I. 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

II. 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

IV. Anatomy

V. 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

VI. 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

VII. Evaluation: Initial Tests

  1. Evaluation should be directed at region of primary Lymphadenopathy
    1. Specific regional approaches are preferred over more broad, shotgun approaches
    2. See Neck Masses in Children
    3. See Neck Masses in Adults
  2. Indications
    1. Specific indications based on location and exposures
    2. Generalized Lymphadenopathy
  3. Tests
    1. Complete Blood Count with manual differential
    2. Monospot (Mononucleosis serology)

VIII. Evaluation: Second-line Tests

IX. 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%)

X. 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): 1313-2
  5. Habermann (2000) Mayo Clin Proc 75:728
  6. Libman (1987) J Gen Intern Med 2(1):48-58
  7. Meier (2014) Am Fam Physician 89(5): 353-8

Images: Related links to external sites (from Google)

Ontology: Lymphadenitis (C0024205)

Definition (NCI) An acute or chronic infectious process affecting the lymph nodes.
Definition (NCI) A disorder characterized by an infectious process involving the lymph nodes.
Definition (MSH) Inflammation of the lymph nodes.
Concepts Disease or Syndrome (T047)
MSH D008199
ICD10 I88.9 , I88.1
SnomedCT 274737001, 154838000, 287688007, 19471005
English Lymphadenitides, Lymphadenitis, LYMPHADENITIS, Lymphadenitis, NOS, Lymphadenitis NOS, Inflammation of lymph node (finding), Lymphadenitis NOS (disorder), Lymphadenitis [Disease/Finding], glands infection lymph, gland infection lymph, Infection;lymph glands, lymph node inflammation, lymph glands infection, glands infections lymph, Lymph gland infection, Adenitis, Inflammation of lymph node, Lymphadenitis (disorder), lymphadenitis, infection; lymph gland, inflammation; lymph node, lymph gland; infection, lymph node; inflammation, Adenitis, NOS, adenitis, lymph gland infection
French ADENITE, Lymphadénite SAI, Infection de ganglion lymphatique, Lymphadénite
Portuguese LINFADENITE, Linfadenite NE, Infecção da glândula linfática, Linfadenite
Spanish LINFADENITIS, Linfadenitis NEOM, Inflammation of lymph node, Lymphadenitis NOS, adenitis, linfadenitis (trastorno), linfadenitis, SAI (trastorno), linfadenitis, SAI, linfadenitis, Infección de glándula linfática, Linfadenitis
German LYMPHADENITIS, Lymphadenitis NNB, Lymphdrueseninfektion, Lymphadenitis
Italian Infezione linfonodale, Linfadenite, Linfadenite NAS, Linfoadenite
Dutch lymfadenitis NAO, infectie; lymfeklier, lymfeklier; infectie, lymfeklier; ontsteking, ontsteking; lymfeklier, lymfadenitis, lymfeklierinfectie, Adenitis, lymf-, Lymfadenitis
Japanese リンパ節炎NOS, リンパ節炎, リンパセツエンNOS, リンパセツエン, リンパ節感染, リンパセツカンセン
Swedish Lymfkörtelinflammation
Czech lymfadenitida, Lymfadenitida NOS, Lymfadenitida, Infekce mízní uzliny
Finnish Imusolmuketulehdus
Russian LIMFADENIT, ADENIT, АДЕНИТ, ЛИМФАДЕНИТ
Croatian LIMFADENITIS
Polish Zapalenie węzłów limfatycznych
Hungarian lymphadenitis, nyirokcsomó fertőzés, lymphadenitis k.m.n.

Ontology: Lymphatic Diseases (C0024228)

Definition (MEDLINEPLUS)

The lymphatic system is a network of tissues and organs. It is made up mainly of lymph vessels, lymph nodes and lymph. Lymph vessels, which are different from blood vessels, carry fluid called lymph throughout your body. Lymph contains white blood cells that defend you against germs. Throughout the vessels are lymph nodes. Along with your spleen, these nodes are where white blood cells fight infection. Your bone marrow and thymus produce the cells in lymph. They are part of the system, too.

The lymphatic system clears away infection and keeps your body fluids in balance. If it's not working properly, fluid builds in your tissues and causes swelling, called lymphedema. Other lymphatic system problems can include infections, blockage, and cancer.

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 (MSH) Diseases of LYMPH; LYMPH NODES; or LYMPHATIC VESSELS.
Concepts Disease or Syndrome (T047)
MSH D008206
SnomedCT 111590001, 3305006, 234087005, 362971004, 155452000, 266326002
English Diseases, Lymphatic, Lymphatic Disease, Lymphatic Diseases, lymphatic disorder, Disease, Lymphatic, DISEASES OF THE LYMPHOID TISSUES, Disorder of lymphatics, NOS, Lymphangiopathy, NOS, Disord of lymph node+lymphat, Lymphatic Disorders, LYMPHATIC DIS, Disease of lymphoid system, SECTION C-7 DISEASES OF THE LYMPHOID TISSUES, Lymphangiopathy NOS, Lymphatic Diseases [Disease/Finding], disorder of lymphatic system, disorders lymphatic system, Diseases of lymph node or lymph vessels, lymphatic disease, lymphatic diseases, lymphatic disorders, lymphatic system disorder, Lymphangiopathies, Lymphatic disorder, Lymphangiopathy, Disorders of lymph node and lymphatics, Disorder of lymphatic system (disorder), Disorder of lymphatic system, Disorders of lymph node and lymphatics (disorder), disease (or disorder); lymphatic, Lymphatic disease, Disease of lymphoid system (disorder), Disorder of lymphatics, Disorder of lymphoid system (disorder), Disorder of lymphoid system
Italian Linfangiopatia, Linfangiopatie, Patologia linfatica, Linfangiopatia NAS, Malattie linfatiche
Dutch lymfangiopathie NAO, aandoening; lymfatisch, lymfangiopathie, lymfe-angiopathieën, lymfeaandoening, Aandoening, lymfe-, Aandoeningen, lymfe-, Lymfadenopathie, Lymfeaandoening, Lymfeaandoeningen
French Lymphangiopathie SAI, Lymphangiopathies, Lymphangiopathie, Trouble lymphatique, Maladies lymphatiques, Lymphopathies, Maladies du système lymphatique
German Lymphangiopathie NNB, Lymphangiopathien, Lymphangiopathie, Lympherkrankungen, Lymphatische Krankheiten
Portuguese Linfangiopatia NE, Linfagiopatias, Afecção linfática, Linfangiopatia, Doenças Linfáticas, Estado Linfático
Spanish Linfangiopatía NEOM, enfermedad del sistema linfático, enfermedad del sistema linfático (trastorno), linfangiopatía, Lymphatic disease, enfermedad de los tejidos linfáticos (trastorno), enfermedad de los tejidos linfáticos, trastorno del sistema linfático (trastorno), trastorno del sistema linfático, trastornos de los ganglios linfáticos (trastorno), trastornos de los ganglios linfáticos, Linfangiopatías, Linfangiopatía, Trastorno linfático, trastorno del sistema linfoide (trastorno), trastorno del sistema linfoide, Enfermedades Linfáticas, Enfermedades Linfaticas
Japanese リンパ管障害, リンパ管障害NOS, リンパ管症, リンパ系障害, リンパケイショウガイ, リンパカンショウガイNOS, リンパカンショウ, リンパカンショウガイ
Swedish Lymfatiska sjukdomar
Czech lymfatické nemoci, Lymfangiopatie, Lymfangiopatie NOS, Onemocnění lymfatických cév, Lymfatická porucha
Finnish Imukudosjärjestelmän sairaudet
Russian LIMFADENOPATIIA, LIMFATICHESKOI SISTEMY BOLEZNI, RETIKULEZ, РЕТИКУЛЕЗ, РЕТИКУЛОЭНДОТЕЛИОЗ, RETIKULOENDOTELIOZ, ЛИМФАДЕНОПАТИЯ, ЛИМФАТИЧЕСКОЙ СИСТЕМЫ БОЛЕЗНИ
Croatian LIMFATIČNE BOLESTI
Polish Choroby układu limfatycznego, Siatkowico-śródbłonkowica, Choroby układu chłonnego
Hungarian lymphatikus betegség, Lymphangiopathiak, Lymphangiopathia k.m.n., Lymphangiopathia