Presentation on theme: "Approach to a Patient with Lymphadenopathy. Lymphadenopathy Enlargement of the lymph nodes. Can be considered normal: 1) soft, flat, submandibular nodes."— Presentation transcript:
Approach to a Patient with Lymphadenopathy
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.
Clinical Assessment Medical History Physical Examination Laboratory Tests Excisional LN Biopsy
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.
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.
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.)
Site of Localized Adenopathy Occipital Preauricular Neck Supraclavicular and scalene Virchows nodes Axillary Inguinal
Size of the Node <1.0 cm 2 –benign; non-specific causes. >2.0 cm/ >2.25cm 2 -malignant or granulomatous disease.
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.)
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.
Abdominal and Retroperitoneal Adenopathy Usually malignant. TB mesenteric lymphadenitis; lymphoma; GCT in young men.
Laboratory Investigation CBC Serology CXR CT and MRI Ultrasound
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 (>2.25cm 2 ), hard and non-tender
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 Waldeyers ring caused by IM.)