Cervical lymphadenopathy

Question 1

What can cause generalised lymphadenopathy?

Answer 1

· Infection.
· Lymphoproliferative - Hodgkin’s/Non-Hodgkin’s/CLL/ALL.
· Connective tissue disorders - SLE, RA.
· Infiltration - Sarcoidosis.
· Drugs - Phenytoin.
· Endocrine - Thyrotoxicosis.

Question 2

What is the epidemiology of cervical lymphadenopathy?

Answer 2

· Most common in young children.

· Rare causes in some ethnic groups, such as sarcoidosis in Africans.

Question 3

What is the pathophysiology of cervical lymphadenopathy?

Answer 3

· Disease involving the reticuloendothelial system, secondary to an increase in normal lymphocytes and macrophages in response to an antigen.

· Most lymphadenopathy in children is benign, self-limiting disease such as viral infections.

· Cervical nodes drain the:

• Tongue.
• External ear.
• Parotid gland.
• Deep structures of the neck - larynx, thyroid and trachea.

Question 4

What is the aetiology of cervical lymphadenopathy?

Answer 4

· Infection:

- URTI. 
- Ear infections. 
- Tonsillitis. 
- Glandular fever. 
- HIV. 
- TB. 
- Dental infection. 
- Local skin infection. 

· Metastases.
	- ALL. 
	- AML. 
· Lymphoma.
· Phenytoin use.

Question 5

List the potential risk factors.

Answer 5

· Infection.
· Phenytoin use.
· Young age.

Question 6

What are the typical signs and symptoms of cervical lymphadenopathy?

Answer 6

· Infection:

- Painful.
- Develops quickly. 
- Less than 1cm. 
- Soft and unfixed. 

· Malignancy:
	- Painless.
	- Develops slowly. 
	- B symptoms - fever, night sweats, fatigue and weight loss. 
	- Larger nodes.
· Hard and fixed. 
· Rubbery in HL/NHL.

Question 7

A mass in which location can indicate a metastatic malignancy from a primary tumour below the clavicle?

Answer 7

Left supraclavicular region (virchows node)

Question 8

What investigations would you do in order to help diagnose cervical lymphadenopathy?

Answer 8

· Examine the nodes.
· ENT examination if isolated cervical lymphadenopathy as oropharyngeal malignancies commonly metastasise here.
· FBC, ESR, CRP.
· Lactate dehydrogenase, calcium, uric acid - if suspecting lymphoma.
· Serology for infection - monospot for EBV, CMV, rubella.
· Chest x-ray.
· Biopsy.

Question 9

What would you comment on when examining the nodes?

Answer 9

· Extent.
· Site.
· Size.
· Consistency.
· Tenderness.
· Fixation.

Question 10

Differentials?

Answer 10

· ALL, AML.
· Lymphoma.
· Infection.

Question 11

What are the current treatment options?

Answer 11

· Abx for infection.
· Biopsy.
· Treatment for malignancy:
- Referral to ENT.

Question 12

What complications may arise?

Answer 12

· Missed malignancy diagnosis.
· Associated with lymphadenitis - cellulitis, internal jugular vein thrombosis, abscess.
· Complications related to the cause - sepsis, metastatic disease, quinsy.