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Approach to a Patient with Lymphadenopathy

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Presentation on theme: "Approach to a Patient with Lymphadenopathy"— Presentation transcript:

1 Approach to a Patient with Lymphadenopathy

2 Lymphadenopathy Enlargement of the lymph nodes.
Can be considered normal: 1) soft, flat, submandibular nodes (<1cm) in healthy children and young adults; 2) palpabale inguinal lymph nodes of up to 2cm in diameter in healthy adults. May be a primary or secondary manifestation of numerous disorders, both benign and malignant.

3 Clinical Assessment Medical History Physical Examination
Laboratory Tests Excisional LN Biopsy

4 Medical History Reveals the setting in which lymphadenopathy is occuring. General information, accompanying symptoms, personal and social history. Ex.: viral/bacterial URTI, toxoplasmosis, TB benign disorders in children and young adults; if>50 y/o increase incidence of malignant disorder.

5 Physical Examination Extent of lymphadenopathy ( localized or generalized), size, texture, presence/ absence of tenderness, signs of inflammation over the node, skin lesions, and splenomegaly. ENT exam indicated in an adult patient with cervical lymphanedopathy with history of tobacco use.

6 Extent of Lymphadenopathy
Localized/regional- involvement of a single anatomic site. Generalized- involvement of 3 or more non-contiguous lymph node areas; usually indicates non- malignant disorder (except for ALL, CLL, and malignant lymphomas.)

7 Site of Localized Adenopathy
Occipital Preauricular Neck Supraclavicular and scalene Virchow’s nodes Axillary Inguinal

8 Size of the Node <1.0 cm2 –benign; non-specific causes.
>2.0 cm/ >2.25cm2 -malignant or granulomatous disease.

9 Texture and Presence of Pain
Acute leukemia- pain in nodes due to rapid enlargement. Lymphoma- large, discrete, symmetric, rubbery, firm, and non-tender. Metastatic cancer- hard, non-tender, and non moveable. W/ splenomegaly- systemic illness (IM, lymphoma, acute or chronic leukemia, etc.)

10 Thoracic Adenopathy Detected by CXR or work-up for superficial adenopathy. May cause coughing/wheezing, hoarseness, dysphagia, and/or swelling of the face and neck. Due to a primary lung disorder or systemic illness.

11 Abdominal and Retroperitoneal Adenopathy
Usually malignant. TB mesenteric lymphadenitis; lymphoma; GCT in young men.

12 Laboratory Investigation
CBC Serology CXR CT and MRI Ultrasound

13 Lymph Node Biopsy Done if PE findings suggest malignancy.
Biopsy evident primary lesion first. FNAB- not to be used as primary diagnostic procedure; for thyroid nodules or confirmation of relapse in patient whose primary diagnosis is known. Guidelines: Older patients (>40y/o), large LN (>2.25cm2 ), hard and non-tender

14 Follow-up and Treatment
Follow-up at 2-4 weeks interval for benign causes. Antibiotics are given only if there is strong evidence of bacterial infection. DO NOT USE GLUCOCORTICOIDS-might obscure diagnosis or delay healing in cases of infection (EXCEPTION: life-threatening pharyngeal obstruction by enlarged lymph tissue in Waldeyer’s ring caused by IM.)

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