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evaluation of lymph node enlrgment

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lymphadenopathy

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evaluation of lymph node enlrgment

  1. 1. EVALUATION OF LYMPHADENOPATHY Nearly 600 lymphnodes
  2. 2. Normally palpable Sub mandibular Axillary inguinal
  3. 3. Pathophysiology React to threat Hyperplastic response that usually resolves within 1 month
  4. 4. 1.Size & quality Palpable nodes in other regions Any node >1cm abnormal
  5. 5. Nodes >3cm neoplasm
  6. 6. 2.Accompanying symptoms r/c fever >38.5 C,night sweats,weigt loss LYMPHOMAS Lymphngectic streaking
  7. 7. splenomegaly
  8. 8. 3.Distribution GENERALISED
  9. 9. METABOLIC •Hyper thyroidism •Lipidoses
  10. 10. Castleman’s disease Rare,idiopathic,Localised/multicentric,mim ic lymphoma/HIV,systemic symptoms,increased risk of infection
  11. 11. LOCALISED
  12. 12. ANT. AURICULAR POST. AURICULAR
  13. 13. SUB MANDIBULAR CERVICAL B/L
  14. 14. RIGHT SUPRA CLAVICULAR LEFT SUPRA CLAVICULAR
  15. 15. AXILLARY LYMPHADENOPATHY EPITROCHLEAR LYMPHADENOPATHY
  16. 16. INGUINAL LYMPHADENOPATHY
  17. 17. UNILATERAL HILAR LYMPHADENOPATHY BILATERAL HILAR LYMPHADENOPATHY
  18. 18. GASTRIC CA SISTER MARY JOSEPH NODULE
  19. 19. CAT SCRATCH D/S
  20. 20. other lymphatic abnormalities 4. Lymphangitis Lymphadenitis Kikuchi’s disease lymphedema
  21. 21. 1.Is the palpable mass indeed a lymph node???? Enlarged parotid Thyroglossal cyst Abscess Branchial cyst
  22. 22. 2.Acute or chronic ?? 3.Character of enlarged node??? tender.,mobile Firm,rubbery,nontender Painless,stonehard,fixed& matted
  23. 23. 4.Localized or generalised?? 5.Are there associated systemic/localizing symptoms/signs???
  24. 24. 6.Are there unusual epidemiological clues??? Exposure to cats Travel Exposure to bird droppings Lacerations during gardening Exposure to TB Sexual exposure
  25. 25. 1.Complete blood cell count with differential…. Atypical lymphocytosis Eosinophilia Pancytopenia
  26. 26. 2.Serum uric acid 3.Serum liver chemistries
  27. 27. Localised adenopathy 1.Throat culture 2.Urethral/cervical swabs 3.Blood culture 4.biopsy
  28. 28. 5.Abdominal CT 6.Bone marrow biopsy
  29. 29. Generalised adenopathy 1.Serological tests Heterophile test VDRL Antibody titres of viruses,fungi,toxoplasmosis Anti nuclear antibodies Rheumatoid factor
  30. 30. Hilar adenopathy 1.Mantoux test 2.chest X-RAY,CT 3.ACE enzyme determination 4.Bronchoscopy 5.mediastinoscopy
  31. 31. Lymph node biopsy Most direct approach
  32. 32. Indications Approaches & yeild Excitional biopsy preffered FNAC Needle aspiration
  33. 33. Choice of node Largest node Avoid inguinal & axillary Supra clavicular-highest diagnostic yield complications Follow up/empiric treatment
  34. 34. THANKZZZZZZZZ…..ZZZZZZ…..ZZZZ

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