Transcript Lymphadenopathy

Lymphadenopathy
M.JARI.MD.
Objectives
 Define lymphadenopathy
 Develop a systematic approach to the evaluation and
management of lymphadenopathy
 Discuss the differential diagnosis of localize and
generalized lymphadenopathy
Lymphatic System
Lymphtic system
 Lymph nodes
 Lymphatic Vessels
 Spleen
 Thymus
 Adenoid
 Tonsils
Lymphatic capillaries:
 L.capillaries are in all organs except :
 Brain
 Heart
 Epiderm
 Nails
Physiology & Anatomy
 Lymph nodes are populated by:
 dendritic cells, B and T lymphocytes,macrophage
 B Lymphocytes
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T Lymphocytes
Approach to Patient
 Lymphadenopathy – refers to lymph nodes that are
abnormal in size, number or consistency
 Consider:
Age of Patient
 Size of Nodes
 Location of Nodes
 Quality of Nodes
 Localized or generalized
 Time course of the lymphadenopathy
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Size of Lymph Nodes
 Rules of thumb:
 Axillary and cervical nodes < 1 cm
 Inguinal <1.5 cm
 Epitrochlear <0.5 cm
 Nodes tend to be larger in young children
 Odds of malignancy is higher in larger nodes especially
those > 2 cm
Location of Lymph Nodes
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Node Groups
Occipital
Postauriclular
Preauricular
Parotid
Submandibular
Submental
Superficial cervical
Deep cervical
Supraclavicular
Deltopectoral
Axillary
Epitrochlear
Inguinal
Popliteal
Region Drained
 Posterior Scalp
 Temporal & parietal scalp
 Scalp, ear canal, conjunctiva
 Scalp, midface, ear canal and ear, parotid
 Cheek, nose, lips, tongue, subman. gland
 Lower lip, floor of mouth
 Lower larynx, lower ear canal, parotid
 Tonsils, adenoids, scalp, larynx, sinuses
 Mediastinum, lungs, abdomen
 Arm
 Arm, breast, thorax, neck
 Medial arm below elbow
 Lower extremities, genitalia, abdomen
 Lower leg
Quality of Lymph Nodes
 Painful
 Usually infection, especially if erythema, warmth, or fluctance
 Malignancy can cause node tenderness because of hemorrhage
into node and stretching of capsule
 Hard
 Found in cancers because of fibrosis
 Nonmobile
 Become fixed from invasive cancers of inflammation in tissue
surrounding nodes (ie TB or sarcoidosis)
 SOFT, COMPRESSIBLE = NORMAL
Localized Lymphadenopathy
Differential Diagnosis - Infection
 Bacterial
 Localized: Staph aureus, GAS, cat-scratch, tularemia, diphtheria
 Generalized : Brucellosis, leptospirosis, typhoid
 Viral
 EBV, CMV, HSV, HIV, Hep B, Measles, Mumps, Rubella, Dengue Fever
 Myocobacterial
 TB, Atypical mycobacteria
 Fungal
 Coccidiomycosis, Cryptococcosis, Histoplasmosis
 Protozoal
 Toxoplamosis, Leishmaniasis
 Spirochetal
 Lyme disease, symphilis
Differential Diagnosis - Other
 Malignancy
 leukemia, lymphoma, metastasis from solid tumor
 Immunologic
 SLE, serum sickness, Langerhans cell histiocytosis, RA, Drug
Reaction, dermatomyositis, CGD
 Endocrine
 Addison disease, hypothyroidism
 Other
 Amyloidosis, Kawasaki disease, Sarcoidosis, Churg-Strauss
syndrome, Kikuchi disease, Castleman disease
Time Course of Lymphadenopathy
 When to biopsy
 Many advocate biopsy of concerning nodes that have not
decreased after 4-6 weeks or have not normalized in 8-12
weeks
 Lymph nodes present for long time are not likely to be
malignant except for Hodgkins
 Exposure
 medications, animals, uncooked meats, unpasteurized milk
 Associated constitutional symptoms
 Fever, night sweats, weight loss, pruritus, arthralgias, fatigue
Lymphadenitis
 Lymphadenitis – enlarged, inflamed, tender lymph nodes
 Organisms:
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Staph aureus, GAS (80%)
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Southwest US
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Usually submandibular
Yersinia pestis = Bubonic plague
Bartonella henselae = cat scratch
TB and atypical mycobacteria (M. avium and M. scrofulaceum)
 Management
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Culture drainage or of pharyngeal exudate
Treatment
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1st/2nd generation cephalosporin or dicloxacillin
Clindamycin or Augmentin if anaerobe suspected (oral)
Ultrasound to determine if abscess
I&D indicated if abscess present
Diagnostic Testing to Consider
 Blood
 CBC, ESR, LDH
 Specific Serologic testing (EBV, CMV, Bartonella)
 Tuberculin Skin Testing
 Chest X-ray
 Biopsy