This document discusses the evaluation of lymphadenopathy. It outlines the key steps in evaluation which include determining the size and characteristics of palpable lymph nodes, identifying accompanying symptoms, examining the distribution of enlarged lymph nodes, and considering epidemiological factors. A variety of diagnostic tests are described based on the location and suspected causes of lymphadenopathy including blood tests, imaging studies, biopsies and cultures. The goal of evaluation is to arrive at an accurate diagnosis and guide further treatment.

2. EVALUATION OF LYMPHADENOPATHY
Nearly 600
lymphnodes

3. Normally palpable
Sub mandibular
Axillary
inguinal

4. Pathophysiology
React to threat
Hyperplastic response that
usually resolves within 1 month

6. 1.Size & quality
Palpable nodes
in other regions abnormal
Any node >1cm

7. Nodes >3cm neoplasm

8. 2.Accompanying symptoms
r/c fever >38.5 C,night sweats,weigt
loss
LYMPHOMAS
Lymphngectic streaking

9. splenomegaly

10. 3.Distribution
GENERALISED

11. • IMN
• AIDS
infections • AIDS related complex
• Toxoplasmosis
• Secodary syphilis
• LEUKEMIA
Neoplasia • HODGKIN’S DISEASE
• NHL
• Serum sickness
Hypersensitivity • Phenytoin
• Vasculitis,lupus,RA

12. METABOLIC •Hyper thyroidism
•Lipidoses

13. Castleman’s disease
Rare,idiopathic,Localised/multicentric,mim
ic lymphoma/HIV,systemic
symptoms,increased risk of infection

14. LOCALISED
• Viral Conjunctivitis
• Trachoma
ANT.AURICULAR
• Tularemia
• Sarcoidosis
• Rubella
POST.AURICLAR • Scalp infection

15. ANT. AURICULAR POST. AURICULAR

16. • Buccal cavity infection
SUB • Pharyngitis
• Nasopharyngeal tumour
MANDIBULAR • Thyroid malignancy
• IMN
CERVICAL • Sarcoidosis
B/L • Toxoplasmosis
• pharyngitis

17. SUB MANDIBULAR CERVICAL B/L

18. Right • Pulmonary malignancy
• Mediastinal malignancy
Supra • Esophageal malignancy
clavicular
Left • Intra abdominal malignancy
supra • Renal ca
• Testicular or ovarian
clavicular malignancy

19. RIGHT SUPRA CLAVICULAR LEFT SUPRA CLAVICULAR

20. • Ca breast / infection
axillary • Upper extremity infection
• Syphilis(b/l)..Sailor’s handshake
• CLL
Epitrochlear • IMN
• Lymphoma
• Hand infection(u/l)

21. EPITROCHLEAR
AXILLARY LYMPHADENOPATHY LYMPHADENOPATHY

22. • Syphilis
• Genital herpes
• Lympho granuloma
Inguinal venereum
• Chancroid
• Lower extremity/local
infection

23. INGUINAL LYMPHADENOPATHY

24. • Lymphoma
• Bronchogenic ca
Hilar(u/l) •
•
TB
sarcoidosis
• Sarcoidosis
• Fungal(histoplasmosis,coccidiomycosis)
Hilar(b/l) •
•
Lymphoma
Bronchogenic ca
• TB

25. UNILATERAL HILAR LYMPHADENOPATHY BILATERAL HILAR LYMPHADENOPATHY

26. • Adeno ca of gut
• Hodgkin’s d/s
• TB
ABDOMINAL • Bladder ca
• Gastric ca

27. GASTRIC CA
SISTER MARY
JOSEPH NODULE

28. • Cat scratch fever
• Hodgkin’s d/s
• NHL
ANY • Leukemia
REGION • Metastatic ca
• Sarcoidosis
• Granulomatous infection

29. CAT SCRATCH D/S

30. other lymphatic abnormalities
4.
Lymphangitis
Lymphadenitis
Kikuchi’s disease
lymphedema

31. 1.Is the palpable mass indeed a
lymph node????
Enlarged parotid
Thyroglossal cyst
Abscess
Branchial cyst

32. 2.Acute or chronic ??
3.Character of enlarged node???
tender.,mobile
Firm,rubbery,nontender
Painless,stonehard,fixed&
matted

33. 4.Localized or generalised??
5.Are there associated
systemic/localizing symptoms/signs???

34. 6.Are there unusual epidemiological
clues???
Exposure to cats
Travel
Exposure to bird droppings
Lacerations during gardening
Exposure to TB
Sexual exposure

35. 1.Complete blood cell count
with differential….
Atypical lymphocytosis
Eosinophilia
Pancytopenia

36. 2.Serum uric acid
3.Serum liver chemistries

37. Localised adenopathy
1.Throat culture
2.Urethral/cervical swabs
3.Blood culture
4.biopsy

38. 5.Abdominal CT
6.Bone marrow biopsy

39. Generalised adenopathy
1.Serological tests
Heterophile test
VDRL
Antibody titres of
viruses,fungi,toxoplasmosis
Anti nuclear antibodies
Rheumatoid factor

40. Hilar adenopathy
1.Mantoux test 2.chest X-RAY,CT
3.ACE enzyme determination
4.Bronchoscopy
5.mediastinoscopy

41. Lymph node biopsy
Most direct approach

42. Indications
Approaches & yeild
Excitional biopsy preffered
FNAC
Needle aspiration

43. Choice of node
Largest node
Avoid inguinal & axillary
Supra clavicular-highest diagnostic
yield
complications
Follow up/empiric treatment

44. THANKZZZZZZZZ…..ZZZZZZ…..ZZZZ