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2. Lymphadenopathy
• Enlargement of the lymph nodes due to
specific or nonspecific causes.
• LYMPHADENITIS:
• Genaralised or local Lymphadenopathy.

3. • Can be considered normal: 1) soft, flat,
submandibular nodes (<1cm) in healthy
children and young adults; 2) palpabale
inguinal lymph nodes of up to 2cm in
diameter in healthy adults.
• May be a primary or secondary manifestation
of numerous disorders, both benign and
malignant.

4. • 2/3 of causes are non specific, & less than 1% are
malignant.

5. Clinical Assessment
 Medical History
 Physical Examination
 Laboratory Tests
 Excisional LN Biopsy

6. Medical History
 Reveals the setting in which
lymphadenopathy is occuring.
 General information, accompanying
symptoms, personal and social history.

7. GENERAL INFORMATION
I. Age: Young age: TB, Syphilis, primary
malignant lymphoma. Old age; secondary
metastatic carcinoma.
II. Occupation: Brucellosis
III. Socio economic status;

8. accompanying symptoms
I. Fever
II. Soar throat
III. Cough
IV. Fatigue
V. Wt loss
VI. Increased night sweating
VII. Pressure effects

9. History of presenting
complaints
I. Duration
II. Which group was 1st affected?
III. Pain
IV. Fever
V. Primary focus
VI. Loss of appetite & wait
VII. Pressure effects

10. Past history
I. h/o TB,Syphilis, any URTI,
II. h/o recent blood transfusion.
III. immuno suppression.
IV. Any viral infection
V. HISTORY OF MEDICATION: phenytoin,
cyclosporin,allopurinol ,carbamazepine,
hydralazine

11. Personal history
 h/o exposure to pets
 h/o tobacco use, alcohol, smoking, i/v drug
abbuse
 h/o travel to any endemic area

12. Family history
 h/o any TB in family, any malignancy
(lymphoma)

13. HISTORY WITH SPECIAL
FINDINGS
 FEVER:lymphoma,TB,SLE,IMN, AIDS
 Petechial H’agein palate in a young boy with
cervical lymphadenopathy:IMN
 Hard lump in breast +ipsilateral axillary
lymphadenopathy :CA BREAST
 NON PITTING oedema with inguinal
adenopathy :FILARIASIS
 Fever,WT loss loss appetite night sweat
lymphadenopathy:TB ,AIDS,MALINGNANCY

14.  PROLONGED MEDICATION
 LYMPHADENOPATHY with SKIN lesion
:SLE ,SARCOIDOSIS,

15. General examination
I. Malnutrition
II. Anaemia
III. Icterus
IV. Lymphadenopathy
V. Edema

16. Physical Examination
 Introduce yourself
 Consent
 Position: cervical, axillary and inguinal

17.  Palpate normal side first
 Clean, dry warm hands (gloves).

18. General principles of exam
 Before the exam, ask
the patient to identify
painful areas so that
you can examine those
areas last
 During the exam pay
attention to their facial
expression to assess for
sign of discomfort

19. Remember:
 Normal lymph nodes are not palpable
 Examine the draining lymph nodes area of
any lesion
 Examine the area drained by affected lymph
nodes

20. Examination of the lymph
nodes follow the same steps
used in every examination:
Inspection
Palpation
Percussion
Auscultation

22. Inspection

23. An examination of the lymph nodes forms part of the
routine for most body systems.
As there is no need to percuss or auscultate,
examination involves inspection followed by palpation

24. The following groups of lymph nodes are to be
examined:
1- Cervical groups
2- Axillary groups
3- Inguinal groups
4- Epitrochlear lymph nodes.
5-popleteal lymph nodes
5- Remember that the liver and spleen are parts of
the lymphoid tissue

25. Exposure:
 Cervical: all head and neck to clavicles
 Axillary: stripped to the waist
 Inguinal: umblicus to knee

26. Don't forget to examine the draining areas

27. The following points are to
be fulfilled during
inspection:

28.  SSSSS (5S):
1- Site.
2- Shape.
3- Size.
4- Surface: Smooth, nodular, irregular.
5- Skin overlying the swelling (scars, colour…).
6- Other draining lymph nodes.
7- Number
8- pressure effect

29. Palpation
Technique: use the pads of the index and middle
finger to move the skin in circular motions over
the underlying tissues in each area

30. Technique

31. Cervical Lymph nodes
1- seat the patient in a chair
2- palpate from behind (?): right hand for right
side and vice versa
3- slightly bend the neck towards the side to be
examined
3- use one hand at a time
4- Bimanual examination may be employed

34.  Elevated shoulders facilitate palpation of
supraclavicular LN
 Deep nodes are deep to sternomastoid
 Virchow nodes

35. The following points are to be
fulfilled during palpation:
 Confirm your inspection
 Temprature
 Tenderness
 Consistency
 Mobility
 Special signs
 Draining area
 Matted or not

39. Axillary group
 From front: apical, central and pectoral
 From side: lateral group
 From behined: posterior and supraclavicular
groups

40. Palpation of Axillary,
Infraclavicular and
Supraclavicular Lymph Nodes
Examine the sitting patient by palpating the left axilla with your
right hand and vice versa.
Relax the patient’s left arm and axillary muscles by holding the lef
wrist with your left hand and elevating the upper arm toward the
chest wall.
Place your hand in the axilla with the fingers together and the
palm toward the chest wall.
Point your fingers obliquely toward the apex of the axilla.

41.  Now, have the patient rest their left hand on
your examining right arm, while your left
hand supports the shoulder.
 Gently, but firmly, rake the pulps of your
examining fingers along the thoracic cage to
feel for enlarged lymph nodes.

42. Palpation of Axillary,
Infraclavicular and
Supraclavicular Lymph Nodes
The central group of nodes occurs near the middle of the thoracic
wall of the axilla.
The lateral axillary group is located near the upper part of the
humerus and is best demonstrated by having the patient’s arm
elevated so that you can feel along the axillary vein.
With the patient’s arm still elevated, feel along beneath the lateral
edge of the pectoralis major muscle for the pectoral group.

43.  Palpate the subscapular nodes from behind
the patient with the arm raised, palpating
with the left hand under the anterior edge of
the latissimus dorsi muscle.
 Palpate under the clavicle for the
infraclavicular group.
 Enlargement in the supraclavicular group is
sought by feeling the soft tissues above and
behind the clavicle

46.  Epitrochlear nodes: Approximately 3 cm
proximal to the medial humeral epicondyle,
in the groove between the biceps and triceps
brachii.

48.  Palpation of the Inguinal Nodes:
A horizontal group lies along the inguinal
ligament (both above and over) and,
A vertical group is beside the great saphenous
vein in the proximal thigh.
Iliac nodes: aboveand deep to inguinal ligament

50. Palpation of a lymph node:
TT SSSS CE SSS (2T, 4S, CE, 3S).
- Temperature of skin over swelling: normal, warm,
cold (compare with contra-lateral side).
- Tenderness (look to the patient’s face).
- Site.
- Shape.
- Size.

51. - Surface: Smooth, nodular, irregular.
- Consistency: Soft, firm, hard, cystic.
- Edge: Well-defined, ill-defined.
- Surrounding structures and mobility of the swelling:
Relation to muscles etc.
- Special signs: e.g. are pulsations transmitted
or expansile?.
- (Other) Swellings.

52. Relation of a swelling to adjacent muscle by
inspection: The patient is asked to contract the
muscles against resistance:
 If the swelling becomes MORE apparent it is
SUPERFICIAL to the muscles.
 If the swelling becomes LESS apparent it is DEEP
to the muscles.
 If the swelling is NOT AFFECTED it is IN the muscle.

53. OTHER SYSTEMS
 RESP ...SYSTEM
 CVS
 CNS
 GIT

54. At the end:
 Cover the patient
 Thank the patient

55. DDs
 IMN
 SLE
 FILARIASIS
 LYMPHOMA
 AIDS

56. Follow-up and Treatment
• Follow-up at 2-4 weeks interval for benign
causes.
• Antibiotics are given only if there is strong
evidence of bacterial infection.
• DO NOT USE GLUCOCORTICOIDS-might
obscure diagnosis or delay healing in cases of
infection (EXCEPTION: life-threatening
pharyngeal obstruction by enlarged lymph
tissue in Waldeyer’s ring caused by IM.)

57.  CONCLUSSION

58. Thank you