Related Terms: Adenopathy, lymph node enlargement, lymph node disease, lymph nodes, lymphadenopathy, [[glossary:cancer]], [[glossary:infection]] , immune response, granuloma, [[lymphedema]], granulomatous, inflammation, malignancy. CT scan, PET scan, swollen glands. nodules, neoplasm, Polymerase chain reaction, cervical lymphadenopathy,
Lymphadenopathy is commonly referred to as enlarged lymph nodes. When a person is experiencing a virus, cold or infection usually they notice the "glands" in their neck may be swollen. This is part of the bodies immune response to any type of foreign invader. The condition is classified as localized if node enlargement is limited to one area. If two or more areas are affected it is referred to as generalized lymphadenopathy.
There have been many questions in our lymphedema groups concerning swollen glands, so I thought it important to included this information page.
By far and wide, the leading cause of secondary lymphedema is the removal of lymph nodes for biopsy. I personally also feel it most cases it can be prevented by utilization of modern diagnostic techniques. Radiological tests such as ultrasounds, MRI, CT and PET have become increasingly sensitive in their abilities to assist in the diagnostic process.
Small needle biopsy or aspiration has also become more sophisticated in its ability to provide an accurate diagnosis. Therefore, if your doctor suggest a lymph node biopsy, insist that they use scans and perform a small needle biopsy first.
In 2000, a small needle biopsy was performed in my right inguinal region. Lymphoscintigraphy had already shown that many of my main inguinal nodes were missing, thus, to remove more would have been catastrophic for my lymphedema. We decided on a SNB and were able to achieve a correct diagnosis with it. The biopsy caused no further complication or worsening of my existing leg lymphedema.
Following the introduction, there is a list of various conditions that may cause lympadenopathy. I understand how tired we all get from being poked, prodded, tested and scanned, but it is important to be patient with and to work with your doctor to correctly understand, diagnose and treat the underlying medical condition causing the swollen glands.
Also of concern would the duration of the nodal involvement. Rapid onset with subsequent decrease to normalcy would be indicative of some type of immune response.
Nodes that are enlarged for an extended period of time could signal a malignancy and will need to be tested.
Diagnostic focus will be on the cause of the enlarged nodes. These test might include a complete blood work up, x-rays and radiology tests such as ultra sounds, MRI or CAT scans may be used. Evaluation of hepatic and renal function and a urine analysis are useful to identify underlying systemic disorders that may be associated with lymphadenopathy.(1)
For long standing lymphadenopathy (lasting several weeks to several months) in addition to the radiological tests, nodal biopsies may be indicated. Physicians should consider small needle biopsies so as to limit the possibility of lymphedema. Otherwise node removal may be done.
focuses on the underlying condition causing the lymphadenopathy.
Cancer risk in unexplained adenopathy (primary care)
Age over 40 years: 4% cancer risk
Age under 40 years: 0.4% cancer risk
Lymph nodes with abnormal size
Lymph nodes with abnormal consistency
Lymph nodes of abnormal number
Limited to one area of involvement
Two or more non-contiguous areas
General Infectious Causes of Lymphadenopathy
Common Infectious Causes
Sexually Transmitted Disease Causes of Lymphadenopathy
Acute Retroviral Syndrome in HIV Infection
See Lymphadenopathy in HIV
Less Common Infectious Causes
Collagen Vascular Causes of Lymphadenopathy
Neoplastic Causes of Lymphadenopathy
Histiocytic Medullary Reticulosis
Head and neck cancers
Gastrointestinal tract cancers
Miscellaneous Causes of Lymphadenopathy
Causes of Generalized Lymphadenopathy in HIV
Lymphadenopathy of the Head and Neck
Neck Masses in Adults
Neck Masses in Children
Submandibular Nodes (below angle of jaw)
Submental node drainage
Lip and Mouth mucosa
Lymphadenopathy Causes (Infections of head and neck)
Submental Nodes (below chin)
Floor of Mouth
Tip of Tongue
Skin of Cheek
Jugular Nodes (anterior border of sternocleidomastoid)
Posterior Cervical Nodes (behind sternocleidomastoid)
Suboccipital nodes (base of skull, below occiput)
Suboccipital Lymphadenopathy may causes Headache
Back of Scalp and Head
Pediculosis capitis (Lice)
Postauricular nodes (behind pinna of ear)
Posterior Ear pinna
Lymphadenopathy Causes (Local infection)
Preauricular nodes (anterior to ear tragus)
Anterior Ear pinna
External auditory canal
Chancre on face
Ophthalmic Herpes Zoster
Not usually seen in Bacterial Conjunctivitis
Chronic granulomatous Conjunctivitis
Complication of Cat Scratch Disease (Tularemia)
Leptotrichosis (Leptothrix Infection)
Generalized Acute Cervical Lymphadenopathy Causes
Infectious Mononucleosis (Epstein Barr Virus)
Severe drug allergy (e.g. Penicillin)
Cat Scratch Disease
African Trypanosomiasis (African Sleeping Sickness)
Cat Exposure (Cat Scratch Disease or Toxoplasmosis)
Ingestion of undercooked meat (Toxoplasmosis)
Tick bite (Lyme Disease or Tularemia)
Intravenous Drug Abuse
Blood transfusion history
Sexually Transmitted Disease exposure
Occupational or hobby exposure
Hunters or Trappers (Tularemia)
Fish handlers (Erysipeloid)
Travel to Southwestern United States
Travel to Southeastern or central United States
Travel to Southeast Asia and Australia
Travel to central or west Africa
African Trypanosomiasis (African Sleeping Sickness)
Travel to central or south America
American Trypanosomiasis (Chagas' Disease)
Travel East Africa, China, Latin America, Mediterranean
Travel Mexico, Peru, Chile, Pakistan, Egypt, Indonesia
Abnormal lymph node size criteria
Epitrochlear Lymphadenopathy >0.5 cm
Inguinal Lymphadenopathy >1.5 cm
Isolated lymphadenopathy in children >1.5 to 2.0 cm
Other lymphadenopathy >1.0 cm
Tenderness to palpation
Does not differentiate benign from malignant nodes
Lymph node consistency
Rock-hard nodes: metastatic cancer
Firm-rubbery nodes: Lymphoma
Soft nodes: Inflammation or infection
Shotty nodes (multiple small buckshot size): Viral
Matted Nodes (connected nodes)
Chronic Lymphocytic Leukemia
Rarely associated with metastatic cancer
Diagnostic Evaluation: Initial Tests
Specific indications based on location and exposures
Complete Blood Count with manual differential
Monospot (Mononucleosis serology)
Diagnostic Evaluation: Second-line Tests
Specific indications and normal initial tests
Persistent Generalized Lymphadenopathy
Tuberculin Skin Test (Purified Protein Derivative)
Rapid Plasma Reagin (RPR)
Antinuclear Antibody (ANA)
Hepatitis B Serology (HBsAg)
Diagnostic Evaluation: Third-line Tests (Biopsy)
Persistent lymphadenopathy for more than 3-4 weeks
Malignancy or serious disease suspected
Lymph node biopsy of most abnormal or largest node
Excisional Biopsy preferred over FNA or needle biopsy
Highest yield site: Supraclavicular nodes
Lowest yield site: Inguinal nodes
Most common findings on biopsy
Abnormal but non-specific findings (40%)
Metastatic cancer (25%)
Intrinsic malignancy such as Lymphoma (20%)
Dornbland (1992) Adult Ambulatory Care, p. 662-7
Lee (1999) Wintrobe's Hematology, p. 1826-30
Wilson (1991) Harrison's Internal Medicine, p. 354-6
Ferrer (1998) Am Fam Physician 58(6): 1313-2
Habermann (2000) Mayo Clin Proc 75:728
Libman (1987) J Gen Intern Med 2(1):48-58
Ackowledgement: Family Practice Notebook
Lymphadenopathy in the Febrile Returning Traveler
Lymphadenopathy of the Head and Neck
Right Supraclavicular Nodes
Cancer of the retroperitoneum
Left Supraclavicular Nodes
Abdomen (Thoracic duct drainage)
Lymphadenopathy Causes (See Virchow's Node)
Cancer of the thorax
Cancer of the retroperitoneum
Miscellaneous infectious causes
Cat Scratch Disease
Silicone Breast Implants
Epitrochlear Nodes (proximal to elbow medial epicondyle)
Pinky and ring finger
Miscellaneous infectious causes
Horizontal Group (along inguinal ligament)
Skin of lower anterior abdominal wall
Penis and scrotum
Vulva and vagina
Lower anal canal
Vertical Group (along upper great saphenous vein)
Penis and scrotum
Lower limb drainage
Infections of the leg and foot
Sexually Transmitted Diseases
Herpes Simplex Virus
Testicular Cancer metastasizes to para-aortic nodes
Acknowledgement: Family Practice Notebook
Medication Causes of Lymphadenopathy
Epstein-Barr virus, cytomegalovirus, cat-scratch disease, tuberculosis, sexually transmitted diseases, and bacterial infections are among the most common diagnoses to be considered. Bacterial endocarditis can cause lymphadenopathy and is characterized by fever, history of IV drug use, or known heart valve disease.
Fixed, hard, unilateral (one side of the body) nodes can signal cancer.
Palpable (able to be felt) nodes on the side of the neck are usually benign and often infectious, but a history of smoking or chewing tobacco may cause concern about cancer.
Small, "shotty" nodes, named because they feel like lead pellets (shot), are common and can be followed without evaluation.
Abnormal nodes in the supraclavicular (above the collarbone) area suggest cancer and are candidates for early biopsy regardless of size.
For example, a patient with a movable, stable, soft node in the neck who is otherwise healthy can be observed for months. On the other hand, hard axillary (armpit) or supraclavicular (above the collarbone) nodes raise the suspicion of cancer and require aggressive biopsy (a procedure to sample lymph node tissue).
If adenopathy is chronic in one area, a thorough physical examination will determine if other less obvious nodes are involved, and palpating the liver and spleen may help determine the extent of involvement, particularly significant in lymphoma. Persistent, generalized (throughout the body) lymphadenopathy with no other signs is unusual and requires testing.
Are the nodes tender or firm?
What is the probable cause?
Is there evidence of infection?
Should a biopsy be done?
What further tests do
Research Abstracts and Articles
Lymph node enlargement in pulmonary arterial hypertension due to chronic thromboembolism.
J Med Imaging Radiat Oncol. 2008 Feb
Department of Anatomy with Radiology, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand. email@example.com
The aim of this study was to determine the prevalence and location of enlarged mediastinal and hilar lymph nodes in patients with pulmonary arterial hypertension (PAH) due to chronic pulmonary thromboembolism (CPTE) and to identify possible causes. Thoracic CT images of 85 patients (43 men and 42 women, aged 18-80 years) with PAH in whom CPTE was confirmed at surgery (n = 75) or angiography and angioscopy (n = 10) were evaluated by two thoracic radiologists to determine the presence, size and location of lymph nodes more than 1 cm in the short axis. The presence of pleural and pericardial effusions and parenchymal abnormalities were also noted. Enlarged lymph nodes were identified in 38 patients (44.7%), including 11 with possible causes of lymphadenopathy other than CPTE. In the 27 patients with CPTE alone, 67 enlarged lymph nodes were detected (average 2.5 per patient). Nine patients had three or more enlarged lymph nodes. The most common sites of lymph node enlargement were American Thoracic Society locations 7 (n = 13), 6 (n = 10), 11L (n = 9), 10R (n = 7) and 4R (n = 7). Pleural and pericardial effusions were more common in patients with CPTE who also had lymphadenopathy than in the group with no lymphadenopathy (P < 0.05). Lymph node enlargement is common in patients with PAH caused by CPTE. The frequent association of lymphadenopathy with pleural and pericardial effusions suggest a possible pathophysiological mechanism of increased lymphatic flow caused by right heart failure.
Early diagnosis of Kawasaki disease in patients with cervical lymphadenopathy.
Pediatr Int. 2008 Apr
Department of Pediatrics, Kagoshima City Medical Association Hospital, Kagoshima, Japan.
Background: Among typical patients with Kawasaki disease (KD), a few KD patients present with only fever and cervical lymphadenopathy at admission (KDL). These patients have a significant risk for misdiagnosis, delay in treatment for KD, and development of coronary artery abnormalities. Therefore, the development of an easy tool for early diagnosis in these patients is desirable. Methods and Results: Patients who presented with only fever and cervical lymphadenopathy at admission were studied. Of these, 14 patients were eventually diagnosed with KD (KDL) and 24 patients were successfully treated using antibiotics (control). KDL patients were significantly older than control patients (P > 0.022). Among the laboratory findings, neutrophil counts (P > 0.003), C-reactive protein (CRP; P < 0.001), and aspartate aminotransferase (AST; P > 0.018) were significantly different between the groups. To discriminate KDL patients from controls, cut-off points of the aforementioned parameters (KDL indices) were determined using the receiver operating characteristic curves in order to maximize sensitivity and accuracy (age, 5.0 years; neutrophil counts, 10 000/muL; CRP, 7.0 mg/dL; AST, 30 IU/L). One point was assigned if a subject exceeded the cut-off point in a KDL index. If a patient with three or four KDL indices was considered to have KD, the sensitivity was 78% and the specificity 100%. None of the patients with one or zero KDL index developed KD. Conclusions: KDL indices may be helpful in discriminating KDL from lymphadenitis at admission. It is important to monitor the symptoms of KD in a patient with three or four KDL indices at admission.
Abscess-forming lymphadenopathy and osteomyelitis in children with Bartonella henselae infection.
J Med Microbiol. 2008 Apr
1Children's Hospital, University of Würzburg, 97080 Würzburg, Germany.
Bartonella henselae is the agent of cat-scratch disease (CSD), a chronic lymphadenopathy among children and adolescents. A systemic infection is very rare and most of these cases are found in patients with immunodeficiency. Here, cases involving four children of 6-12 years of age are reported. Three of the children had an abscess-forming lymphadenopathy and surrounding myositis in the clavicular region of the upper arm. The diagnosis was made serologically and, in one case, using eubacterial universal PCR. One child was treated with erythromycin for 10 days, the second received cefotaxime and flucloxacillin for 14 days and the third child was not treated with antibiotics. The fourth child had a different course: a significantly elevated signal intensity affecting the complete humerus was found in magnetic resonance imaging, consistent with osteomyelitis. A lymph node abscess was also found in the axilla. Diagnosis was established by indirect fluorescence assay and lymph node biopsy. Antibiotic therapy using clarithromycin, clindamycin and rifampicin was gradually successful. Immunodeficiency was excluded. All described lesions healed without residues. In immunocompetent patients, infection affects skin and draining lymph nodes; however, prolonged fever of unknown origin as in the fourth patient indicated a systemic complication of CSD.
Lymphadenopathy of IgG4-related Sclerosing Disease.
Am J Surg Pathol. 2008 Mar
Departments of *Pathology ‡Medicine, Queen Elizabeth Hospital †Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong Eye Hospital §Bank of America Tower, Central, Hong Kong ∥Melbourne Plaza, Central, Hong Kong.
IgG4-related sclerosing disease is a recently recognized syndrome characterized by mass-forming lesions in exocrine glands or extranodal tissues due to lymphoplasmacytic infiltrates and sclerosis, a raised serum IgG4 level and increased IgG4+ plasma cells in the involved tissues. We report the morphologic features of the enlarged regional (n=3) and nonregional lymph nodes (n=3) in patients with this syndrome. The patients presented with autoimmune pancreatitis, lymphoplasmacytic sclerosing cholangitis, chronic sclerosing dacryoadenitis, or chronic sclerosing sialadenitis. The histologic features of the lymph nodes could be categorized into 3 patterns: Castleman diseaselike, follicular hyperplasia, and interfollicular expansion by immunoblasts and plasma cells. The percentage of IgG4+/IgG+ plasma cells was markedly elevated (mean 62% vs. 9.9% in 54 control lymph nodes comprising a wide variety of reactive conditions). We also report 6 cases of primary lymphadenopathy characterized by increased IgG4+/IgG+plasma cells (mean 58%). These cases share many clinical and pathologic similarities with IgG4-related sclerosing disease. In fact, 2 of these patients developed lymphoplasmacytic sclerosing cholangitis or lacrimal and submandibular gland involvement during the clinical course. These cases therefore probably represent primary lymph node manifestation of the disease. The importance of recognition of the lymphadenopathic form of IgG4-related sclerosing disease lies in the remarkable response to steroid therapy, and the potential of mistaking the disease for lymphoma either clinically or histologically.
Uses and limitations of fine needles aspiration cytology in the diagnostic work-up of patients with superficial lymphadenopathy.
Nig Q J Hosp Med. 2007 Oct-Dec
Faculty of Medicine Bayero University, Kano.
Lymph node fine needle aspirations in 93 patients were studied to ascertain the usefulness of FNA cytology in determining the therapeutic approach. Cytologic results were compared with histologic diagnoses in 35 cases that underwent both aspiration and excisional biopsy. The cases with histological diagnoses included 17 (28.3%) of the 60 cytologically benign cases, 6 (75.0%) of the 8 cytologically suspicious cases, 10 (55.5%) of the 18 cytologically malignant cases and 2 (28.6%) of the 7 cytologically unsatisfactory cases. FNA in the present series showed a sensitivity of 90.0 per cent and specificity of 82.3 percent. It is concluded from this data that FNA can be an accurate, inexpensive and quick method of initial diagnosis in superficial lymphadenopathy.
Lymphadenopathy: Differential Diagnosis and
Lymphadenopathy and Malignancy
Thorax - Lymphadenopathy
Lymph Follicular Hypertrophy
Alternate Names : Lymphadenopathy
Lymph follicular hypertrophy is increased size of the lymph follicles. Lymph nodes act as filters keeping organisms, especially bacteria, from entering the bloodstream.
Diagnostic Codes - ICD10 - ICD 9
2008 ICD-9-CM Diagnosis 289.1
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