Diagnosis of Lymphadenitis
Lymphadenitis Diagnosis: Book Excerpts
Diagnostic Tests for Lymphadenitis: Online Medical Books
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LYMPHADENOPATHY:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is there a history of drug ingestion? Many drugs can cause lymphadenopathy; the most notable is Dilantin, but the antibiotics, aspirin, iodides, and certain antihypertensive drugs can cause lymphadenopathy also.
- Is the lymphadenopathy focal or diffuse? If the adenopathy is focal, one should look for an infectious process in the area supplied by the respective lymph nodes. For example, if there is occipital node enlargement, one would look for ringworm, dermatitis of the scalp, furunculosis, pediculosis, and cellulitis. However, infectious mononucleosis and rubella may begin with enlargement of these nodes.
- Is there fever? The presence of fever should make one think of infectious mononucleosis, brucellosis, dengue fever, toxoplasmosis, and Still's disease, among other diseases.
DIAGNOSTIC WORKUP
Routine diagnostic tests include a CBC, sedimentation rate, nose and throat culture, and culture of material from any area supplied by the enlarged lymph nodes. Blood cultures are indicated in generalized lymphadenopathy. In addition, a chemistry panel should be done, as well as a heterophile antibody titer, brucellin antibody titer, febrile agglutinins, and VDRL test. A chest x-ray and flat plate of the abdomen may be helpful in diagnosing generalized lymphadenopathy. HIV testing is done in patients with a history of high-risk sexual behavior.
X-ray of the long bones may identify metastatic carcinoma, and x-ray of the hands may identify sarcoidosis. A bone marrow examination may identify leukemia or lymphoma. If an infectious process has been ruled out, biopsy of the local node may turn up metastatic carcinoma, Hodgkin's disease, and sarcoidosis. A tuberculin skin test should be done; a Brucellergen skin test and Kveim test may also need to be done. ANA and
rheumatoid arthritis factor
testing may need to be done to rule out a collagen disease. A lymphangiogram may turn up a lymphosarcoma or multiple metastatic lymph nodes. Liver biopsy is also occasionally necessary. Imaging studies of the abdomen and pelvis and the mediastinum are occasionally necessary. Mediastinoscopy may facilitate getting a tissue diagnosis. Before ordering these, a consultation with a hematologist or infectious disease specialist would be prudent.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Lymphadenopathy:
Differential Diagnosis
(In a Page: Signs and Symptoms)
Generalized lymphadenopathy (e.g., cervical, supraclavicular, axillary, and inguinal lymphadenopathy; hepatomegaly; splenomegaly)
-
Infection
–Tuberculosis
–Secondary syphilis
–Mononucleosis
–HIV/AIDS
–Kawasaki's syndrome
–Typhoid fever -
Hypersensitivity reactions
–Serum sickness
–Drugs (e.g., hydantoin, phenytoin, hydralazine, allopurinol, primidone)
-
Lymphoma
-
Leukemia
-
Connective tissue disorders (e.g., SLE, rheumatoid arthritis)
-
Sarcoidosis
-
Metastatic cancer [especially with left supraclavicular lymphadenopathy (Virchow's node) associated with abdominal malignancies, including stomach, pancreas, gallbladder, testis/ovary, kidney, and prostate cancers]
-
Endocrine disorders (e.g., hyperthyroidism, hypoadrenalism)
-
Amyloidosis
-
Castleman's syndrome (angiofollicular lymph node hyperplasia)
-
Kikuchi's disease
Localized lymphadenopathy
-
Reactive hyperplasia, local inflammation (e.g., dermatitis, vaccination, trauma)
-
Infection
–Viral: Mononucleosis, CMV, HIV, rubella, mumps
–Bacterial: Streptococcus, tuberculosis, salmonella, cat-scratch disease (due to Bartonella henselae); gonorrhea, Chlamydia, and other sexually transmitted diseases (inguinal)
–Parasitic: Malaria, toxoplasmosis
–Fungal: Histoplasmosis,
coccidioidomycosis
- Lymphoma or metastatic disease (e.g. head
and neck squamous cell cancer leads to
cervical lymphadenopathy)
Workup and Diagnosis
- History and physical examination
–Note extent of lymphadenopathy (localized or generalized), size of nodes, texture, presence or absence of nodal tenderness (tenderness suggests infection), signs of inflammation over the node, skin lesions, petechiae, splenomegaly, and hepatomegaly
–Thorough ENT examination in adult patients with cervical adenopathy and/or a history of tobacco use
–Supraclavicular and epitrochlear lymphadenopathy carry a high risk of malignancy or other abnormality and are rarely normal or reactive
–Lymph nodes greater than 1 cm, and particularly greater than 2 cm, are likely to be pathologic
-
Initial labs may include CBC, peripheral smear, ESR, CRP, uric acid, PPD, blood cultures, viral titers for specific organisms (e.g., HIV, CMV, toxoplasmosis, rubella), and serologies for brucellosis and typhoid
–Atypical lymphocytes may indicate a viral illness
–Immature leukocytes/blasts may indicate leukemia
–Leukocytosis often indicates infection
-
Chest X-ray and/or abdominal ultrasound may be used to evaluate for lymphadenopathy
-
Biopsy is the gold standard for diagnosis
–Strongly consider biopsy if node is >2.0 cm, associated with abnormal chest X-ray, and/or age >40 years
-
Bone marrow aspiration may be necessary in some cases to rule out an underlying malignancy
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Lymphadenopathy:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Infectious
–Viral (URI, varicella, EBV, CMV, HIV, rubella, mumps, measles)
–Bacterial (strep, staph, mycobacterium, atypical mycobacterium, brucellosis, tularemia, syphilis, chlamydia)
–Fungal (histoplasmosis, coccidioidomycosis)
–Protozoal (toxoplasmosis, malaria)
–Scalp infection
-
Allergy
–Seasonal or individual
-
Inflammatory
–Kawasaki disease
–Sarcoidosis
–Cat-scratch disease (Bartonella henselae)
–Drug-induced (phenytoin, isoniazid,
hydralazine, dapsone, procainamide, allopurinol)
-
Malignancy
–Leukemia
–Hodgkin disease
–Non-Hodgkin lymphoma
–Neuroblastoma
–Rhabdomyosarcoma
–Histiocytic disorder
-
Collagen vascular disease or systemic illness
–Rheumatoid arthritis
–Systemic lupus erythematosus
–Serum sickness
–Autoimmune hemolytic anemia
–Cystic fibrosis
-
Immunodeficiency
-
Storage diseases
–Gaucher disease
–Niemann-Pick disease
-
Non-lymph node masses simulating
lympadenopathy
–Thyroglossal duct cysts
–Branchial cleft cysts
–Cystic hygroma
–Hemangioma
–Teratoma
–Thymoma
–Inguinal hernia
Workup and Diagnosis
-
History
–Duration, fever, weight loss, night sweats
–Sore throat, rash, limp, joint swelling/pain, bone pain
–Sexual history and HIV risk factors
–Exposures: Food contamination, pets (e.g., kittens)
–Immunizations, recurrent infections, meds, allergies
–Long-standing or unexplained skin rash, transfusions
–Family history of autoimmune/inflammatory diseases
-
Physical exam
–All lymph node chains: Size, tenderness, fluctuance,
consistency, warmth, surrounding erythema
–Splenomegaly, hepatomegaly
–Trauma or animal/insect bites along lymph drainage
–Rash, including “eczema,” lesions, petechiae, purpura
–Signs of respiratory compromise
–Scalp for signs of infection
–Genitalia for signs of sexually transmitted disease
- Labs
–Common: CBC/peripheral smear, ESR, LDH, electrolytes, BUN, Cr, LFT, uric acid, EBV, CMV, B. henselae titers, PPD, throat culture
–Less common: ANA, ACE level, anti-dsDNA, specific infection titers, immunodeficiency workup - Studies
–Chest X-ray; bone marrow exam; biopsy or I&D of node, echo/ECG, biopsy of rash
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
LYMPHADENOPATHY, GENERALIZED:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Obviously, it is tempting simply to do a lymph node biopsy, but certain other procedures should be done first. If the patient is febrile, febrile agglutinins, Monospot test, blood cultures, and cultures of any other suspicious body fluid should be made. An FTA-ABS test should be done as well as a chest x-ray and tuberculin test to rule out tuberculosis. A blood count usually shows leukemia, but a bone marrow may be necessary to diagnose leukemia, Hodgkin disease, and the reticuloendothelioses. Other x-rays, skin tests, and special diagnostic procedures may be necessary.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Lymphadenopathy:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Ask the patient when he first noticed the swelling and whether it’s located on one side of his body or both. Are the swollen areas sore, hard, or red? Ask the patient if he has recently had an infection or other health problem. Also ask if a biopsy has ever been done on any node because this may indicate a previously diagnosed cancer. Find out if the patient has a family history of cancer.
Palpate the entire lymph node system to determine the extent of lymphade-nopathy and to detect other areas of local enlargement. Use the pads of your index and middle fingers to move the skin over underlying tissues at the nodal area. If you detect enlarged nodes, note their size in centimeters and whether they’re fixed or mobile, tender or nontender, and erythematous or not. Note their texture: Is the node discrete, or does the area feel matted? If you detect tender, erythematous lymph nodes, check the area drained by that part of the lymph system for signs of infection, such as erythema and swelling. Also, palpate for and percuss the spleen.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Lymphadenopathy:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Ask the patient when he first noticed the swelling, and whether it’s located on one side of his body or both. Are the swollen areas sore, hard, or red? Ask the patient if he has recently had an infection or other health problem. Also ask if a biopsy has ever been done on any node because this may indicate a previously diagnosed cancer. Find out if the patient has a family history of cancer.
Palpate the entire lymph node system to determine the extent of lymphadenopathy and to detect any other areas of local enlargement. Use the pads of your index and middle fingers to move the skin over underlying tissues at the nodal area. If you detect enlarged nodes, note their size in centimeters and whether they’re fixed or mobile, tender or nontender, and erythematous or not. Note their texture: Is the node discrete, or does the area feel matted? If you detect tender, erythematous lymph nodes, check the area drained by that part of the lymph system for signs of infection, such as erythema and swelling. Also, palpate for and percuss the spleen.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Lymphadenopathy, Localized:
History
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A comprehensive history is critical in evaluating lymphadenopathy. It is important to elicit as accurately as possible the time course of the process. Progressive enlargement of a lymph node over several weeks or months suggests an underlying malignancy or granulomatous inflammation (e.g., tuberculosis or sarcoidosis). However, reactive lymphadenopathy can also persist for months. The presence of localizing or systemic signs (e.g., weight loss, night sweats, rash, or fever) suggests a particular pathologic process. Epidemiologic clues such as exposure to cats may suggest cat scratch disease. A history of contact with a new sexual partner raises the possibility of a sexually transmitted disease. Manifestations of regional lymphadenopathy within the thorax or abdomen can present as cough, shortness of breath, abdominal pain, urinary frequency, or intestinal obstruction. Rarely, pain in an area of lymphadenopathy following alcohol ingestion is the presenting symptom of Hodgkin’s disease.
Physical examination
On physical examination, the first question that needs to be answered is whether the structure being palpated is truly a lymph node. Parotid enlargement, thyroid masses, sternocleidomastoid tumors, dermoid cysts, hemangiomas, or other tumors occasionally mimic lymphadenopathy. Thoroughly examine the anatomic region or regions drained by the affected nodes. Carefully note the characteristics of the lymph nodes and surrounding tissues. Tender lymph nodes that are mobile often represent lymphadenitis or acute inflammation. Matted, hard lymph nodes that are fixed to surrounding tissue imply an underlying metastatic carcinoma. Rubbery, nontender nodes may be seen in lymphoma.
In otherwise healthy children, lymph nodes up to 2.5 cm in diameter, particularly in the inguinal, suboccipital, and cervical regions, may be seen (3). In adults, lymph nodes larger than 1 cm in diameter should arouse suspicion, and nodes larger than 3 cm are highly suggestive of a malignant process (2). In both children and adults, supraclavicular lymph nodes larger than 1 or 2 cm in diameter should be investigated aggressively.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Lymphadenopathy, Generalized:
History
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
should focus on those common causes of generalized lymphadenopathy.
A. History of present illness should focus on the duration, location, quality, and context of the lymphadenopathy. Note associated signs and symptoms such as rash, fever, sore throat, and cough (4) (Chapters 2.6, 8.1, and 13.6). The goal is to ascertain if the adenopathy is attributable to a specific cause.
B. Past medical history should focus on known illness, medication usage, and allergies. Serum sickness from antibiotic use as well as diphenylhydantoin for seizure prevention can cause generalized lymphadenopathy. Common chronic illnesses (e.g., lupus erythematosus and rheumatoid arthritis) can also cause generalized lymphadenopathy.
C. Social history should focus on the patient’s occupation, sexual history, and alcohol use. Hepatitis B, secondary syphilis, and early human immunodeficiency virus (HIV) can all present with generalized lymphadenopathy. Patients with Hodgkin’s disease can develop painful adenopathy with alcohol use.
D. Family history. Inquire about family illness with a genetic predisposition as well as any exposures to household contacts with infectious diseases (e.g., tuberculosis, infectious mononucleosis, or hepatitis B).
E. Review of systems should focus on constitutional symptoms such as weight loss, fatigue, night sweats, malaise, arthralgias, nausea, and vomiting (1).
Physical examination
A. General. A comprehensive physical examination should be performed on all patients with generalized lymphadenopathy. Focus on those findings consistent with the most frequent causes of generalized lymphadenopathy. Note the patient’s temperature and weight, because fever and weight loss are frequent findings. Examine the skin, mucous membranes, abdominal organs, and joints; specifically, the presence of rash, mucocutaneous ulceration, organomegaly, and arthritis can be a guide to possible causes of the adenopathy. The presence of splenomegaly in a patient with adenopathy implies a systemic illness (e.g., infectious mononucleosis, lymphoma, leukemia, lupus, sarcoidosis, toxoplasmosis, or cat scratch disease) (Chapter 15.4). Additionally, search for other abnormal lymph nodes. Studies have shown that clinicians identified only 17% of those cases of generalized lymphadenopathy when it was present (1).
B. Nodal examination. The abnormal lymph node groups should be specifically examined.
1. Size. Lymph nodes enlarged up to 1 cm in diameter can be considered normal in size. These have a low malignancy risk and can usually be observed. Lymph nodes greater than 1.5 cm × 1.5 cm in area have been shown to have a 38% risk of cancer involvement and merit further workup (2).
2. Location. Anterior cervical, submandibular, and inguinal nodes are normally palpable. The presence of supraclavicular adenopathy is always abnormal and carries a 90% cancer risk in those aged more than 40 years. Postocciptal nodes are associated with infectious mononucleosis, scalp lesions, toxoplasmosis, and non-Hodgkin’s lymphoma. Axillary nodes are associated with upper extremity infections, breast cancer, cat scratch disease, and lymphomas. Epitrochlear nodes are associated with pyogenic infections, sarcoidosis, tularemia, and syphilis. Inguinal nodes are associated with lower extremity infections and sexually transmitted diseases.
3. Pain. The presence or absence of pain is not a reliable indicator of the cause of adenopathy. Capsular swelling from acute infections can cause pain as can necrotic hemorrhage from a malignant lymph node.
4. Consistency. Rock hard nodes are consistent with metastatic disease (2). Firm rubbery nodes are found with lymphomas. Soft nodes tend to occur with infectious causes; however, this should not be considered diagnostic.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Lymphadenopathy:
Differential Overview
(Field Guide to Bedside Diagnosis)
Generalized
❑ Infectious mononucleosis
❑ Drugs
❑ Connective tissue disease
❑ HIV infection
❑ Sarcoidosis
❑ Serum sickness
❑ Toxoplasmosis
❑ Secondary syphilis
Localized
❑ Regional infection
❑ Lymphadenitis
❑ Hodgkin lymphoma
❑ Cat-scratch disease
Diagnostic Approach
Palpable adenopathy is present in half of healthy young adults. Red flags for malignancy include a node larger than 2 cm in size and enlarging, age older than 40 years, weight loss greater than 10%, and a supraclavicular node. Constitutional symptoms such as fever, night sweats and weight loss should prompt further evaluation. On occasion, reactive lymphadenopathy may persist for months, but observation for enlargement over time is a useful tool to select which patients need biopsy. Nodes with an irregular shape and firm rubbery consistency suggest malignancy. Matted nodes or those fixed to the deep fascia also suggest malignancy.
Coexistence of splenomegaly implies a systemic illness such as lymphoma/leukemia, infectious mononucleosis, systemic lupus, sarcoidosis, or toxoplasmosis.
Structures that may be mistaken for cervical lymph nodes include the parotid gland, thyroglossal and branchial cysts, an abscess, a lipoma, thyroid nodules, submaxillary infections, or dental infections.
Tenderness is usually associated with an infectious etiology. Fluctuation or suppuration occuring over a few days is usually due to staphylococcal or streptococcal infection. Progression over weeks to months occurs with tuberculosis, atypical mycobacteria, Bartonella (cat-scratch disease), sporotrichosis or rare cases of anthrax, plague, tularemia, chancroid, or lymphogranuloma venereum.
The location of adenopathy narrows the differential:
Anterior cervical Unilateral: pharyngitis, thyroid cancer, nasopharyngeal cancer, or buccal infection. Bilateral: pharyngitis, mononucleosis, sarcoidosis, or toxoplasmosis.
Preauricular They are common in oculoglandular fevers such as adenoviral conjunctivitis, rubella, tularemia, and leptospirosis. These are also commonly found in infection in the cheek, eyelid, ear, or temporal scalp. If a source is not evident, look for a retinal melanoma.
Posterior auricular Consider infectious mononucleosis, rubella, otitis media, lymphoma, or head and neck malignancy.
Right supraclavicular Consider an intrathoracic (lungs, mediastinum, or esophagus) malignancy.
Left supraclavicular A sentinel or Virchow node, draining the thoracic duct, suggests intra-abdominal malignancy (stomach, gallbladder, pancreas, kidneys, testicles, ovaries, or prostate).
Axillary Drainage is from the arm, chest wall, and breast, so consider breast malignancy, upper extremity infection such as cat-scratch disease, or Hodgkin lymphoma.
Epitrochlear Consider secondary syphilis (bilateral), hand infection (unilateral), sarcoidosis and rheumatoid arthritis (helps differentiate from osteoarthritis).
Inguinal A lower extremity infection or sexually transmitted disease (primary syphilis, genital herpes, chancroid, lymphogranuloma venereum) are the usual causes. Regional metastases from the skin (e.g. melanoma) or genital organs also occur. A femoral hernia can be confused with adenopathy.
Occipital Consider scalp infection (especially pediculosis capitis), secondary syphilis, Hodgkin lymphoma, and tuberculosis.
Periumbilical Consider abdominal malignancy.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Lymphadenopathy:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Ask the patient when he first noticed the swelling and whether it’s located on one side of his body or both. Are the swollen areas sore, hard, or red? Ask the patient if he has recently had an infection or other health problem. Also ask if a biopsy has ever been done on any node because this may indicate a previously diagnosed cancer. Find out if the patient has a family history of cancer.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Lymphadenopathy:
Clinical Features and Diagnosis: Localized Lymphadenopathy
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Cervical
Cervicallymph nodes, which drain head and neck structures, include superficialand deep cervical chains.Reactive hyperplasia (usually secondaryto viral upper respiratory infections [URIs] and pharyngitis)and cervical adenitis are most common causes of cervical node enlargement.Less common causes include Kawasaki disease and neoplastic disorders(leukemia, Hodgkin disease, non-Hodgkin lymphoma, neuroblastoma,rhabdomyosarcoma, thyroid carcinoma).See Chap.42, Neck Masses. Submandibular/Submental
Submandibularnodes drain buccal mucosa, side of nose, gums, upper lip, lateralpart of lower lip, and anterior part of tongue margin.Submental nodes drain center portionsof lip and floor of mouth as well as skin of chin.Reactive hyperplasia (viral URIs, pharyngitis,tonsillitis, herpetic gingivostomatitis, dental abscesses) and primaryadenitis (usually secondary to pyogenic infection with group A Streptococcusor S. aureus) are most common causes of lymph node enlargement inthese areas. Preauricular
Preauricularnodes drain anterior and temporal regions of scalp, anterior aspectof external auditory canal, pinna, and lateral conjunctivae.Causes of preauricular adenopathy includeoculoglandular syndrome (conjunctivitis and ipsilateral preauricularadenopathy), adenoviral infection (epidemic keratoconjunctivitis,pharyngoconjunctival fever), cat scratch disease (B. henselae infection),and tularemia. Postauricular
Postauricularnodes drain temporal and parietal scalp, posterior wall of externalauditory canal, and upper half of pinna.Causes of node enlargement are infectionsof scalp and infections caused by human herpesviruses 6 and 7, rubellavirus, and parvovirus B19. Occipital
Occipitalnodes drain occipital region of scalp.Common causes of occipital adenopathyare tinea capitis, seborrheic dermatitis, and scalp cellulitis/abscess.Isolated adenopathy in this area mayoccur secondary to rubella infection and toxoplasmosis. Supraclavicular
Supraclavicularnodes are located in supraclavicular triangle and drain entire head andneck, arms, superficial thorax, abdomen, lungs, and mediastinum.Enlarged nodes without other cervicaladenopathy suggest mediastinal, lung, or abdominal disease, whichcan be infectious, inflammatory, or neoplastic.Chest radiography may demonstrate enlargedmediastinal nodes, and chest CT can define location and extent.Common causes of supraclavicular andmediastinal adenopathy include histoplasmosis, tuberculosis, catscratch disease, Hodgkin disease, non-Hodgkin lymphoma, and sarcoidosis. Axillary
Axillarylymph nodes drain arm, chest wall, and upper lateral abdominal wall.Any local inflammation or infection in these areas may cause lymphnode enlargement.Enlarged tender nodes may occur withcat scratch disease after bite or scratch by kitten or cat to fingers,hand, or forearm.Rapid enlargement of firm, painlesslymph node in axilla with no identifiable inflammatory or infectiouscause suggests neoplastic process (e.g., Hodgkin disease or non-Hodgkinlymphoma). In this circumstance, lymph node biopsy is diagnostic. Epitrochlear
Epitrochlearnodes drain distal arm and third, fourth, and fifth fingers.Common causes of epitrochlear adenopathyare staphylococcal and streptococcal skin infections, infectiousmononucleosis, and cat scratch disease. Hodgkin disease also maypresent with enlarged epitrochlear nodes. Inguinal
Inguinalnodes drain skin of lower extremities, penis, scrotum, perineum,gluteal region, and abdominal wall below umbilicus.Most common cause of inguinal adenopathyis skin infection involving lower extremities. Genital infections(herpes simplex, lymphogranuloma venereum, chancroid, primary syphilis)also may cause enlarged inguinal nodes. Other causes of inguinaladenopathy include testicular tumors, metastatic lower extremitybone tumors, Hodgkin disease, cat scratch disease, and mycobacterialinfection. Femoral
Enlarged femoral nodes are palpable on legbelow inguinal ligament and may enlarge secondary to superficialor deep infection of lower extremity.
Popliteal
Poplitealnodes drain knee joint and skin of lateral side of lower leg and foot.Common cause of enlarged poplitealnodes are infections of lower leg, foot, or knee joint.
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Lymphadenopathy:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Ask the patient when he first noticed the swelling and whether it's located on one side of his body or both. Are the swollen areas sore, hard, or red? Ask the patient if he has recently had an infection or other health problem. Also ask if a biopsy has ever been done on any node because this may indicate a previously diagnosed cancer. Find out if the patient has a family history of cancer.
Palpate the entire lymph node system to determine the extent of lymphadenopathy and to detect other areas of local enlargement. Use the pads of your index and middle fingers to move the skin over underlying tissues at the nodal area. If you detect enlarged nodes, note their size in centimeters and whether they're fixed or mobile, tender or nontender, and erythematous or not. Note their texture: Is the node discrete, or does the area feel matted? If you detect tender, erythematous lymph nodes, check the area drained by that part of the lymph system for signs of infection, such as erythema and swelling. Also, palpate for and percuss the spleen.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
LYMPHADENOPATHY, GENERALIZED:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Obviously, it is tempting simply to do a lymph node biopsy, but certain
other procedures should be done first. If the patient is febrile, febrile
agglutinins, monospot test, blood cultures, and cultures of any other
suspicious body fluid should be made. A fluorescent treponemal antibody
absorption test (FTA-ABS) test should be done as well as a chest x-ray and
tuberculin test to rule out tuberculosis. A blood count usually shows
leukemia, but a bone marrow biopsy may be necessary to diagnose leukemia, Hodgkin lymphoma, and
the reticuloendothelioses. Other x-rays, skin tests, and special diagnostic
procedures may be necessary.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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