lymphadenopathy or adenopathy is disease of the lymph nodes, in which they are abnormality in size, character and consistency

2. LYMPADENOPATHY
• lymphadenopathy or adenopathy is disease of
the lymph nodes, in which they are abnormality
in size, character and consistency .
• Lymphadenopathy of an inflammatory type
(the most common type) is lymphadenitis,
producing swollen or enlarged lymph nodes
• According to Davidsons “lymphadenopathy can
be caused by benign or malignant disease”
The clinical site of lymphadenopathy
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3. CLASSIFICATION
Localised Lymphadenopathy: this is due to a localized spot of
infection(if only one area is involved)
e.g: 1. an infected spot on the the scalp, ear, mouth, face or teeth
will cause lymph nodes in the neck on that same side to swell up.
2. an infected spot on the breast will cause lymph nodes in
the axillary to enlarge
3. an infected spot on the perineum or external genitalia will
cause lymph nodes in inguinal region on that same side to swell
up.
Generalised Lymphadenopathy:this is due to systemic
infections of the body (if lymph node are enlarge two or more
area involves )e.g. influenza, secondary syphilis.
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4. CAUSE OF LYMPHADENOPATHY
•Infective
• bacterial eg : streptococcal, tuberculosis, brucellosis
• viral eg: cmv, viral hepatitis, mumps virus, adenovirus, measles, rubella,
influenza virus, human immunodeficiency virus (hiv)
• protozoal eg : toxoplasmosis
• fungal eg : coccidiodomycosis ,histoplasmosis, coccidioidomycosis
• parasitic e.g. toxoplasmosis, filariasis, pediculosis etc.
•Neoplastic
• primary: lymphomas, leukaemias, neuroblastoma
• secondary: lung, breast, thyroid, stomach
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5. .Autoimmune; e.g juvenile rheumatoid arthritis, systemic
lupus erythematosus, langerhans cell histiocytosis,
dermatomyositis.
.Miscellaneous/ unusual; e.g. kawasaki disease
(mucocutaneous lymph node syndrome), sarcoidosis.etc
.Latrogenic e.g. serum sickness, medications like;
captopril, carbamazepine, phenytoin, etc.
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6. THE SIGNS AND SYMPTOMS OF LYMPHADENOPATHY
•Painful, warm, or red lump under your skin.
•More tired than usual.
•Skin rash.
•Unexplained weight loss.
•Enlarged spleen (organ that filters blood)
•Fever or night sweats.
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7. DIAGNOSIS OF LYMPHADENOPATHY
• Careful history and physical examination are the core of the evaluation. in most
cases, a careful history and physical examination will identify a readily
diagnosable cause of the lymphadenopathy, such as upper respiratory tract
infection, pharyngitis, periodontal disease, conjunctivitis, lymphadenitis, tinea,
insect bites, recent immunization, cat-scratch disease or dermatitis, and no
further assessment is necessary.
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8. PHYSICAL EXAMINATION
when lymphadenopathy is localized, the clinician should examine the region drained by the
nodes for evidence of infection, skin lesions or tumors
other nodal sites should also be carefully examined to exclude the possibility of generalized
rather than localized lymphadenopathy.
careful palpation of the submandibular, anterior and posterior cervical, supraclavicular,
axillary and inguinal nodes can be accomplished in a short time and will identify patients with
generalized lymphadenopathy
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9. • if lymph nodes are detected, the following five characteristics should be noted and
described:
1.size 4.matting 7.tissue invasion
2.pain/tenderness ; 5.location
3.consistency ; 6.mobility;
Matting: a group of nodes that feels connected and seems to move as a unit is said to be
“matted.” nodes that are matted can be either benign (e.g., tuberculosis, sarcoidosis or
lymphogranuloma venereum) or malignant (e.g., metastatic carcinoma or lymphomas)
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10. • Mobility :fixed or matted nodes suggest metastatic carcinoma, whereas freely
movable nodes may occur in infections, collagen vascular disease and lymphoma.
• Tissue Invasion:lymphovascular invasion ( LVI or lymphovascular space invasion )
is spread of a cancer to the blood vessels and/or lymphatics. It has got prognostic
significance in some cancers
• Consistency : stony-hard nodes are typically a sign of cancer, usually metastatic.
very firm, rubbery nodes suggest lymphoma. softer nodes are the result of infections
or inflammatory conditions
• Pain/Tenderness : when a lymph node rapidly increases in size, its capsule stretches
and causes pain
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11. Head and Neck lymphadenopathy
Cervical lymphadenopathy: this includes posterior
cervical nodes, which drain the scalp, neck and upper
thoracic skin. the anterior cervical nodes drain the
larynx, tongue, oropharynx and anterior neck.
Sub-maxillary and submental lymphadenopathy:
these affected nodes drain the teeth, tongue, gums and
buccal mucosa. enlargement is usually due to
pharyngitis, herpetic gingivostomatitis and dental
abscess.
Preauricular lymphadenopathy:
affected nodes drain the eyelids, skin of cheeks and
temporal region of the scalp.
SITE AND DIFFERENTIAL DIAGNOSIS OF LYMPHADENOPATHY
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12. AXILLARY LYMPHADENOPATHY
The affected axillary nodes drain the breast and upper
extremity of the thoracic wall.
Epitrochlear lymphadenopathy: the affected lymph
nodes drain the ulnar, forearm and hand.
Mediastinal lymphadenopathy: the affected nodes
drain the thoracic viscera, that is the lungs, thymus
gland, heart ant thoracic oesophagus.
Supraclavicular and infraclavicular lymphadenopathy.
the affected nodes drain the git, genitourinary tract and
pulmonary region. common etiologies include; tb,
coccidiodomycosis, histoplasmosis, etc.
Abdominal lymphadenopathy: the affected nodes
drain the lower extremities, pelvis and abdominal
organs.
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13. Iliac and inguinal lymphadenopathy:
the affected nodes include the
horizontal node group and vertical
node group. these groups drain
the lower abdomen, external
genitalia skin, anal canal, lower
third of the vagina and lower
extremity.
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14. REFERENCES
• HARRISON'S PRINCIPLES OF INTERNAL MEDICINE, 18TH EDITION
• DAVIDSON'S PRINCIPLES AND PRACTICE OF MEDICINE,18TH EDITION
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15. THANKS FOR
YOUR
ATTENTION
DR Ndayisaba Corneille