Lymphadenopathy: Difference between revisions

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==[[Lymphadenopathy differential diagnosis|Differentiating Lymphadenopathy from other Diseases]]==
==[[Lymphadenopathy differential diagnosis|Differentiating Lymphadenopathy from other Diseases]]==
==[[Epidemiology and Demographics]]==


=Localized Peripheral Lymphadenopathy=
==Laboratory Evaluation of Lymphadenopathy==


'''Head and Neck Lymph Nodes'''
==Diagnostic Radiological Testing==


'''Viral infection'''
*Viral URI 
*Mononucleosis
*Herpes virus
*Coxsackievirus
*Cytomegalovirus
*HIV
'''Bacterial infection'''
*Staphylococcal aureus
*Group A Streptococcus pyogenes
*Mycobacterium
*Dental abscess
*Cat scratch disease
'''Malignancy'''
*Hodgkin disease
*Non-Hodgkin lymphoma
*Thyroid cancer
*Squamous cell carcinomas of the head and neck
'''Inguinal Peripheral Lymphadenopathy'''
'''Infection'''
*STDs
*Cellulitis
'''Malignancy'''
*Lymphoma
*Squamous cell carcinoma of genitalia
*Malignant melanoma
'''Axillary Lymphadenopathy'''
'''Infection'''
*Localized Staphylococcal aureus
*Cat-scratch disease
*Brucellosis
'''Malignancy'''
*Lymphoma
*Breast cancer
*Melanoma
*Reaction to breast implants
'''Supraclavicular Adenopathy'''
*Infections
*Mycobacteria
*Fungi
*Malignancy
'''Thoracic and abdominal neoplasms'''
*Hodgkin disease
*Non-Hodgkin lymphoma
==[[Lymphadenopathy epidemiology and demographics|Epidemiology and Demographics]]==
Generalities can safely be made about the epidemiology of lymphadenopathy. <ref name="pmid30188316">{{cite journal| author=Siddiqui S, Osher J| title=Assessment of Neck Lumps in Relation to Dentistry. | journal=Prim Dent J | year= 2017 | volume= 6 | issue= 3 | pages= 44-50 | pmid=30188316 | doi=10.1308/205016817821931079 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30188316  }} </ref> <ref name="pmid30290041">{{cite journal| author=Loizos A, Soteriades ES, Pieridou D, Koliou MG| title=Lymphadenitis by non-tuberculous mycobacteria in children. | journal=Pediatr Int | year= 2018 | volume= 60 | issue= 12 | pages= 1062-1067 | pmid=30290041 | doi=10.1111/ped.13708 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30290041  }} </ref> <ref name="pmid29594802">{{cite journal| author=Prudent E, La Scola B, Drancourt M, Angelakis E, Raoult D| title=Molecular strategy for the diagnosis of infectious lymphadenitis. | journal=Eur J Clin Microbiol Infect Dis | year= 2018 | volume= 37 | issue= 6 | pages= 1179-1186 | pmid=29594802 | doi=10.1007/s10096-018-3238-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29594802  }} </ref>
First, both generalized and localized lymphadenopathies are fairly equally distributed without regard to gender.
Second, lymphadenopathy is more prevalent in the pediatric population than in the adult population secondary to the greater number of viral infections. It would follow that the majority of the time, lymphadenopathy in the pediatric population is of less consequence again secondary to the prevalence of viral and bacterial infections in that age group. Three-quarters of all lymphadenopathy observed are localized, and of those three-quarters, half of these are localized to the head and neck area. All remaining localized lymphadenopathy is found in the inguinal area, and the remaining lymphadenopathy is found in the axilla in the supraclavicular area. Of note, the differential diagnosis of lymphadenopathy changes significantly with the age of the patient.
Third, the patient's location and circumstance are very revealing and lymphadenopathy. For example, in the developing world (sub-Saharan Africa, Southeast Asia, Indian subcontinent), exposure to parasites, HIV, and miliary TB are far more likely to be causes of generalized lymphadenopathy then in the United States and Europe. Whereas, Epstein-Barr virus, streptococcal pharyngitis, and some neoplastic processes are more likely candidates to cause lymphadenopathy in the United States and the remainder of the localized industrial world. An exposure history is very important for diagnosis.
Exposure to blood and blood-borne products either through transfusion, unsafe sexual practices, intravenous drug abuse, or vocation
Exposure to infectious disease whether it be travel, in the workplace, or the home
Medication exposure-prescription, nonprescription, or supplements
Exposure to animal-borne illness either via pets or the workplace
Exposure to arthropod bites
==[[Lymphadenopathy natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
==[[Diagnosis]]==
[[Pharyngitis diagnostic study of choice|Diagnostic Study of Choice]] | [[Pharyngitis history and symptoms|History and Symptoms]] | [[Pharyngitis physical examination|Physical Examination]]  | [[Pharyngitis laboratory findings|Laboratory Findings]] | [[Pharyngitis electrocardiogram|Electrocardiogram]] | [[Pharyngitis chest x ray|Chest X Ray]] | [[Pharyngitis CT findings|CT]] | [[Pharyngitis ultrasound findings|Ultrasound]] | [[Pharyngitis other diagnostic studies|Other Diagnostic Studies]]
=Laboratory Evaluation of Lymphadenopathy=
*'''CBC with manual differential''': This is a foundational test in the diagnosis of both generalized and regional lymphadenopathy. The number and differential of the white blood cells can indicate bacterial, viral, or fungal pathology. In addition, characteristic white blood cell (WBC) patterns are observed with several of the hematological neoplasms producing lymphadenopathy
*'''EBV serology''': Epstein-Barr viral mono is present causing regionalized lymphadenopathy
*Sedimentation rate: A measure of inflammation though not diagnostic, it can contribute to diagnostic reasoning
*'''Cytomegalovirus titers''': This viral serology is indicative of possible of CMV mononucleosis
*'''HIV serology''': This serology can be used to diagnose acute HIV syndrome-related lymphadenopathy or to infer the diagnosis of secondary HIV-elated pathologies causing lymphadenopathy.
*'''Bartonella henselae serology''': used for the diagnosis of cat-scratch lymphadenopathy
*'''FTA\RPR''': These tests can diagnose syphilis as the cause of lymphadenopathy
*'''Herpes simplex serology''': can determine if the lymphadenopathy is herpes-related. Herpes simplex can produce symptoms that are similar to mononucleosis.
*'''Toxoplasmosis serology''': can be used to diagnose  toxoplasmosis
*'''Hepatitis B serology''': Serological tests for hepatitis B to establish it as a contributing factor for lymphadenopathy
*'''ANA''': this is a screening test for SLE that can help establish it as a cause for generalized lymphadenopathy
=Diagnostic Radiological Testing=
*'''Chest x-ray''': can reveal tuberculosis, pulmonary sarcoidosis, and pulmonary neoplasm.
*'''Chest CT scan''': This modality of radiological imaging can define the above processes and reveal hilar adenopathy.
*'''Abdominal and pelvic CT scan''': These images, in combination with chest CT scan, can be revealed in cases of supraclavicular adenopathy and the diagnosis of secondary neoplasm.
*'''Ultrasonography''': can be used in the assessment of number, size, size, shape, the marginal definition, and internal structures in patients with lymphadenopathy. Color Doppler ultrasonography is of use in distinguishing the vascular pattern between more established, pre-existing lymphadenopathy and acute lymphadenopathy. Studies have indicated that a low long axis to short axis ratio of lymphadenopathy as measured by ultrasound can be a significant indicator of lymphoma and metastatic cancer as a cause of lymphadenopathy.
*'''MRI scanning''': useful in the evaluation of thoracic, abdominal, and pelvic masses.
*'''PPD''': can be used in the diagnosis of tuberculosis
*'''Tissue diagnosis of the node''': this is done by incisional biopsy and remains the gold standard for diagnosis of lymphadenopathy.


==Treatment==
==Treatment==


Treatment of lymphadenopathy is based on the etiology. Generally, treatment of lymphadenopathy is as follows:
*Infectious causes of lymphadenopathy can be treated with antibiotic therapy, antiviral therapy, or antifungal therapy.
*Immune therapy, systemic glucocorticoids can be used for autoimmune causes of lymphadenopathy
*For malignancies, any combination of surgery, chemotherapy, and radiation therapy can be used.
*If medication is the suspected cause, discontinue the medication if possible.


==References==
==References==

Latest revision as of 18:21, 26 November 2021

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Synonyms and keywords: Lymph nodes enlarged; Enlarged lymph nodes; Lymphadenitis; Swollen lymph nodes; Swollen/enlarged lymph nodes
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