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Lymphadenopathy
EVALUATION OF LYMPHADENOPATHY




Nearly 600
lymphnodes
Normally palpable
     Sub mandibular
     Axillary
      inguinal
Pathophysiology


  React to threat


Hyperplastic response that
usually resolves within 1 month
Lymphadenopathy
1.Size & quality
      Palpable nodes
      in other regions   abnormal
      Any node >1cm
Nodes >3cm   neoplasm
2.Accompanying symptoms

r/c fever >38.5 C,night sweats,weigt
loss
            LYMPHOMAS


Lymphngectic streaking
splenomegaly
3.Distribution
 GENERALISED
• IMN
                   • AIDS
   infections      • AIDS related complex
                   • Toxoplasmosis
                   • Secodary syphilis




                           • LEUKEMIA
     Neoplasia             • HODGKIN’S DISEASE
                           • NHL




                   • Serum sickness
Hypersensitivity   • Phenytoin
                   • Vasculitis,lupus,RA
METABOLIC   •Hyper thyroidism
            •Lipidoses
Castleman’s disease
Rare,idiopathic,Localised/multicentric,mim
ic lymphoma/HIV,systemic
symptoms,increased risk of infection
LOCALISED

              • Viral Conjunctivitis
              • Trachoma
ANT.AURICULAR
              • Tularemia
              • Sarcoidosis



                • Rubella
POST.AURICLAR   • Scalp infection
ANT. AURICULAR   POST. AURICULAR
• Buccal cavity infection
   SUB       • Pharyngitis
             • Nasopharyngeal tumour
MANDIBULAR   • Thyroid malignancy




             • IMN
 CERVICAL    • Sarcoidosis
   B/L       • Toxoplasmosis
             • pharyngitis
SUB MANDIBULAR   CERVICAL B/L
Right       • Pulmonary malignancy
              • Mediastinal malignancy
  Supra       • Esophageal malignancy
clavicular


   Left      • Intra abdominal malignancy
  supra      • Renal ca
             • Testicular or ovarian
clavicular     malignancy
RIGHT SUPRA CLAVICULAR   LEFT SUPRA CLAVICULAR
• Ca breast / infection
 axillary      • Upper extremity infection




               • Syphilis(b/l)..Sailor’s handshake
               • CLL
Epitrochlear   • IMN
               • Lymphoma
               • Hand infection(u/l)
EPITROCHLEAR
AXILLARY LYMPHADENOPATHY   LYMPHADENOPATHY
• Syphilis
           • Genital herpes
           • Lympho granuloma
Inguinal     venereum
           • Chancroid
           • Lower extremity/local
             infection
INGUINAL LYMPHADENOPATHY
•   Lymphoma
             •   Bronchogenic ca
Hilar(u/l)   •
             •
                 TB
                 sarcoidosis




             •   Sarcoidosis
             •   Fungal(histoplasmosis,coccidiomycosis)

Hilar(b/l)   •
             •
                 Lymphoma
                 Bronchogenic ca
             •   TB
UNILATERAL HILAR LYMPHADENOPATHY   BILATERAL HILAR LYMPHADENOPATHY
• Adeno ca of gut
            • Hodgkin’s d/s
            • TB
ABDOMINAL   • Bladder ca
            • Gastric ca
GASTRIC CA




             SISTER MARY
             JOSEPH NODULE
• Cat scratch fever
         • Hodgkin’s d/s
         • NHL
 ANY     • Leukemia
REGION   • Metastatic ca
         • Sarcoidosis
         • Granulomatous infection
CAT SCRATCH D/S
other lymphatic abnormalities
4.



     Lymphangitis
     Lymphadenitis
     Kikuchi’s disease
     lymphedema
1.Is the palpable mass indeed a
lymph node????
                  Enlarged parotid
                  Thyroglossal cyst
                  Abscess
                  Branchial cyst
2.Acute or chronic ??


3.Character of enlarged node???
      tender.,mobile
      Firm,rubbery,nontender
      Painless,stonehard,fixed&
      matted
4.Localized or generalised??



5.Are there associated
systemic/localizing symptoms/signs???
6.Are there unusual epidemiological
clues???

        Exposure to cats
        Travel
        Exposure to bird droppings
        Lacerations during gardening
        Exposure to TB
        Sexual exposure
1.Complete blood cell count
with differential….
        Atypical lymphocytosis
        Eosinophilia
        Pancytopenia
2.Serum uric acid



3.Serum liver chemistries
Localised adenopathy


1.Throat culture

2.Urethral/cervical swabs

3.Blood culture

4.biopsy
5.Abdominal CT

6.Bone marrow biopsy
Generalised adenopathy

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

1.Mantoux test 2.chest X-RAY,CT

3.ACE enzyme determination

4.Bronchoscopy

5.mediastinoscopy
Lymph node biopsy
 Most direct approach
Indications



Approaches & yeild
      Excitional biopsy preffered
      FNAC
      Needle aspiration
Choice of node
     Largest node
     Avoid inguinal & axillary
     Supra clavicular-highest diagnostic
     yield


complications

 Follow up/empiric treatment
THANKZZZZZZZZ…..ZZZZZZ…..ZZZZ

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