Hematology and Oncology Book

http://www.fpnotebook.com/

Lymphadenopathy

Advertisement

  1. Epidemiology
    1. Cancer risk in unexplained adenopathy (primary care)
      1. Age over 40 years: 4% cancer risk
      2. Age under 40 years: 0.4% cancer risk
  2. Definitions
    1. Lymphadenopathy
      1. Lymph nodes with abnormal size
      2. Lymph nodes with abnormal consistency
      3. Lymph nodes of abnormal number
    2. Classifications
      1. Localized lymphadenopathy
        1. Limited to one area of involvement
      2. Generalized Lymphadenopathy
        1. Two or more non-contiguous areas
  3. Causes
    1. See Medication Causes of Lymphadenopathy
    2. See Lymphadenopathy in the Febrile Returning Traveler
    3. See Generalized Lymphadenopathy
    4. See Lymphadenopathy of the Head and Neck
    5. See Regional Lymphadenopathy
    6. See Hilar Adenopathy
  4. History: Exposures
    1. Cat Exposure (Cat Scratch Disease or Toxoplasmosis)
    2. Ingestion of undercooked meat (Toxoplasmosis)
    3. Tick bite (Lyme Disease or Tularemia)
    4. Tuberculosis exposure
    5. Intravenous Drug Abuse
    6. Blood transfusion history
    7. Sexually Transmitted Disease exposure
    8. Occupational or hobby exposure
      1. Hunters or Trappers (Tularemia)
      2. Fish handlers (Erysipeloid)
    9. Travel to Southwestern United States
      1. Coccidioidomycosis
      2. Bubonic Plague
    10. Travel to Southeastern or central United States
      1. Histoplasmosis
    11. Travel to Southeast Asia and Australia
      1. Scrub Typhus
    12. Travel to central or west Africa
      1. African Trypanosomiasis (African Sleeping Sickness)
    13. Travel to central or south America
      1. American Trypanosomiasis (Chagas' Disease)
    14. Travel East Africa, China, Latin America, Mediterranean
      1. Kala-azar (Leishmaniasis)
    15. Travel Mexico, Peru, Chile, Pakistan, Egypt, Indonesia
      1. Typhoid Fever
  5. Signs
    1. Abnormal lymph node size criteria
      1. Epitrochlear Lymphadenopathy >0.5 cm
      2. Inguinal Lymphadenopathy >1.5 cm
      3. Isolated lymphadenopathy in children >1.5 to 2.0 cm
      4. Other lymphadenopathy >1.0 cm
    2. Tenderness to palpation
      1. Does not differentiate benign from malignant nodes
    3. Lymph node consistency
      1. Rock-hard nodes: metastatic cancer
      2. Firm-rubbery nodes: Lymphoma
      3. Soft nodes: Inflammation or infection
      4. Shotty nodes (multiple small buckshot size): Viral
    4. Matted Nodes (connected nodes)
      1. Benign causes
        1. Tuberculosis
        2. Sarcoidosis
        3. Lymphogranuloma venereum
      2. Malignant causes
        1. Metastatic cancer
        2. Lymphoma
    5. Splenomegaly
      1. Infectious Mononucleosis
      2. Hodgkin's Disease
      3. Non-Hodgkin's Lymphoma
      4. Chronic Lymphocytic Leukemia
      5. Acute Leukemia
      6. Rarely associated with metastatic cancer
  6. Diagnostic Evaluation: Initial Tests
    1. Indications
      1. Specific indications based on location and exposures
      2. Generalized Lymphadenopathy
    2. Tests
      1. Complete Blood Count with manual differential
      2. Monospot (Mononucleosis serology)
  7. Diagnostic Evaluation: Second-line Tests
    1. Indications
      1. Specific indications and normal initial tests
      2. Persistent Generalized Lymphadenopathy
    2. Tests
      1. Tuberculin Skin Test (Purified Protein Derivative)
      2. Rapid Plasma Reagin (RPR)
      3. Antinuclear Antibody (ANA)
      4. Hepatitis B Serology (HBsAg)
      5. HIV Test
      6. Chest XRay
  8. Diagnostic Evaluation: Third-line Tests (Biopsy)
    1. Indications
      1. Persistent lymphadenopathy for more than 3-4 weeks
      2. Malignancy or serious disease suspected
    2. Biopsy
      1. Lymph node biopsy of most abnormal or largest node
      2. Excisional Biopsy preferred over FNA or needle biopsy
    3. Efficacy
      1. Highest yield site: Supraclavicular nodes
      2. Lowest yield site: Inguinal nodes
    4. Most common findings on biopsy
      1. Abnormal but non-specific findings (40%)
      2. Metastatic cancer (25%)
      3. Intrinsic malignancy such as Lymphoma (20%)
      4. Tuberculosis (10%)
  9. References
    1. Dornbland (1992) Adult Ambulatory Care, p. 662-7
    2. Lee (1999) Wintrobe's Hematology, p. 1826-30
    3. Wilson (1991) Harrison's Internal Medicine, p. 354-6
    4. Ferrer (1998) Am Fam Physician 58(6):1313
    5. Habermann (2000) Mayo Clin Proc 75:728
    6. Libman (1987) J Gen Intern Med 2(1):48

Lymphatic Diseases (C0024228)

Definition (MSH)Diseases of LYMPH; LYMPH NODES; or LYMPHATIC VESSELS.
Definition (CSP)condition in which there is a deviation from or interruption of the normal structure or function of the lymph or lymph vessels.
Definition (NCI)(ad-en-OP-a-thee) Large or swollen lymph glands.
Definition (NCI)Disease or swelling of the lymph nodes.
Definition (NCI)Lymphadenopathy: the abnormal enlargement of lymph nodes.
ConceptsDisease or Syndrome (T047)
MSHD008206
EnglishAdenopathy, Disease of lymphoid system, Disorder of lymphatic system, Disorder of lymphatics, Disorder of lymphoid system, Disorders of lymph node and lymphatics, Lymphadenopathy, Lymphangiopathy, LYMPHATIC DIS, Lymphatic disease, Lymphatic Diseases, lymphatic disorder, Lymphatic Disorders
Spanishenfermedad de los tejidos linfaticos, enfermedad del sistema linfatico, linfangiopatia, trastorno del sistema linfatico, trastorno del sistema linfoide, trastornos de los ganglios linfaticos
Parent ConceptsAutoimmune Diseases (C0004364), Lymphatic Diseases (C0024228), Disease (C0012634), Hemic and Lymphatic System (C0549527), Hemic and Lymphatic Diseases (C0018981), Hematopoietic system finding (C1292123), Disorder of body system (C1285159), Disorder of hematopoietic structure (C1532235), Disorder of immune structure (C1532238)
SourcesAOD, COSTAR, CSP, CST, MEDLINEPLUS, MSH, MTH, NCI, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree