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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

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Lymphadenopathy

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  1. Lymphadenopathy M.JARI.MD.

  2. Objectives • Define lymphadenopathy • Develop a systematic approach to the evaluation and management of lymphadenopathy • Discuss the differential diagnosis of localize and generalized lymphadenopathy

  3. Lymphatic System

  4. Lymphtic system • Lymph nodes • Lymphatic Vessels • Spleen • Thymus • Adenoid • Tonsils

  5. Lymphatic capillaries: • L.capillaries are in all organs except : • Brain • Heart • Epiderm • Nails

  6. Physiology & Anatomy • Lymph nodes are populated by: • dendritic cells, B and T lymphocytes,macrophage • B Lymphocytes • T Lymphocytes

  7. 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

  8. 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

  9. Location of Lymph Nodes 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

  10. 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

  11. Localized Lymphadenopathy

  12. 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

  13. 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

  14. 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

  15. Lymphadenitis • Lymphadenitis – enlarged, inflamed, tender lymph nodes • Organisms: • Staph aureus, GAS (80%) • Usually submandibular • Southwest US • Yersinia pestis = Bubonic plague • Bartonella henselae = cat scratch • TB and atypical mycobacteria (M. avium and M. scrofulaceum) • Management • Culture drainage or of pharyngeal exudate • Treatment • 1st/2nd generation cephalosporin or dicloxacillin • Clindamycin or Augmentin if anaerobe suspected (oral) • Ultrasound to determine if abscess • I&D indicated if abscess present

  16. Diagnostic Testing to Consider • Blood • CBC, ESR, LDH • Specific Serologic testing (EBV, CMV, Bartonella) • Tuberculin Skin Testing • Chest X-ray • Biopsy

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