Lymph nodes examination

1. lymph Node Examination
Dr. Abeer A bdulkareem

2. Examination of the lymph nodes forms a portion of the routine exam for:
1. General Examination
2. Most Body Regions: e.g. ENT, thyroid and breast examination
 Normally, lymph nodes should be nonpalpable.
Remember that the liver and spleen are often enlarged in the
presence of generalized lymphadenopathy ,These should be
examined
Introduction

3. Several groups of lymph nodes are accessible
for physical examination.
In the head and neck, these are located along
the anterior and posterior aspects of the neck
and on the underside and angle of the jaw .
In the upper limb and trunk, lymph nodes are
located in the epitrochlear and axillary regions
 In the lower limbs nodes can be examined in
the inguinal and popliteal regions.

4. Cervical lymph nodes
• Submental
• Submandibular
• Tonsillar
• Pre-auricular
• Post-auricular
• Occipital
• Anterior cervical
( Deep and Superficial cervical)
• Posterior cervical
• Supraclavicular

5. AXILLARY LYMPH NODES

6. Inguinal LYMPH NODES
There are two chains of superficial inguinal
lymph nodes:
a horizontal chain that runs just below the
inguinal ligament, and a vertical chain that
runs along the saphenous vein

7. lymph Node Examination

8. R W I I P P P E E

9. General inspection
General appearance
Cachexia – underlying malignancy
Rashes – cutaneous manifestations of lymphoma
Evidence of bleeding or bruising – thrombocytopenia
Vital signs – pyrexia

10. The IPPA Sequence of local examination
Inspection
Palpation
Percussion
Auscultation
There is no need to percuss or auscultate, Examination involves inspection and palpation.

11. Inspection
 Large nodes are often clearly visible on inspection,
particularly if the enlargement is asymmetrical.
 If nodes are infected, the overlying skin may be
red and inflamed.
scars- masses- skin changes

12. Cervical L.N.
Examination
PALPATION TECHNIQUE
Lymph nodes should be palpated using
the most sensitive part of your hands the
fingertips.
Head and neck
The nodes should be palpated with the
patient in: Sitting position and the
examiner standing behind.

13. Submental: in the midline behind the tip of
the mandible
Submandibular: midway and along the inner
surface of the inferior margin of the
mandible
Tonsillar: at the angle of the jaw
Pre-auricular: in front of the ear opposite the
tragus
Post-auricular: over the mastoid process
(behind the ear)
Positions in order usually examined

14. Occipital: back of the head at the base of the
skull
Posterior cervical: run along the anterior
border of the trapezius muscle
Superficial cervical: along the body of the
sternomastoid
Deep cervical: deep to the lateral border of
the sternomastoid
Supraclavicular: lie on the top of the clavicle
Infraclavicular: lie along the inferior border
of the clavicle
Positions in order usually examined

15. Axillary L.N.
Examination
To examine the nodes at the right axilla:
The patient should be sitting
comfortably and you should stand at their
right side.
Support their right arm abducted to 90°
with your right hand.
Examine the axilla with your left hand.To examine the nodes at the left axilla:
Perform the same maneuver as for the
right, but on the opposite side.

16. Examination of axilla should cover the anterior, central ,
posterior, lateral, and apical groups of lymph nodes.
An example :
1. With your palm facing towards you, palpate behind the
lateral edge of pectoralis major (anterior).
2. Turn your palm medially and with your fingertips at the
apex of the axilla palpate against the wall of the thorax
(central).
3. Facing your palm away from you now, feel inside the
lateral edge of latissimus dorsi (posterior).
4. Palpate the inner aspect of the arm in the axilla (lateral).
5. Reach upwards into apex of the axilla with fingertips.

18. Inguinal Lymph Nodes
1. Ask your patient to lower their trousers and underwear to expose the
inguinal region.
2. Lower the couch so the patient is lying flat.
3. Inspect for any obvious swellings or irregularities.
4. Palpate immediately inferior to the inguinal ligament (horizontal
group), which runs between the anterior superior iliac spine (ASIS) and
pubic tubercle.
5. Palpate 3cm lateral to the pubic tubercle, vertically down over the
saphenous opening and the proximal portion of the great saphenous
vein (vertical group)

19. Epitrochlear Lymph Nodes
This is rare, but usually very obvious when
lymphadenopathy is present here (the patient
will often point this out if present).
Place the palm of your right hand under the
patient’s slightly flexed right elbow and feel with
your fingers in the groove above and posterior to
the medial epicondyle of the humerus.

20. Describing masses
Note their characteristics using the mnemonic:
C C S S S L M N O P

22. Interpretation of lymph node findings:
• Benign: Smooth, rounded, non-tender and mobile.
• Reactive: Associated infective symptoms, smooth, rounded, tender
and mobile.
• Metastases: Regional lymphadenopathy present in areas of drainage
from affected organ. Typically hard, firm and irregular.