Lymphadenopathy Flashcards
Most common etiology of inguinal LAD
Lower extremity infxn
STD
Cancer
LAD in this region is almost always pathologic
Epitrochlear LAD
3 factors to determine need for Bx in LAD in young adult (up to 25 y/o)
Abnormal CXR
LAD > 2cm
ENT Sx
LAD and animals
Cats? Other pets to cause infxn?
LAD and diet
Undercooked meat?… Toxoplasmosis
Insects and LAD
Ticks?… Lyme dz
Constitutional Sx & LAD
Fever, night sweats, weight loss
TB
Lymphoma
Other malignancy
Rx that cause LAD
Allopurinol Atenolol Carbamazepine Cephalosporins Hydralazine PCN Sulfonamides
Peripheral LAD appreciated. Why do abd exam?
Splenomegaly: lymphoma; CLL, acute leukemia, infectious mononucleosis
Localized LAD should prompt search for local cause, but what are some systemic dz that may present with localized LAD?
Tularemia
Plague
Aggressive lymphomas
LAD size
> 1 cm
Clinical significance of Shotty LAD
No clinical significance
Firm LAD
Found in cancers that induce fibrosis & when previous inflammation has left fibrosis
Firm, rubbery nodes
Lymphomas
Chronic leukemia
LAD in acute leukemia
Softer LAD
Why do nodes become fixed
Cancer invasion or inflammation of tissue surrounding nodes
Painful LAD
- Rapid growth from infxn or inflammation stretches capsule
- hemorrhage into node
- immunologic stimulation
- malignancy
Generalized LAD of uncertain etiology w/u
- cbc
- CXR
- if normal, consider PPD, HIV, RPR, ANA, heterophile test
Indication for Bx in LAD
- Not resolved after 4 weeks
* even can’t miss Dx like lymphoma, TB, head/neck CA should still be in window of treatment after 4 weeks of observation
Unexplained LAD and empiric ABX
Empiric ABX not useful
Common causes of cervical LAD
EBV/mono
CMV
Toxoplasmosis
Posterior cervical LAD
EBV TB Lymphoma Kikuchi's dz Head/neck malignancy (lymphomas or metastatic squamous cell carcinoma)
Fluctuant cervical LAD
Staph/strep
Multiple enlarged cervical nodes develop over weeks-months, then become fluctuate or matted w/o significant inflammation or tenderness
Infxn with mycobacterium tuberculosis or atypical mycobacterium
Tuberculous LAD: Local or general?
Localized… Usu of head & neck
*exception is miliary TB–generalized LAD
Multiple enlarged cervical lymph nodes, has pets
Cat scratch dz (bartonella henselae
Older pt or a pt who smokes with hard LAD of neck. Suspect? Who to refer to?
ENT surgeon for fiber optic exam, possible triple endoscopy
R supraclavicular LAD
Cancer: mediastinum, lungs, esophagus
Left supraclavicular LAD (Virchow’s node)
Abdominal cancer: stomach, gallbladder, pancreas, kidneys, testes, ovaries, prostate
Axillary LAD. Pt has breast implants
Silicone breast implants can cause LAD in axillary or supraclavicular regions
Palpable epitrochlear node size
THESE ARE NOT NORMALLY PALPABLE. PALPABLE EPITROCHLEAR NODES ARE ALWAYS PATHOLOGIC, IRRESPECTIVE OF SIZE
DDx: local infxn; lymphoma; sarcoidosis; tularemia; secondary syphilis
Generalized LAD, no tender, involves axillary, cervical, occipital nodes
Acute HIV
TB LAD in neck alone
Scrofula
Important consideration in generalized LAD that is often mistaken for malignancy
Miliary TB
Posterior cervical node location
Posterior to SCM, but anterior to trapezius
Anterior cervical node location
Superficial or deep to SCM
TRIAD:
- Moderate-high fever
- LAD
- Pharyngitis
Infectious mononucleosis
**LAD mostly in posterior cervical chain, but can also be in axillary and groin, distinguishing ~ from other causes of pharyngitis
Infectious causes of heterophile negative mononucleosis-like syndromes
CMV HHV 6 HIV Adenovirus HSV Strep pyogenes Toxoplasma gondii
What percent of pt with SLE dvlp LAD
50%
Typically, LAD is soft, no tender, discrete, vary in size
Cervical, axillary, inguinal
Usu @ onset of dz or w/exacerbation
If tender, suspect infxn in addition to SLE
Massive LAD, fevers, HSM, polyclonal hypergammaglobulinemia
Castleman Dz (angiofollicular LN hyperplasia)
Localized dz treated by excision
Generalized form is fatal w/o chemo
Young woman with cervical LAD & Fever. Pathology showing findings suggestive of lymphoma
Kikuchi Dz (rare, benign condition of unknown cause)
Most frequent cause of childhood vasculitis, associated with cervical LAD
Kawasaki
Generalized LAD, Fever, HSM, hemolytic anemia, polyclonal hypergammaglobulinemia
Angioimmunoblastic T cell lymphoma (aka angioimmunoblastic lymphadenopathy)
80% follows aggressive course
LAD of 1+ lymph node groups, systemic Sx. Bx shows fibrosing inflammatory process
Inflammatory pseudo tumor
Amyloidosis & LAD
Amyloid is rare cause of LAD in absence of amyloid infiltration of other organs
Inflamed SQ tissue of head & neck, LAD in these regions
Mild elevation IgE
Eosinophilia
Kimura Dz
Unexplained, asymptomatic persistent or recurrent LAD in a male. LAD involves head/neck
Progressive Transformation of Germinal Center (PTGC)
Uncommon
May eventually dvlp Hodgkin lymphoma
Rosai-Dorfman dz
Sinus histiocytosis with massive LAD. Dz usu self limited, but complications from compression
