Lymphadenopathy - pathophysiology Lymph node enlargement may occur via any of the following mechanisms: Nodal cells may replicate in response to antigenic stimulation or malignant transformation (e.g., lymphoma). Large number of reactive cells from outside node (e.g., neutrophils or metastatic cells) may enter node. Foreign material may be deposited into node by lipid-laden histiocytes (e.g., lipid storage diseases). Vascular engorgement and edema may occur secondary to local cytokine release. Suppuration secondary to tissue necrosis (e.g., Mycobacterium tuberculosis)
g. Familial Mediterranean feverh. Severe hypertriglyceridemiai. Vascular transformation ofsinuses j. Inflammatory pseudotumor oflymph node
Few causes of large nodes Lymphangitis Acute Suppurative-staphylococci most common cause-mode is firm and tender, erythematous and swollen Cat Scratch- most common cause, node lasting longer than 3 wks. Found in any nodes, large, red, tender Hodgkin- malignant nodes matted, firm, rubbery, asymmetry is the rule Non-Hodgkin-malignant-well defined and solid, nontender Lymphadenitis – node it’s self is infected- one node enlarged, red , warm, tender- no streaking
The causes of lymphadenopathy is broad. A patients medical history and review of systems is important in narrowing this differential. Upon examination, recognizing the pattern of lymph drainage aids in seeking an infectious focus.