Lymph Flashcards
Lymphadenopathy
- Body has 600 lymph nodes
- Can enlarge by proliferation of normal cells
- Infiltration by foreign or abnormal cells
Lymph Nodes
Anatomy
- Bean-shaped
- Covered thickly with the fibrous capsule
- Inward pointing trabeculae
Lymph Nodes
Two Parts
- Two Basic Parts
- Cortex
- Populated with lymphocytes
- Primary resting place for B Cell
- Undergo mitosis and divide
- Produce immunoglobulins
- T Lymphocytes
- Circulate lymph nodes
- Blood stream
- Lymphatic ducts
- Primary resting place for B Cell
- Populated with lymphocytes
- Medulla
- Made up of macrophages attached to reticular fibers
- Cortex
Overview of Lymph Nodes
- Cervical Lymph Node
- Tender on physical examination is reassuring
- Diameter greater than 2cm or that are firm and matted
- More likely to be malignant
Size of the Node
- Normal for axillary and cervical region to have up to 1cm
- Inguinal region up to 1.5
- Epitrochlear region up to .5
- Risk of underlying malignancy
- Greater than 2cm
- Mononucleosis, epstein barr, and strep
- Greater than 2cm
Location and Quality of the Nodes
- Palpable node in supraclavicular fossa
- Inguinal and axillary lymph nodes less likely of malignant disease
- Tender is more likely to be infection
- If there is hemorrhage in the node due to malignancy, may be painful
- Nodes that are fixed and matted to each others
- Cancers
- Invasive inflammations like TB or sarcoidosis
Age of Patient
- Not palpable in newborn
Congenital lesions that can be confused include
- Cystic hygroma
- Branchial cleft cyst
- Thyroglossal duct cyst “
- Cervical rib
Shotty Node
Buckshot under the skin
Most common between 3-5
Localized or Generalized
- Duration of lymphadenopathy
- Progression in size or number
- Hodgkin’s more indolent in course and there can be 6-12 months of lymphadenopathy
- Associated symptoms
- Night sweats, fever, weight loss, pruritus, arthralgias, fatigue
Lymph Nodes
The neck is divided into…
Two major anatomic triangles
SCM
Anterior triangle
Bound superiorly by mandibular border and extends along the sternocleidomastoid muscle to the mid line of the neck anteriorly.
Posterior triangle
Bounded by the sternocleidomastoid muscle, the distal two thirds of the clavicle and the posterior mid line of the neck.
Palpating Lymph Nodes
Palpate with the pads of your index and middle fingers for the various lymph node groups
Preauricular
In front of the ear
Drains anterior and temporal scalp, anterior ear canal and pinna, conjunctiva
Could be adenovirus or conjunctivitis of eye
Postauricular
Behind the ear
Drains temporal and parietal scap
Head lice
Occipital
At the base of the skull
Drains the posterior scalp
Seen on either side
Lice
Tonsillar and superficial cervical nodes
At the angle of the jaw
Lower larynx, lower ear canal, and parotid
Submandibular
Under the jaw on the side
Drain cheek, nose, lips, tongue, submandibular gland, buccal mucosa
Submental
Under the jaw in the mid line
Drains lower lip and floor of the mouth
Dental Disease
Supraclavicular
In the angle of the SCM and the clavicle
Drains the right side, mediastinum and lungs
Drains the left side abdomen
Deep Cervical Chain
- Lies below the sternomastoid
- Cannot be palpated without getting underneath the muscle
- Hook your fingers under the anterior edge of the sternomastoid muscle
- Drains the tonsils, adenoids, posterior scalp and neck, tongue, larynx, thyroid, palate, nose, esophagus, paranasal sinuses
SHOTTY NODES
Small
Mobile
Soft
Non-tender
Axillary
Drainage site
Arm, breast, thorax, neck
Inguinal Drainage
Lower extremities, genitalia, buttocks, abdominal wall below umbilicus
Popliteal drainage
Lower leg
Epitrochlear drainage
medial arm and below elbow
Reactive Adenopathy
REaction to an infection in the drainage area
Pharyngitis
Otitis Media
Conjunctivitis
Lymphadenitis
- Inflamed, enlarged, tender lymph node
- Acute onset
- Associated with tender, erythematous , warm lymph noces with fever
- Ultrasound identifies abscess
Lymphadenopathy
- Less common than localized adenitis
- Can be a sign of serious underlying systemic disease
- Major causes of non infectious lymphadenopathy
- Medication (as part of serum sickness
- Malignancy
- Autoimmune diseases
Lymphadenopathy
Looking for…
- Abnormal in size
- Abnormal in number
- Abnormal in consistency
- Differential of Lymphadenopathy
- Age of the patient
- Size of the node
- Location of the node
- Quality of the node
- Localized or generalized
- Time course of the lymphadenopathy and associated symptoms
