphadenopathy

Continuing Medical Education (CME)

CME Programs on Sandbox: Lymphadenopathy

International

Sandbox: Lymphadenopathy en Espanol

Sandbox: Lymphadenopathy en Francais

Business

Sandbox: Lymphadenopathy in the Marketplace

Patents on Sandbox: Lymphadenopathy

Experimental / Informatics

List of terms related to Sandbox: Lymphadenopathy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

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

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.[1] 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%.[2] 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.

Classification

  • Lymphadenopathy may be classified according to distribution into 2 groups:[2]
  • Generalized lymphadenopathy
  • Localized lymphadenopathy

Pathophysiology

  • 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.[2]
  • The inmune response between the antigen and lymphocyte that leads to cellular proliferation and enlargement of the lymph nodes.
  • Lymph nodes may also be enlarged secondarily as a result of the activation and proliferation of antigen-specific T and B cells (clonal expansion).
  • On gross pathology, characteristic findings of lymphadenopathy, include:
  • Enlarged lymph node
  • Soft greasy yellow areas within capsule
  • On microscopic histopathological analysis, characteristic findings of lymphadenopathy will depend on the aetiology.
  • Common findings, include:[2]

Non-specific reactive follicular hyperplasia (NSRFH)

  • Large spaced cortical follicles
  • Tingible body macrophages, normal dark/light GC pattern

Lymph node metastasis

  • Foreign cell population (usually in subcapsular sinuses)
  • +/-nuclear atypia
  • +/-malignant architecture

Toxoplasmosis

  • Large follicles
  • Epithelioid cells perifollicular & intrafollicular
  • Reactive GCs
  • Monocytoid cell clusters

Cat-scratch disease

  • PMNs in necrotic area
  • "Stellate" (or serpentine) shaped micro-abscesses
  • Presence of granulomas

Dermatopathic lymphadenopathy

  • Melanin-laden histiocytes
  • Histiocytosis

Systemic lupus erythematosus lymphadenopathy

  • Blue hematoxylin bodies
  • Necrosis
  • No PMNs

Causes

  • Common causes of lymphadenopathy, include:[2]
  • Infections (acute suppurative)
  • Reactive
  • Follicular hyperplasia
  • Paracortical hyperplasia
  • Sinus histiocytosis
  • Granulomatous
  • Neoplastic
  • Drugs (e.g. cyclosporin, phenytoin, methotrexate)
  • Lipid storage diseases
  • IgG4-related sclerosing disease

Epidemiology and Demographics

  • Lymphadenopathy is very common.
  • The estimated incidence of lymphadenopathy among children in the United States ranges from 35%- 45%.[2]

Age

  • Patients of all age groups may develop lymphadenopathy.
  • Lymphadenopathy is more commonly observed among children.

Gender

  • Lymphadenopathy affects men and women equally.

Race

  • There is no racial predilection for lymphadenopathy.[2]

Risk Factors

  • The most common risk factors in the development of lymphadenopathy, include:

Natural History, Complications and Prognosis

  • Patients with lymphadenopathy may be symptomatic or asymptomatic, depending on the aetiology.[2]
  • Early clinical features include palpable tenderness, pain, and fever.
  • Common complications of lymphadenopathy, include:

Mediastinal lymphadenopathy

Abdominal lymphadenopathy

Superficial lymphadenopathy

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

Symptoms

  • Symptoms of lymphadenopathy may include the following:[2]
  • Constitutional symptoms
  • A directed history should be obtained to ascertain:[2]
  • Use of drugs causing lymphadenopathy
  • Travel to endemic areas
  • Occupational risk (e.g. Fishermen, slaughterhouse workers, hunters, trappers)
  • High risk behavior or high risk sexual behaviors (e.g. I.V drug abuse, multiple partners)

Physical Examination

  • Patients with lymphadenopathy may have a pale or normal appearance.
  • Physical examination may be remarkable for:

Vitals

  • Temperature
  • High grade fever
  • Low grade fever
  • Pulse
  • Rapid (e.g. acute infections)

Skin

  • Rash may be present
  • Color change (indicative of inflammation)
  • Skin fistula draining pus may be present
  • Ulcers

Head

Palpating Anterior Cervical Lymph Nodes

Lymph nodes should be examined in the following order:[2]

  • Anterior Cervical
  • Posterior Cervical
  • Tonsillar
  • Sub-Mandibular
  • Sub-Mental
  • Supra-clavicular

Characteristics to be noted while palpating lymph nodes:

  • Size
  • Pain/ tenderness
  • Increased tenderness (e.g infected lymph nodes)
  • Consistency
  • Matting

Gallery

  • Cervical adenopathy: massive right side cervical adenopathy and facial asymmetry due to metastatic, intraoral squamous cell cancer. Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.

    Cervical adenopathy: massive right side cervical adenopathy and facial asymmetry due to metastatic, intraoral squamous cell cancer. Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.

  • Cervical adenopathy: massive right side cervical adenopathy and facial asymmetry due to metastatic, intraoral squamous cell cancer. Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.

    Cervical adenopathy: massive right side cervical adenopathy and facial asymmetry due to metastatic, intraoral squamous cell cancer. Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.

  • Cervical adenopathy: large right anterior cervical lymph node. Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.

    Cervical adenopathy: large right anterior cervical lymph node. Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.

  • Cervical lymphadenopathy. Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.

    Cervical lymphadenopathy. Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.

  • Cervical Adenopathy: multiple right sided cervical lymph nodes. Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.

    Cervical Adenopathy: multiple right sided cervical lymph nodes. Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.

Laboratory Findings

  • Laboratory findings consistent with the diagnosis of lymphadenopathy, may include:[2]

Complete Blood Count

  • Elevated lactate dehydrogenase (LDH)
  • Mild neutropenia
  • Leukocytosis
  • Elevated markers of inflammation and acute phase reactants (e.g. ESR, C-reactive protein, ferritin)

Imaging Findings

Ultrasonography

  • On ultrasound, characteristic findings of lymphadenopathy, include:[2][3]
  • Round, hypoechoic mass (less than 1 cm)
  • Extent of lymph node involvement

CT

  • On CT, characteristic findings of lymphadenopathy, include:[2][3]
  • Most nodes: 10 mm in short-axis
  • Sub-mental and sub-mandibular: 15 mm
  • Retropharyngeal: 8 mm
  • Loss of fatty hilum
  • Focal necrosis
  • Cystic necrotic nodes
  • Long-to-short axis ratio (>2cm - usually benign)
  • The upper limit in size of a normal node varies with location.

Treatment

  • There is no treatment for lymphadenopathy; the mainstay of therapy is treating the underlying condition.[2]
  • For instance, infectious lymphadenopathy responds well to prompt treatment with antibiotics, and usually leads to a complete recovery. However, it may take months, for swelling to disappear. The amount of time to recovery depends on the cause.

References

  1. ↑ King, D; Ramachandra, J; Yeomanson, D (2 January 2014). "Lymphadenopathy in children: refer or reassure?". Archives of Disease in Childhood: Education and Practice Edition. 99: 101–110. doi:10.1136/archdischild-2013-304443. PMID 24385291.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 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.
  3. ↑ 3.0 3.1 Lymph node enlargment. Radiopedia. http://radiopaedia.org/articles/lymph-node-enlargement Accessed on May 9, 2016
Retrieved from "https://www.wikidoc.org/index.php?title=Sandbox:_Lymphadenopathy&oldid=1232541"