1. Clinical approach to Lymphadenopathy

2. EVALUATION OF LYMPHADENOPATHY
Nearly 600 lymphnodes

3. Normally palpable
Sub mandibular
Axillary
inguinal

4. Pathophysiology React to threat
Hyperplastic response that usually resolves within 1 month

6. Clinical presentations
Size & quality
Palpable nodes in other regions
Any node >1cm
abnormal

7. Nodes >3cm
neoplasm

8. 2.Accompanying symptoms
r/c fever >38.5 C,night sweats,weigt loss
LYMPHOMAS
Lymphngectic streaking

9. splenomegaly

10. 3.Distribution
GENERALISED

11. infections Neoplasia Hypersensitivity IMN AIDS AIDS related complex
Toxoplasmosis
Secodary syphilis
infections
Serum sickness
Phenytoin
Vasculitis,lupus,RA
Hypersensitivity
LEUKEMIA
HODGKIN’S DISEASE
NHL
Neoplasia

12. METABOLIC
Hyper thyroidism
Lipidoses

13. Castleman’s disease
lymphoma/HIV,sysemicreased risk of infection

14. LOCALISED POST.AURICLAR ANT.AURICULAR Viral Conjunctivitis Trachoma
Tularemia
Sarcoidosis
ANT.AURICULAR
Rubella
Scalp infection
POST.AURICLAR

15. ANT. AURICULAR
POST. AURICULAR

16. SUB MANDIBULAR CERVICAL B/L IMN Sarcoidosis Toxoplasmosis pharyngitis
Buccal cavity infection
Pharyngitis
Nasopharyngeal tumour
Thyroid malignancy
SUB MANDIBULAR
IMN
Sarcoidosis
Toxoplasmosis
pharyngitis
CERVICAL B/L

17. SUB MANDIBULAR
CERVICAL B/L

18. Right Supra clavicular
Pulmonary malignancy
Mediastinal malignancy
Esophageal malignancy
Right Supra clavicular
Intra abdominal malignancy
Renal ca
Testicular or ovarian malignancy
Left supra clavicular

19. RIGHT SUPRA CLAVICULAR
LEFT SUPRA CLAVICULAR

20. axillary Epitrochlear Ca breast / infection Upper extremity infection
Syphilis(b/l)..Sailor’s handshake
CLL
IMN
Lymphoma
Hand infection(u/l)
Epitrochlear

21. EPITROCHLEAR LYMPHADENOPATHY
AXILLARY LYMPHADENOPATHY

22. Inguinal Syphilis Genital herpes Lympho granuloma venereum Chancroid
Lower extremity/local infection
Inguinal

23. INGUINAL LYMPHADENOPATHY

24. Hilar(u/l) Hilar(b/l) Lymphoma Bronchogenic ca TB sarcoidosis
Fungal(histoplasmosis,coccidiomycosis)
Hilar(b/l)

25. UNILATERAL HILAR LYMPHADENOPATHY
BILATERAL HILAR LYMPHADENOPATHY

26. Adeno ca of gut
Hodgkin’s d/s TB
Bladder ca
Gastric ca
ABDOMINAL

27. SISTER MARY JOSEPH NODULE
GASTRIC CA
SISTER MARY JOSEPH NODULE

28. ANY REGION Cat scratch fever Hodgkin’s d/s NHL Leukemia Metastatic ca
Sarcoidosis
Granulomatous infection
ANY REGION

29. CAT SCRATCH D/S

30. Lymphangitis Lymphadenitis Kikuchi’s disease lymphedema
4.Other lymphatic abnormalities
Lymphangitis
Lymphadenitis
Kikuchi’s disease
lymphedema

31. History & examination
1.Is the palpable mass indeed a lymph node????

32. 6.Are there unusual epidemiological clues???
Exposure to cats
Travel
Exposure to bird droppings
Lacerations during gardening
Exposure to TB
Sexual exposure

33. Laboratory investigations
1.Complete blood cell count with differential….
Atypical lymphocytosis
Eosinophilia
Pancytopenia

34. 2.Serum uric acid
3.Serum liver chemistries

35. Localised adenopathy 1.Throat culture 2.Urethral/cervical swabs
3.Blood culture
4.biopsy

36. 5.Abdominal CT
6.Bone marrow biopsy

37. Generalised adenopathy
1.Serological tests
Heterophile test
VDRL
Antibody titres of viruses,fungi,toxoplasmosis
Anti nuclear antibodies
Rheumatoid factor

38. Hilar adenopathy 2.chest X-RAY,CT 1.Mantoux test
3.ACE enzyme determination
4.Bronchoscopy
5.mediastinoscopy

39. Lymph node biopsy
Most direct approach

40. Indications Approaches & yeild Excitional biopsy preffered FNAC
Needle aspiration

41. complications Choice of node Follow up/empiric treatment Largest node
Avoid inguinal & axillary
Supra clavicular-highest diagnostic yield
complications
Follow up/empiric treatment