Lymphadenopathy• Enlargement of the lymph nodes due to specific or nonspecific causes.• LYMPHADENITIS:• Genaralised or local Lymphadenopathy.
• 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.
• 2/3 of causes are non specific, & less than 1% are malignant.
History of presentingcomplaintsI. DurationII. Which group was 1st affected?III. PainIV. FeverV. Primary focusVI. Loss of appetite & waitVII. Pressure effects
Past historyI. h/o TB,Syphilis, any URTI,II. h/o recent blood transfusion.III. immuno suppression.IV. Any viral infectionV. HISTORY OF MEDICATION: phenytoin, cyclosporin,allopurinol ,carbamazepine, hydralazine
Personal history h/o exposure to pets h/o tobacco use, alcohol, smoking, i/v drug abbuse h/o travel to any endemic area
Family history h/o any TB in family, any malignancy (lymphoma)
HISTORY WITH SPECIALFINDINGS 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
PROLONGED MEDICATION LYMPHADENOPATHY with SKIN lesion :SLE ,SARCOIDOSIS,
General examinationI. MalnutritionII. AnaemiaIII. IcterusIV. LymphadenopathyV. Edema
Palpate normal side first Clean, dry warm hands (gloves).
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
Remember: Normal lymph nodes are not palpable Examine the draining lymph nodes area of any lesion Examine the area drained by affected lymph nodes
Examination of the lymphnodes follow the same stepsused in every examination:InspectionPalpationPercussionAuscultation
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
The following groups of lymph nodes are to be examined:1- Cervical groups2- Axillary groups3- Inguinal groups4- Epitrochlear lymph nodes.5-popleteal lymph nodes5- Remember that the liver and spleen are parts of the lymphoid tissue
Exposure: Cervical: all head and neck to clavicles Axillary: stripped to the waist Inguinal: umblicus to knee
Cervical Lymph nodes1- seat the patient in a chair2- palpate from behind (?): right hand for right side and vice versa3- slightly bend the neck towards the side to be examined3- use one hand at a time4- Bimanual examination may be employed
Elevated shoulders facilitate palpation of supraclavicular LN Deep nodes are deep to sternomastoid Virchow nodes
The following points are to befulfilled during palpation: Confirm your inspection Temprature Tenderness Consistency Mobility Special signs Draining area Matted or not
Axillary group From front: apical, central and pectoral From side: lateral group From behined: posterior and supraclavicular groups
Palpation of Axillary, Infraclavicular and Supraclavicular Lymph NodesExamine the sitting patient by palpating the left axilla with yourright hand and vice versa.Relax the patient’s left arm and axillary muscles by holding the lefwrist with your left hand and elevating the upper arm toward thechest wall.Place your hand in the axilla with the fingers together and thepalm toward the chest wall.Point your fingers obliquely toward the apex of the axilla.
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.
Palpation of Axillary, Infraclavicular and Supraclavicular Lymph NodesThe central group of nodes occurs near the middle of the thoracicwall of the axilla.The lateral axillary group is located near the upper part of thehumerus and is best demonstrated by having the patient’s armelevated so that you can feel along the axillary vein.With the patient’s arm still elevated, feel along beneath the lateraledge of the pectoralis major muscle for the pectoral group.
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
Epitrochlear nodes: Approximately 3 cm proximal to the medial humeral epicondyle, in the groove between the biceps and triceps brachii.
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
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.
- 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 transmittedor expansile?.- (Other) Swellings.
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 isSUPERFICIAL to the muscles. If the swelling becomes LESS apparent it is DEEPto the muscles. If the swelling is NOT AFFECTED it is IN the muscle.
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.)