Lymphadenopathy its causes,diagnosis,newest treatment

lymphadenopathy can be associated with a wide range of disorders from relatively benign medical problems such as streptococcal pharyngitis to life-threatening malignancies. The discovery of enlarged nodes represents an important physical finding that demands a systematic evaluation.

Attention should be directed to the size, shape, and consistency of enlarged nodes.

Enlarged lymph nodes that have an irregular shape and a rubbery, hard consistency may be infiltrated by malignant cells.

 Tender nodes are suggestive of an inflammatory process

Matted nodes or nodes fixed to underlying structures should raise the question of malignancy or infection;

 Freely movable nodes are more likely to occur in benign conditions.

Generalized Lymphadenopathy

is defined as enlargement of more than 2 noncontiguous lymph node groups.

The Possible causes are:

Infections

–        

Viral

»        Common upper respiratory infections

»        Infectious mononucleosis

»        CMV

»        HIV

»        Rubella

»        Varicella

»        Measles

–        Bacterial

–        Septicemia

–        Typhoid fever

–        Tuberculosis

–        Syphilis

–        Plague

Protozoal as Toxoplasmosis.

Fungal as Coccidioidomycosis

B.         Autoimmune disorders and hypersensitivity states

»        1.            Juvenile RA

•          2.            SLE

•          3.            Drug reactions (phenytoin, allopurinol and INH)

•          4.            Serum sickness

»        

Storage Diseases

Gaucher disease

»        Niemann-Pick disease.

Neoplastic and proliferative disorders   

»        Acute leukemias (ALL, AML)

»        Lymphomas (Hodgkin, non-Hodgkin)

»        Neuroblastoma

»        Histiocytoses.

•          

II. Regional lymphadenopathy

1- Cervical Lymphadenopathy

*Viral upper respiratory infection

*Infectious mononucleosis

*Rubella                                 *Catscratch disease

*Streptococcal pharyngitis

*Acute bacterial lymphadenitis

*Toxoplasmosis                       *Tuberculosis

*atypical mycobacterial infection

*Acute leukemia                     *Lymphoma

*Neuroblastoma

*Rhabdomyosarcoma            *Kawasaki disease.

*Oral and dental infections    *Acute lymphadenitis

•          

Occipital

•          Pediculosis capitis

•          Tinea capitis

•          Secondary to local skin infection

•          Rubella

•          Preauricular

•          Local skin infection

•          Chronic ophthalmic infection

•          Catscratch disease

–        

D.            Mediastinal

Acute lymphoblastic leukemia

–        Lymphoma

–        Sarcoidosis

–        Cystic fibrosis

–        Tuberculosis

–        Histoplasmosis

–        Coccidioidomycosis

Supraclavicular

Lymphoma

*Tuberculosis

*Histoplasmosis

*Coccidioidomycosis

   Axillary

*Local infection

*Catscratch D.

*Brucellosis

*Reactions to

immunizations

*Lymphoma

*Juvenile RA

•          Abdominal

Acute mesenteric adenitis

•          Lymphoma

Inguinal

•          Local infection

•          Diaper dermatitis

•          Insect bites

•          Syphilis

•          Lymphogranuloma venereum

diagnosis can be made after a careful history, physical examination, and appropriate testing including hematological parameters, serologic tests, skin tests, and routine x-rays.

If a specific diagnosis cannot be established, but infection is suspected, cautious observation after appropriate cultures have been obtained may be warranted.

 On the other hand, if the diagnosis cannot be established and a malignancy is a major concern, biopsy of a lymph node is appropriate.

Although the differential diagnosis of lymphadenopathy may be broad and sometimes initially confusing, the careful gathering of data from the history, physical examination, and appropriate 

laboratory tests will resolve the differential in the vast majority of patients