Lymphadenopathy, or enlarged lymph nodes, can have many potential causes. This document discusses the differential diagnosis of lymphadenopathy and evaluates the suspected causes. It begins with the anatomy and examination of lymph nodes in the head and neck region. Potential infectious causes like viruses, bacteria, fungi and parasites are covered. Immunologic disorders, malignancies, and other miscellaneous disorders are also reviewed. Imaging-based classification of neck lymph nodes and specific conditions like cat scratch disease and tuberculosis are described in detail. Rheumatoid arthritis and systemic lupus erythematosus are highlighted as important immunologic causes of lymphadenopathy.

1. DIFFERENTIAL DIAGNOSIS
OF LYMPHADENOPATHY
Guided By-
Dr. Anil Ghom
Dr. Ajit Mishra
Dr. Shweta Singh
Dr Savita Ghom
Presented By-
Dr. Bratati Dey (PG – II, OMR)

2. CONTENTS
֍ Introduction
֍ Anatomical Structure
֍ Physical Examination Of Lymph node
֍ Imaging based Nodal Classification for neck metastasis
֍ Evaluation of suspected cause of lymphadenopathy
֍ Cause Of Cervical Lymphadenopathy
֍ Management
֍ References

3. INTRODUCTION
 Lymphadenopathy is an abnormal increase in size or altered
consistency in lymph nodes.
 The condition is generally not a disease, it may be a symptom
of one of many possible underlying problems.

4. The peripheral nodes are arranged in two
circles superficial and deep
Deep circle of cervical lymph node
Prelaryngeal and
pretracheal
paretracheal Retropharyngeal Waldeyer’s ring
Superficial nodes
submental Submandibuar
Buccal &
mandibular
Pre
auricular
Post
auricular
Occipital
Anterior
cervical
Superficial
cervical

6. LYMPHNODES OF HEAD AND NECK
The entire lymph from the
head and neck drains
ultimately into the deep
cervical nodes
The jugulo digastric nodes
Jugulo omohyoid nodes

8. STRUCTURE OF LYMPH NODE

9. WHY LYMPH NODES ENLARGE ?
Immune
response to
infective
agent
Inflammtory
cell
accumulation
Infiltration of
neoplastic
cell
Inflammation
of
macrophages

11. MECHANISM OF LYMPHADENOPATHY
There are two mechanism of lymphadenopathy – hyperplasia
and infiltration
Hyperplasia Infiltration
It occurs in response to
immunologic or infectious
stimuli
It occurs by infiltration by
various cell types, including
cancer cells, lipid cells or
glycoprotein laden
macrophages.

12. PHYSICAL EXAMINATION & ANATOMY OF
NECK
 Physical Examination of a region involves
 Inspection
 Palpation
 To detect changes in the contour of neck we must know the
normal topography of this region.
 Certain normal skeletal & soft tissue structures of the neck are
readily identified by palpation.
 Normal size, contour, consistency is necessary to identify them
NORMAL PALPABLE MASSES PATHOLOGIC ONE

13. PHYSICAL EXAMINATION & ANATOMY OF
NECK
 SKIN AND SUBCUTANEOUS TISSUE (Neck)
 The investing cervical fascia is attached to lower border of
mandible, mastoid process, hyoid bone and clavicles.
It forms the heavy membrane over the deep structures of
neck.
The mobile skin and subcutaneous tissue are superficial to
the investing fascia.
Thus masses arising within this area exhibit the mobility
unless fibrosis or malignancy has fixed the deeper layer.

14. SPECIFIC REGIONS OF NECK
Submandibular
region
Parotid
region
Median –
paramedian
region
Lateral
region

15. SUBMANDIBULAR REGION
 Area drain to lymphnode
 How to examine

16. PAROTID REGION
 Area drain
 How to examine

17. MEDIAN-PARAMEDIAN REGION
 Area drain
Anterior cervical group
superficial anterior jugular
pre laryngeal
pre tracheal
Submental Group
anterior
middle
posterior

18. How to examine

19. LATERAL REGION
• Greatest no. of lymphnode are present
• Most common site of metastases

21. Examination of deep cervical nodes
⁕ Ask the patient to sit erect and turn the head to one side to
relax the sternomastoid muscle.
⁕ Use thumb and finger to palpate under the anterior and
posterior borders of the relaxed muscle and repeat the
procedure on the opposite side.
⁕ Palpate the posterior cervical nodes in the posterior triangle
close to the anterior border of the trapezius muscle.
⁕ Finally, check for supraclavicular nodes just above the
clavicle, lateral to the attachment of the sternomastoid.

22. How to examine

23. LYMPH NODES OF THE NECK
 A capillary plexus of endothelial tubes is found below the
epidermis and oral mucosa of the head and neck.
 It collects the fluid from the interstitial space for return to the
large venus trunks at the base of the neck.

24. Causes of lymphadenopathy
Classification
Infectious diseases
Immunologic diseases
Malignant diseases
Lipid storage diseases
Endocrine diseases
Other disorders

25. INFECTIOUS
1. VIRAL – Infectious mononucleosis (EBV, CMV), infectious Hepatitis,
Herpes symplex, HHV-6, VZV, Rubella, Measels, adenovirus, HIV
2. BACTERIAL – streptococcus, Staphylococcus, cat-scratch disease,
brucellosis, tuberculosis, atypical mycobacterial infection, primary and
secondary syphilis, diphtheria, leprosy.
3. FUNGAL — histoplasmosis, coccidioidomycosis, paracoccidioidomycosis
4. CHLAMYDIAL—lyphogranuloma venereum, trachoma
5. PARASITIC—toxoplasmosis, leismaniasis, trypanosomiasis, filariasis
6. RICKETTSIAL—scrub typhus, richettsialpox

26. IMMUNOLOGIC DISEASES
1. Rheumatoid arthritis
2. Mixed connective tissue disease
3. Systemic lupus erythematosus
4. Dermatomyositis
5. Sjogren’s syndrome
6. Serum sickness
7. Drug hypersensitivity
8. Primary biliary cirrhosis
9. Graft-vs-host disease
10. Silicone-associated

27. MALIGNANT DISEASES
1. Hematologic (Hodgkin’s, non-Hodgkin’s, ALL, CLL, hairy
cell leukemia, malignant histocytosis, T-cell lymphoma,
multiple myeloma with amyloidosis)
2. Metastatic—from primary sites

28. LIPID STORAGE DISEASE
1. Gaucher’s disease
2. Niemann-pick disease
3. Tangier disease
ENDOCRINE DISEASE
1. Hyperthyroid,
2. Adrenal insufficiency
3. Thyroiditis

29. OTHER DISORDERS
A. Castleman’s disease (giant lymph node hyperplasia)
B. Sarcoidosis
C. Dermatopathic lymphadenitis
D. Lymphomatoid granulomatosis
E. Kikuchi’s disease (histiocytic nectrotizing lymphadenitis)
F. Kawasaki’s disease (mucocutaneous lymph node syndrome)
G. Histocytosis X
H. Severe hypertriglyceridemia

30. Imaging-Based Nodal Classification for
Evaluation of Neck Metastatic

31. Level I: • Above hyoid bone
Below mylohyoid muscle
Anterior to back of submandibular gland
Previously classified as submental and
submandibular nodes
Level IA: Between medial margins of anterior bellies
of digastric muscles
Previously classified as submental nodes
Level IB: Posterolateral to level IA nodes
Previously classified as submandibular nodes

32. Level II: From skull base to level of lower body of hyoid bone
Posterior to back of submandibular gland
Anterior to back of sternocleidomastoid muscle
Level IIA: Anterior, lateral, medial, or posterior to internal
jugular vein
Inseparable from internal jugular vein (if posterior to
vein)
Previously classified as upper internal jugular nodes
Level IIB: Posterior to internal jugular vein with fat plane
separating nodes and vein
Previously classified as upper spinal accessory nodes

33. Level III: From level of lower body of hyoid bone to level of lower cricoid
cartilage
Anterior to back of sternocleidomastoid muscle
Previously known as mid jugular nodes
Level IV: From level of lower cricoid cartilage to level of clavicle
Anterior to line connecting back of sternocleidomastoid muscle and
posterolateral margin of anterior scalene muscle
Lateral to carotid arteries
Previously known as low jugular nodes
Level V: Posterior to back of sternocleidomastoid muscle from skull base to level
of lower cricoid arch
From level of lower cricoid arch to level of clavicle as seen on each axial
scan
Posterior to line connecting back of sternocleidomastoid muscle and
posterolateral margin of anterior scalene muscle
Anterior to anterior edge of trapezius muscle

34. Level VA: From skull base to level of bottom of cricoid cartilage arch
Posterior to back of sternocleidomastoid muscle
Previously known as upper level V nodes
Level VB: From level of lower cricoid arch to level of clavicle as seen on
each axial scan
Posterior to line connecting back of sternocleidomastoid muscle and
posterolateral margin of anterior scalene muscle
Previously known as lower level V nodes
Level VI: Between carotid arteries from level of lower body of hyoid bone to
level superior to top of manubrium
Previously known as visceral nodes
Level VII: Between carotid arteries below level of top of manubrium
Caudal to level of innominate vein
Previously known as superior mediastinal nodes

35. Supraclavicular: At or caudal to level of clavicle as seen on each
axial scan
Lateral to carotid artery on each side of neck
Above and medial to ribs
Retropharyngeal: Within 2 cm of skull base and medial to
internal carotid arteries

41. MEDICATIONS THAT MAY CAUSE
LYMPHADENOPATHY
– Allopurinol (Zyloprim)
– Atenolol (Tenormin)
– Captopril (Capozide)
– Carbamazepine (Tegretol)
– Cephalosporins
– Hydralazine (Apresoline)
– Penicillin
– Phenytoin (Dilantin)
– Primidone (Mysoline)
– Pyrimethamine (Daraprim)
– Quinidine
– Sulfonamides
– Sulindac (Clinoril)

42. INFECTIONS
UPPER RESPIRATORY INFECTION –
Acute bacterial cervical lymphadenopathy commonly caused
by bacteria and viruses that infect the upper respiratory tract.
Viruses that frequently cause this infection include adenovirus,
influenza virus, group A beta hemolytic streptococcus
( bacterial pharyngitis)
Other common bacteria causing infection are Group b C and G
hemolytic streptococci, cornybacteria & several anaerobes.

43. INFECTIONS
Clinical Features –
symptoms – cough, sinus congestion, rhinorrhea, and
occasionally fever and malaise
sign – Cervical lymph nodes bilateral palpable, and may
persist for weeks after the resolution of other symptoms.
Diagnosis –
based on symptoms.
Viral culture, serological antigen detection for persistent
infection
Management – Palliative treatment

44. LOCAL INFECTION
 Local bacterial infections of the head and neck often cause
cervical adenopathy when the infection localize within the
node.
 Common bacterial pathogens are staphylococcus aureus &
streptococcus pyogens.
 It includes tonsillar abscess, salivary adenitis & dental
abscess
 Source – viral infection (herpes simplex, coxasackie virus)

45. LOCAL INFECTION
 Clinical features –
 Often affect children and adolesents
 Acute painful oral ulcers and oropharynx
 Enlarge bilateral tender lymph nodes in anterior triangle of neck
 Submandibular and sub mental adenopathy
 Occasionally fever and malaise
 Do not present with other systemic complications
(hepatospleenomegaly or generalized lymphadenopathy)
 D/D – Acute pyogenic cervical lymphadenitis

47. SYSTEMIC INFECTION
 Severe acute and chronic infection cause cervical
lymphadenopathy.
 Cervical adenopathy is a common features of many viral
infections
 Systemic viral infections may cause acute syndrome such as
hand foot mouth diseases, chicken pox, measles, rubella.
 Enlarge lymph nodes are firm tender characteristically not
warm and erythematous.

48. Nontender Lymphoid Hyperplasia
 One or two such enlarged nodes are found during routine
papation.
 It represents persistent chronic lymphadenitis or a permanently
enlarged node after an acute or chronic lymphadenitis.
 Features –
the nodes are solitary, discrete, asymptomatic, freely
movable.
Ex – submandibular and submental group of lymphnode

49. Nontender Lymphoid Hyperplasia
Differential Diagnosis – secondary carcinoma
Management –
The patient should reexamined at two weeks to see the
mass, changes perceptibly
If doubt still exists, biopsy and microscopic study are
adviced

50. CAT – SCRATCH DISEASE
 Causative organism – Bartholena species (B Henselae)
 Clinical Features –
 fever, headache, malaise,
 Cervical lymphadenopathy involving parotid and
submandibular gland.
 At the site of inoculation pustular skin lesion is formed
 Nodes often warm, tender, erythematous, may be indurated
or supporative.

51. CAT – SCRATCH DISEASE
Investigations –
1. Serologic testing for the presence of antibody to B
Henselae
2. Lymphnode biopsy
Management –
 Self limiting, resolving with out treatment within 2 – 3
months.
 Antibiotic – trimethoprin-sulfamethoxazole.

52. TUBERCULOSIS
Caused by– M. Tuberculosis (infectious communicable organism)
Clinical features –
 Weight loss, night sweat, fever, malaise, anorexia
 Persistent cough (pulmonary TB)
 Hemoptysis and nonpurulent sputum
 Chronic granulomatous lymphadenitis typically within
nodes draining salivary glands.
 Tubercular cervical lymphadenitis (scrofula)

53. TUBERCULOSIS
Investigations –
 Chest X-ray
 Tuberculin test
 Mantoux test
 Histopathologicallly gram staining and
Löwenstein–Jensen medium staining

54. Rheumatoid Arthritis
 Autoimmune condition.
 Characterized by chronic inflammation of the synovium with
an affinity for small joints often leading to destruction of bone
& cartilage.
 Inflammation of surrounding tendon and joint deformity.
 Other clinical signs and symptoms may include fatigue,
anorexia, weakness, and muscular pain.

55. Rheumatoid Arthritis
 75% of patients with rheumatoid arthritis may present with
enlarged lymph nodes.
 Enlarged nodes are associated with active disease and are often
localized near an inflamed joint, although generalized
lymphadenopathy is also quite common.
 Histopathology - Rheumatoid arthritis will typically contain
an extensive reactive follicular hyperplasia and interfollicular
plasmacytosis.

56. Rheumatoid Arthritis
 Differential diagnosis –
Malignant Lymphoma
 Investigation –
Rheumatoid factor
ESR
C reactive protein
Anti cyclic citrillinated peptidase (CCP) Antibody test

57. Systemic Lupus erythematosus
 This disease is characterized by production of auto antibodies
and immune complex, which lead to array of systemic
complication.
 Specifically, the formation of immune complex results in an
immune reaction, which activate the compliment system.
 The ultimate outcome is tissue injury caused by vasculitis,
fibrosis, and tissue necrosis.
 Lymphadenopathy is recognized as one of the clinical
manifestations of SLE.

58. Systemic Lupus erythematosus
 Clinical manifestations –
 The classic categorization of LE into SLE and DLE has during recent
years been supplemented with acute cutaneous lupus erythematosus
and subacute cutaneous lupus erythematosus.
 SLE may also occur in concert with other rheumatologic diseases such
as secondary Sjögren’s syndrome and mixed connective tissue disease.
 These lesions may form butterfly-like rashes over the cheeks and nose
known as malar rash.

59. Histopathology
۞A diffuse hyperplasia with small lymphocytes, plasma cells.
Follicles may be scarce or absent, however, there are some
reports of finding follicular hyperplasia.

60. SJÖGREN’S SYNDROME
 This chronic autoimmune disorder is characterized by
xerostomia, xerophthalmia, and exocrine gland involvement.
When this triad is present, Sjögren’s syndrome may also be
referred to as “sicca complex.”
 Individuals with Sjögren’s syndrome display a wide spectrum
of severity that may involve multiple organ systems, including
the eyes, oral cavity, salivary glands, the lungs, kidneys, skin,
and nervous system.

61. SJÖGREN’S SYNDROME
 Clinical features –
 Keratoconjunctivitis,
 Hypofunction of the salivary glands,
 Vasculitis,
 Glomerulonephritis,
 Interstitial nephritis,
 Parotid gland enlargement,
 Polyneuropathies

62. SJÖGREN’S SYNDROME
 Lymph node histology –
 Paracortical hyperplasia with prominent vascular
proliferation and many lymphoid follicles with germinal
centers.
 The paracortical area of the node typically contains
numerous T-lymphocytes without cytological atypia,
accompanied by a variable number of plasma cells, B-
immunoblasts, and histiocytes.

63. SJÖGREN’S SYNDROME
 Laboratory blood studies are helpful in the evaluation of dry
mouth, particularly in suspected cases of Sjögren’s syndrome.
 The presence of nonspecific markers of autoimmunity, such as
antinuclear antibodies, rheumatoid factors, elevated
immunoglobulins (particularly [IgG]), and ESR, and the
presence of antibodies directed against the extractable nuclear
antigens SS-A/Ro or SS-B/La are important contributors to
the definitive diagnosis of Sjögren’s syndrome.

64. MALIGNANCY
 There are several metastatic tumors that may present as
cervical lymphadenopathy; these are tumors of the skin and
appendages, oropharynx, larynx, thyroid gland, salivary gland,
and nasophrynx.
 Widespread lymphadenopathy may be seen with many solid
tumors.
 Malignancies arising from cells in the immune system may
also cause lymphadenopathy.

65. MALIGNANCY OF LYMPHOID TISSUE
Hodgkin’s
lymphoma
Non –
hodgkin’s
lymphoma
Burkitt’s
lymphoma
Primary
reticular cell
sarcoma
Leukemia

66. Hodgkin’s lymphoma
Lymphoproliferative disorders arising from lymph nodes and
from lymphoid components of various organs.
It was first described by British pathologist, Thomas Hodgkin
in 1832. It is characterized by painless enlargement of
lymphoid tissue throughout the body.
It is neoplastic proliferation of lymhopoietic portion of
reticuloendothelial system.

67. Hodgkin’s lymphoma
Lymphocyte predominant
abundant lymphocytes, few plasma
cells, occasional Reed-Sternberg
cell, localized involvement of one
side of diaphragm.
Mixed cellularity lymphocytes,
plasma cells, eosinophils, easily
identified Reed-Sternberg cell.
Nodular sclerosis sparse
lymphocytes, stromal cells, fibrosis
and numerous but bizarre Reed-
Sternberg cells.
Lymphocyte depletion
lymphocytes, plasma cells,
eosinophils with localized
involvement.
Types

68. • Symptoms—the involved nodes are painless. Generalized
weakness, loss of weight, cough, dyspnea and anorexia are
seen. Pain in back and abdomen owing to splenic enlargement
• Signs—the lymph nodes are discrete and rubbery in
consistency with overlying skin being freely mobile.
• Pel Ebstein fever - a cyclic spiking of high fever.
• It may appear in the oral cavity as an ulcer or a swelling or as
an intra-bony lesion.

69. Radiographic Features
• Site—Rarely seen in jaws (posterior maxilla and mandible).
• Appearance – Irregular bone loss. There are radiolucent areas
separated from each other by normal appearing bone which
later become confluent.
• Margins – The radiolucent lesions have diffuse ill defined
margins which suggest infiltration of bone.
• Osteoblastic type – uncommon in jaws, but it is seen in the
vertebrae and pelvis. In it, there is frank sclerosis with filling
of the marrow spaces by bone.

70. Non-Hodgkin’s Lymphoma
(Lymphosarcoma)
• Frequently widespread at the time of diagnosis, often
involving not only the lymph nodes but also bone marrow,
spleen and other tissue. Early involvement of bone marrow is
typical.
• Etiology
– Viral—the herpes virus and Epstein barr virus.
– Immunological—there may be induced immunologic effect
permitting a malignant clone to proliferate.

71. Clinical Features
• Age/Sex - all age, M>F
• Painless lymph node enlargement of abdominal & mediastinal
region
• Symptoms—Patient C/o of tiredness, loss of weight, fever and
sweating. Pain is the main symptom of bone involvement
which may present as a pathological fracture.
• hepatosplenomegaly is present. The growth is fleshy and is
prone to ulceration.
• palatal lesions have been described as slow growing, painless,
bluish soft tissues mass

72. Radiographic Features
• Small radiolucent foci scattered throughout the area.
• Moth eaten radiolucency with poorly defined margins.
• Marked expansion of bone. Erosion and perforation of cortex
may occur.
• Teeth—cortices of unerupted tooth buds and lamina dura of
adjacent teeth are lost. Teeth may be resorbed

73. Differential Diagnosis
• Multiple myeloma – Bence Jones proteins are present in urine,
borders of lesion are usually well defined.
• Metastatic carcinoma – history of primary tumor.
• Ewing’s sarcoma – It occurs in younger age group.
• Osteosarcoma – It can be differentiated by clinical features.

74. Burkitt’s Lymphoma
(African jaw lymphoma)
• Etiology - Epstein-Barr virus
Clinical Features
• Age & sex - 6 - 9 years. Males :females ratio of 2:1.
• maxilla > mandible, where it may spread rapidly to the floor of
the orbit.
• Symptoms - Painless swelling of jaws, abdomen
• peripheral lymphadenopathy common.
• loosening or mobility of permanent teeth. There is gross
distortion of the face due to swelling

75. Radiographic Features
• Moth eaten appearance—small radiolucent foci scattered
throughout the affected area. Focal areas of radiolucency are
darker and sharper than the shadow of the marrow space lined
by normal bony trabeculae.
• Sunray appearance seen
• Margins—ill defined and non-corticated.
• Shape—rapidly expand and are ballooned shaped.
• Maxillary sinus—in the maxilla, there is blurring of shadow of
antrum

76. Radiographic Features
• Teeth—Lesions are osteolytic with loss of lamina dura about
the erupted teeth and crypts of developing teeth are enlarged.
Erupted teeth in the area are grossly displaced, as are the
developing tooth crypts.
• Effect on surrounding structures—rapidly expand, causing
gross balloon-like expansion with thinning of adjacent
structures and production of soft tissue mass adjacent to the
osseous lesion. Erosion and perforation of the cortex is seen.
In some cases, orbit is involved and there is displacement of
orbital content.

77. ᴥ Differential diagnosis –
ᴥ Infectious mononucleosis – in this disease the nodes often
tender
ᴥ Paul – Bunnel heterophilic test is positive

78. METASTATIC CARCINOMA OF CERVICAL
NODES
 The cervical lymph nodes are most frequently the site of
metastatic carcinoma than primary tumors (lymphoma)
 In aditional in squomous cell carcinoma of the larynx and
vocal cords, tumors can metastasize to regional nodes
 Squomous cell carcinoma constitute the prevalance of primary
malignancy of the head and neck
 Adenocarcinoma of the salivary glands, SCC of the skin and
melanoma are next most common metastasize to the cervical
node.
 Sarcoma rarely involve lymphnode.

79. Acute lymphadenitis
 Lymphadenitis is an inflammation or infection of a
lymphnode, & it frequently occurs when an infection is present
in the tissue drained by the particular nodes pathway.
 It is the 2nd most common pathologic cervical mass and the
most common painful enlargement.
 Primary source of infection may be oral cavity, nasal cavity,
pharynx, tonsils.

80. ACUTE LYMPHADENITIS
Clinical features –
It is usually tender on palpation
Single affected nodes are round firm , may be movable or
fixed
Several nodes may be involved in such cases
accompanying inflammation cause a firm swelling. That
prevent palpation of lymph nodes
D/D – Ludwig’s angina
infected cyst of neck

81.  Management –
 In most cases, when the primary mucosal infection is
eliminated the secondary acute lymphadenitis soon
regresses.
 Adequate dose of antibiotic specific to the organism is
administered.

82. Rare varieties of specific
lymphadenitis
 It results from primary infection by bacteria / vurus
 The specific lesions with in lymph nodes generated by
tuberculosis, histoplasmosis, sarcoidosis, infectious
mononucleosis
 Investigation –
Biopsy
Culture to be one of the specific infection.

83. Kikuchi disease
 It is a type of cervical sub-acute necrotising lymphadenopathy,
characterised by extensive areas of necrosis bounded by broad
zones of histiocytes and activated lymphoid cells.
 It is one of the important Diagnosis because it is often
misdiagnosed as lymphoma.
 Cervical lymphadenopathy is common clinical condition and
in most cases histopathologic examination is enough to
diagnose the etiology of cervical lymphadenopathy.

84. EVALUATION OF SUSPECTED CAUSE OF
CERVICAL LYMPHADENOPATHY
Disease Clinical features Investigatory findings
Infectious
Mononucleosis
Fatigue, malase, fever, atypical
lymphocytosis
Monospot, IgM early antibody
or viral capsid antigen
Toxoplasmosis 80 – 90 % patient are
asymptomatic
IgM toxoplasm antibody
Cytomegalo
Virus
Often mild symptoms,
Hepatitis
IgM CMV antibody, viral
culture of urine or blood
Cat scatch
disease
Fever, cervico – facial lymph
nodes are palpable
Usually clinical criteria,
biopsy if necessary
Pharyngitis due
to group A
streptococcus
Fever, Pharyngeal exudates,
cervical nodes
Throat culture on appropriate
medium
Tuberculous
lymphadenitis
Painless, chain of cervico –
facial lymphadenopathy
Purified protein derivative,
biopsy

85. EVALUATION OF SUSPECTED CAUSE OF
CERVICAL LYMPHADENOPATHY
Disease Clinical features Investigatory findings
Lymphoma Fever, night sweats, weight
loss in 20 -30 % cases
biopsy
Leukemia Blood dyscreasis, bruising Blood smear, bone marow
Serum sickness Fever, malase, urthralgia,
urticaria
Complement assay
Sarcoidosis Hilar nodes, skin lesions,
dyspnoea
Biopsy
kawasakidisease Fever, conjunctivitis rash,
mucous membrane disease
Clinical criteria

86. Investigation (FNAC)
Straw colored fluid contain cholesterol crystals, seen in some
odontogenic and fissural cyst.
Thick yellowish white &
granular fluid
epidermoid and keratocyst in which lamina is
filled with keratin
Yellowish cheesy material dermoid cyst
Sebum sebaceous cyst
Amber colored fluid thyroglossal duct cyst
Lymph fluid colorless with high lipid content, appears
cloudy and frothy. It is seen in hygroma and
lymphoma
Blue blood hematoma, hemangioma
Brighter red blood aneurysm and arteriovenous fistula
Pus abscess
Sulfur granules actinomycosis

87. Consistency of pathological mass
SOFT CHEESY RUBBERY FIRM BONY HARD
Inflammatory
hyperplasia
Cystic
hyperplasia
Cystic hygroma
Tubercular
node
Sebaceous
dermoid and
epidermoid
cyst.
Lymphoma
(hodgkin’s
lymphoma,
Nonhodgkin’
lymphoma,
Burkitt
lymphoma)
Myxoma
Myoblastoma
Inflammation
& infection of
lynphnode
Ex – dental
abscess
Osteosarcoma
Metastatic
lymphnode
Squamous cell
carcinoma
Malignant
lymphoma
Malignant
melanoma
Metastatic
tumor
Sarcoma

88.  An understanding of head and neck surface anatomy.
Recognition of the major structures, along with knowledge of
the distribution of lymph nodes in the head and neck, will help
identify normal versus abnormal.
 It helps to describe the physical findings Thorough physical
examination includes evaluation of the skin, neck, ears, eyes,
nose, and throat.
 Intraorally, the patient’s oropharynx should be visualized. The
oral mucosa, tongue, periodontium, and dentition should also
be examined.

89. REFERENCES
 Wood and Goaz, Differential diagnosis of Oral and Maxillofacial Lesions,
5th edition 521 – 539
 Dr. Nitin Upadhyayet al, cervical lymphadenopathy, Journal of Dental
Sciences & Oral Rehabilitation : Jan-March 2012
 Anil Govindrao Ghom, Textbook of ORAL MEDICINE, third edition
 Ernesta Parisi et al, Cervical lymphadenopathy in the dental patient: A
review of clinical approach QUINTESSENCE
INTERNATIONAL,VOLUME 36, NUMBER 6, JUNE 2005
 Yogesh M. Paikrao et al, Clinicopathological study of cervical
lymphadenopathy at rural tertiary health care centre Paikrao YM et al. Int
J Adv Med. 2018 Feb;5(1):154-158 pISSN 2349-3925 | eISSN 2349-3933
 Peter M. Som et al, Imaging-Based Nodal Classification for Evaluation of
Neck Metastatic Adenopathy, AJR:174, March 2000
 Martin S. Greenberg et al, Burket’s oral medicine Eleventh Edition, 435 -
460

90. THANKYOU