lymphodenopathy

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LYMPHADENOPATHY

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,  

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Discussion:

Lymphadenopathy is commonly referred to as enlarged lymph nodesWhen 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.  

*Patient Alert*

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.

Etiology:

The causes of lymphadenopathy are extensive and include bacterial, viral, fungal infections.  Long term lymphadenopathy might be caused by lymphomas, other malignancies.

Diagnosis:

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.

Treatment:

Treatment focuses on the underlying condition causing the lymphadenopathy.

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Lymphadenopathy

Epidemiology

Cancer risk in unexplained adenopathy (primary care)
Age over 40 years: 4% cancer risk
Age under 40 years: 0.4% cancer risk


Definitions

Lymphadenopathy

Lymph nodes with abnormal size
Lymph nodes with abnormal consistency
Lymph nodes of abnormal number

Classifications
Localized lymphadenopathy


Limited to one area of involvement

Generalized Lymphadenopathy

Two or more non-contiguous areas

Causes


General Infectious Causes of Lymphadenopathy 

Common Infectious Causes

Infectious Mononucleosis (Epstein-Barr Virus
Toxoplasmosis 
Cytomegalovirus 
Cat Scratch Disease (Cat Scratch Fever) 
Pharyngitis 
Tuberculosis 
Scarlet Fever 
Scabies 
Varicella Zoster Virus (Shingles)

Sexually Transmitted Disease Causes of Lymphadenopathy 

Hepatitis B 
Acute Retroviral Syndrome in HIV Infection 
See Lymphadenopathy in HIV 
Secondary Syphilis 
Lymphogranuloma venereum 
Chancroid

Less Common Infectious Causes 

Lyme Disease 
Measles 
Rubella 
Tularemia 
Brucellosis 
Bubonic Plague 
Typhoid Fever 
African Trypanosomiasis (African Sleeping Sickness) 
Chagas' Disease 
Kala-azar 
Sporotrichosis

Collagen Vascular Causes of Lymphadenopathy 

Common 

Systemic Lupus Erythematosus 
Rheumatoid Arthritis 
Less Common 
Still's Disease 
Dermatomyositis 

Neoplastic Causes of Lymphadenopathy 

Hodgkin's Lymphoma 
Lymphosarcoma 
Histiocytic Medullary Reticulosis 
Leukemia 
Lymphocytic Leukemia 
Myelocytic Leukemia 
Metastatic cancer 
Melanoma 
Kaposi's Sarcoma 
Neuroblastoma 
Seminoma 
Lung Cancer 
Breast Cancer 
Prostate Cancer 
Renal carcinoma 
Head and neck cancers 
Gastrointestinal tract cancers

Miscellaneous Causes of Lymphadenopathy 

Common 

Serum Sickness 
Sarcoidosis 
Hyperthyroidism

Less Common

Kawasaki Disease 
Amyloidosis 
Niemann-Pick Disease 
Gaucher's Disease 

Causes of Generalized Lymphadenopathy in HIV 

Acute Retroviral Syndrome in HIV Infection 
Kaposi's Sarcoma 
Cytomegalovirus (CMV) 
Toxoplasmosis 
Tuberculosis 
Cryptococcosis 
Syphilis 
Lymphoma 

Lymphadenopathy of the Head and Neck

See Also: 
Neck Masses in Adults 
Neck Masses in Children 

Submandibular Exam 
Oral Exam 
Lip Exam 
Virchow's Node

Submandibular Nodes (below angle of jaw)

Drainage Pattern

Tongue 
Submaxillary gland 
Submental node drainage 
Lip and Mouth mucosa 
Medial Conjunctiva 

Lymphadenopathy Causes (Infections of head and neck) 

Acute Sinusitis 
Chronic Sinusitis 
Otitis Media 
Conjunctivitis 
Tinea Capitis 
Pharyngitis

Submental Nodes (below chin)

Drainage Pattern

Lower lip 
Floor of Mouth 
Tip of Tongue 
Skin of Cheek

Lymphadenopathy Causes

Mononucleosis (Epstein-Barr Virus) 
Cytomegalovirus 
Toxoplasmosis

Jugular Nodes (anterior border of sternocleidomastoid)

Drainage Pattern

Tongue (except apex) 
Tonsil 
Ear pinna 
Parotid Gland

Lymphadenopathy Causes 

Pharyngitis 
Rubella

Posterior Cervical Nodes (behind sternocleidomastoid)

Drainage Pattern

Scalp 
Neck 
Arm and pectoral skin 
Thorax 
Cervical and axillary node drainage

Lymphadenopathy Causes

Tuberculosis 
Lymphoma (especially Hodgkin's Lymphoma) 
Head and neck cancer 
African Trypanosomiasis (Winterbottom's Sign)

Suboccipital nodes (base of skull, below occiput)

Suboccipital Lymphadenopathy may causes Headache

Drainage Pattern

Back of Scalp and Head 

Lymphadenopathy Causes

Local infection 
Tinea Capitis 
Pediculosis capitis (Lice) 
Seborrheic Dermatitis 
Secondary Syphilis 
Neoplasm

Postauricular nodes (behind pinna of ear)

Drainage Pattern

External auditory meatus 
Posterior Ear pinna 
Temproal Scalp

Lymphadenopathy Causes (Local infection)

Otitis Externa 
Tinea Capitis 
Secondary Syphilis 
Rubella

Preauricular nodes (anterior to ear tragus)

Drainage Pattern

Lateral Eyelids 
Palpebral Conjunctiva 
Temporal skin 
Anterior Ear pinna 
External auditory canal

Lymphadenopathy Causes

Local infection

Rodent ulcer 
Epithelioma 
Chancre on face 
Erysipelas 
Ophthalmic Herpes Zoster 
Rubella 
Trachoma

Viral Conjunctivitis

Epidemic Keratoconjunctivitis 
Adenoidal-pharyngeal-Conjunctivitis Virus 
Not usually seen in Bacterial Conjunctivitis

Chronic granulomatous Conjunctivitis

Parinaud's oculoglandular syndrome 
Complication of Cat Scratch Disease (Tularemia
Chancre (Syphilis) 
Tuberculosis 
Leptotrichosis (Leptothrix Infection) 
Gonorrhea ophthalmia 
Sporotrichosis 
Glanders 
Chancroid 
Lymphogranuloma venereum 
Chagas Disease

Generalized Acute Cervical Lymphadenopathy Causes

Secondary Syphilis 
Rubella 
Infectious Mononucleosis (Epstein Barr Virus) 
Generalized Furunculosis 
Lice infestation 
Serum Sickness 
Severe drug allergy (e.g. Penicillin) 
Cat Scratch Disease 
Cytomegalovirus 
Adenovirus 
Toxoplasmosis 
African Trypanosomiasis (African Sleeping Sickness) 
Kala Azar 
Scrub Typhus 


History: Exposures

Cat Exposure (Cat Scratch Disease or Toxoplasmosis)
Ingestion of undercooked meat (Toxoplasmosis)
Tick bite (Lyme Disease or Tularemia)
Tuberculosis exposure
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
Coccidioidomycosis
Bubonic Plague
Travel to Southeastern or central United States
Histoplasmosis
Travel to Southeast Asia and Australia
Scrub Typhus
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
Kala-azar (Leishmaniasis)
Travel Mexico, Peru, Chile, Pakistan, Egypt, Indonesia
Typhoid Fever

Signs

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)

Benign causes

Tuberculosis
Sarcoidosis
Lymphogranuloma venereum
Malignant causes
Metastatic cancer
Lymphoma

Splenomegaly

Infectious Mononucleosis
Hodgkin's Disease
Non-Hodgkin's Lymphoma
Chronic Lymphocytic Leukemia
Acute Leukemia
Rarely associated with metastatic cancer

Diagnostic Evaluation: Initial Tests

Indications

Specific indications based on location and exposures
Generalized Lymphadenopathy

Tests

Complete Blood Count with manual differential
Monospot (Mononucleosis serology)

Diagnostic Evaluation: Second-line Tests

Indications

Specific indications and normal initial tests
Persistent Generalized Lymphadenopathy
Tests
Tuberculin Skin Test (Purified Protein Derivative)
Rapid Plasma Reagin (RPR)
Antinuclear Antibody (ANA)
Hepatitis B Serology (HBsAg)
HIV Test
Chest XRay

Diagnostic Evaluation: Third-line Tests (Biopsy)

Indications

Persistent lymphadenopathy for more than 3-4 weeks
Malignancy or serious disease suspected

Biopsy

Lymph node biopsy of most abnormal or largest node
Excisional Biopsy preferred over FNA or needle biopsy

Efficacy

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%)
Tuberculosis (10%)

References

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

http://www.fpnotebook.com/asp3/search2.aspx?qu=lymphadenopathy

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Regional Lymphadenopathy

See Also

Lymphadenopathy
Lymphadenopathy Causes
Lymphadenopathy in the Febrile Returning Traveler
Lymphadenopathy of the Head and Neck
Hilar Adenopathy

Right Supraclavicular Nodes

Drainage Patterns
Mediastinum
Lungs
Esophagus

Lymphadenopathy Causes

Lung Cancer
Gastrointestinal cancer
Cancer of the retroperitoneum

Left Supraclavicular Nodes

Drainage Patterns

Thorax
Abdomen (Thoracic duct drainage)

Lymphadenopathy Causes (See Virchow's Node)

Lymphoma
Cancer of the thorax
Cancer of the retroperitoneum
Bacterial infection
Fungal infection

Axillary Nodes

Drainage Patterns

Arm
Thoracic wall
Breast

Lymphadenopathy Causes

Miscellaneous infectious causes

Cat Scratch Disease
Lymphoma
Breast Cancer
Silicone Breast Implants
Brucellosis
Melanoma

Epitrochlear Nodes (proximal to elbow medial epicondyle)

Drainage Patterns

Ulnar forearm
Ulnar hand
Pinky and ring finger

Lymphadenopathy Causes

Miscellaneous infectious causes

Lymphoma
Sarcoidosis
Tularemia
Secondary Syphilis

Inguinal Nodes

Drainage Patterns

Horizontal Group (along inguinal ligament)

Skin of lower anterior abdominal wall
Retroperitoneal drainage
Penis and scrotum
Vulva and vagina
Gluteal region
Lower anal canal
Perineum

Vertical Group (along upper great saphenous vein)

Penis and scrotum
Gluteal region
Lower limb drainage

Lymphadenopathy Causes

Infections of the leg and foot
Lymphoma
Pelvic malignancy
Bubonic Plague
Tuberculosis
Sexually Transmitted Diseases
Herpes Simplex Virus
Gonorrhea
Syphilis
Chancroid
Granuloma inguinale
Lymphogranuloma venereum

Non-Causes

Testicular Cancer metastasizes to para-aortic nodes

Acknowledgement: Family Practice Notebook

http://www.fpnotebook.com/
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Medication Causes of Lymphadenopathy

Causes 

Allopurinol 
Atenolol (Tenormin) 
Captopril 
Carbamazepine (Tegretol) 
Cephalosporin Antibiotics 
Gold 
Hydralazine (Apresoline) 
Penicillin 
Phenytoin (Dilantin) 
Primidone (Mysoline) 
Pyrimethamine 
Quinidine 
Sulfonamides 
Sulindac (Clinoril) 


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Lymphadenopathy

Causes of lymphadenopathy

Clinical Assessment

Investigation

Sentinel node biopsy

http://www.surgical-tutor.org.uk/default-home.htm

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Submandibular Lymphadenopathy

Definition of Submandibular Lymphadenopathy

Submandibular lymphadenopathy refers to enlarged lymph nodes located beneath the mandible (lower jaw).

Description of Submandibular Lymphadenopathy

Hot, swollen, tender, supple lymph nodes usually indicate infection and are accompanied by other symptoms. Infectious nodes are frequently swollen, hot, tender, and accompanied by constitutional symptoms (fever, fatigue, muscle aches).

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.

Causes and Risk Factors of Submandibular Lymphadenopathy

Noncarcinogenic and noninfectious illnesses such as drug-induced lymphadenopathy, collagen vascular disorders, and sarcoidosis  may also cause generalized or localized adenopathy. While nearly any drug can spur a reaction in the lymph nodes, phenytoin sodium (Dilantin) is a common cause. Peripheral lymphadenopathy is common in asymptomatic sarcoidosis, which frequently becomes evident on biopsy.

Fixed, hard, unilateral (one side of the body) nodes can signal cancer.

Symptoms of Submandibular Lymphadenopathy

The location of enlarged nodes is a powerful key to sorting out possible causes and determining a course of action.

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.

Diagnosis of Submandibular Lymphadenopathy

In general, the presence or absence of other signs and symptoms, changes in the nodes over time, and the characteristics of the nodes themselves determine how assertive any diagnostic plan should be.

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.

Treatment of Submandibular Lymphadenopathy

Because many illnesses can cause adenopathy, the management can range from an immediate surgical consultation to noninvasive testing to observation for a 3 to 6 month period, depending on the patient's medical history and physical findings.

Questions To Ask Your Doctor About Submandibular Lymphadenopathy

What is the extent of node enlargement?

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

you recommend?

http://www.healthscout.com/ency/68/566/main.html

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Research Abstracts and Articles

Intrathoracic lymphadenopathy: An unusual manifestation of rheumatoid arthritis].

Feb 2012
[Article in French]
Khammassi N, Bayouth A, Abdelhedi H, Balhouane I, Hergli I, Cherif O.

Source

Service de médecine interne, hôpital Razi, 2010, La Manouba, Tunisie.

Abstract


Lung disease is the most frequent extra-articular manifestation of rheumatoid arthritis. It is detected in nearly 50% of patients with this multisystem affection, his knowledge has benefited from advances in computed tomography (CT). The inflammation can affect the pleura, the airways and the lung parenchyma. Intrathoracic lymphadenopathy complicating rheumatoid lung are not usual, and then pose the problem of differential diagnosis. We report a 51-year-old man, with a history of tobacco intoxication, suffering from rheumatoid arthritis who developed an interstitial lung disease at stage of fibrosis with mediastinal and hilar adenopathy. We will discuss the clinical, paraclinical, evolutionary and therapeutic particularities case.

PubMed

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Melioidosis presenting with mediastinal lymphadenopathy masquerading as malignancy: a case report.

Jan 2012
Saravu K, Mukhopadhyay C, Eshwara VK, Shastry BA, Ramamoorthi K, Krishna S, Satyanarayanan V.

Abstract

ABSTRACT: INTRODUCTION: 

Melioidosis, endemic in Thailand and in the Northern Territory of Australia is an emerging infectious disease in India which can present with varied forms. A case of melioidosis, presenting as a rare anterior mediastinal mass which can masquerade as a malignancy or as tuberculosis, is described. Our patient developed new submandibular lymph nodes and the mediastinal node initially increased in size on treatment. To the best of our knowledge, this phenomenon has not been documented in the literature. It is important to document the same which is highlighted in this case report. 

Case Presentation: 

A 43-year-old Asian man with diabetes presented with fever, loss of appetite, weight loss for one month and painful swelling below his left mandible for five days. An examination revealed an enlarged left submandibular lymph node and bilateral axillary lymph nodes. A chest X-ray showed mediastinal widening. Computed tomography of his thorax showed a lobulated heterogeneously enhancing anterior mediastinal mass encasing the superior vena cava suggestive of malignancy. An excision biopsy of the lymph node showed granulomas suggestive of tuberculosis but bone marrow culture and lymph node aspirate culture grew Burkholderia pseudomallei. He was treated with parenteral ceftazidime and amoxicillin-clavulanic acid. During the course of treatment, he developed an enlargement of the submandibular lymph node on the opposite side. It gradually subsided with the continuation of therapy orally with a combination of cotrimoxazole and doxycycline for six months. A repeat computed tomography chest scan showed resolution of the mediastinal mass. 

CONCLUSION: 

Melioidosis can present as a mediastinal mass that mimics tuberculosis or malignancy. During the treatment of melioidosis, the appearance of new lymph nodes or an increase in the size of the existing lymph nodes does not mean treatment failure. Inexperienced clinicians may consider this as treatment failure and may switch treatment. To the best of our knowledge, this is the first report documenting this phenomenon in melioidosis cases. 

Journal of Medical Case  Reports

Primary IgG4-related lymphadenopathy with prominent granulomatous inflammation and reactivation of Epstein-Barr virus.

Jan 2012
Takahashi E, Kojima M, Kobayashi M, Kitamura A, Yokoi T, Hara K, Nakamura S.

Source

Department of Pathology, Aichi Medical University Hospital, Nagakute, Japan, emikot@aichi-med-u.ac.jp.

Abstract


Keywords  IgG4-related lymphadenopathy – IgG4-related disease – Granulomatous inflammation – Epstein−Barr virus – Reactivation of Epstein−Barr virus

We report a unique case of primary IgG4-related lymphadenopathy showing prominent granulomatous inflammation and Epstein-Barr virus (EBV) reactivation. Involved lymph nodes showed an expanded interfollicular zone with prominent granulomatous inflammation, including a predominance of epithelioid macrophages and occasional Langhans multinucleated giant cells. Bundles of spindle cells were also observed. Intermingled with the granulomatous inflammation were numerous mature plasma cells, eosinophils, and neutrophils. The percentage of IgG4+/IgG+ plasma cells was markedly elevated (70%), along with raised serum IgG4 levels. The plasma cells did not show immunoglobulin light-chain restriction. EBV-positive lymphocytes were scattered throughout the paracortical areas. Corticosteroid treatment was very effective. IgG4-related lymphadenopathy has a broad histological spectrum and might be misdiagnosed due to other conditions which morphologically closely resemble it. The correct diagnosis is important in view of the remarkable response to steroid therapy. 

Springerlink

Progressive mesenteric lymphadenopathy with protein-losing enteropathy; a devastating complication in Gaucher disease. 

Dec 2011


Lee BH, Kim DY, Kim GH, Cho KJ, Yoon HK, Yoo HW.

Source

Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.

Abstract


Mesenteric lymphadenopathy has been rarely reported in pediatric patients with Gaucher disease, developing despite the enzyme replacement therapy. The clinical implication of this condition is undetermined, with no consensus on treatment strategies. However, this condition can reflect the progression of Gaucher disease. Moreover, it can be accompanied by the serious complication, protein-losing enteropathy. Our experience underlines the importance of careful monitoring and early intervention for mesenteric lymphadenopathy, especially in pediatric patients with neuronopathic Gaucher disease.

SciVerse

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Kikuchi - Fujimoto disease: cervical lymphadenopathy suggestive of relapsing lymphoma in patient with lymphoblastic lymphoma.  


Dec 2011

Kankaya D, Urun Y, Dogan M, Yalcin B, Icli F, Utkan G.

Source

Department of Medical Oncology, Cebeci Hospital, Ankara University School of Medicine, 06590, Dikimevi, Ankara, Turkey.

Abstract


Aim: Kikuchi - Fujimoto disease (KFD) or histiocytic necrotizing lymphadenitis is a rare disorder and often confused with lymphoma. Patient: There is presented a case of 28-year-old patient with cervical lymphadenopathy, who had history of lymphoma. Results: On immunohistopathologic examination diagnosis of KFD was made and patient followed without any treatment. Conclusion: Patient's lymphadenopathy had almost resolved and he was completely asymptomatic after three months. In patient with cervical lymphadenopathy KFD should be considered in the differential diagnosis. 

KFD or histiocytic necrotizing lymphadenitis is a rare disorder. Although it is primarily affecting young adults of Asian descent, KFD is being increasingly reported in other areas [1–3]. It is generally a self-limiting benign condition and is characterized by patients presenting with cervical lymphadenopathy, fevers and malaise. The clinical features can also be consistent with malign lymphomatous disorders [4]. The clinician being referred patients with cervical lumps should be aware of this condition as part of their clinical assessment. Histological examination is the only means of definitive diagnosis, so the provision of clear clinical information and adequate biopsy material to the pathologist is critical.

Experimental Oncology

http://exp-oncology.com.ua/article/2437

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Fever, urticaria, lymphadenopathy, and protracted arthralgia and myalgia resistant to corticosteroid therapy. 

Sept 2011

Source

Section of Allergy and Immunology, Louisiana State University Health Sciences Center, Shreveport, 71130-3932, USA.

Abstract

Allergen immunotherapy is commonly incorporated in the management of allergic rhinoconjunctivitis, allergic asthma, and insect sting hypersensitivity. It is generally safe, but systemic reactions occasionally occur, mainly of the immediate type and rarely of the delayed type. We report a case of a 50-year-old man with allergic rhinoconjunctivitis on immunotherapy for 3 years and then received an injection from another patient's extract. The latter contained a higher concentration of house-dust mite and pollens of grasses, trees, and weeds. It also contained molds that the patient's correct extract did not have. Within half an hour, he developed a systemic reaction that resolved with symptomatic treatment. Two weeks later, he received one-half of his usual immunotherapy dose. Within a week, he developed urticaria, arthralgia, myalgia, fever, andlymphadenopathy. Laboratory abnormalities included leukocytosis, elevated erythrocyte sedimentation rate, hematuria, and elevated liver enzymes. Oral corticosteroid therapy for 3 weeks was ineffective. He developed significant myalgia and apparent mood changes, attributable to corticosteroid intake. After a single plasmapheresis, he felt remarkable improvement within <24 hours. Corticosteroid therapy was gradually withdrawn over 10 weeks without relapse of symptoms. This is a rare case of probable serum sickness after the administration of a wrong allergy immunotherapy extract. However, a causal relationship could not be proven. The response was poor to prolonged corticosteroid therapy but was remarkable to one plasmapheresis.

Ingenta - PubMed

http://www.ncbi.nlm.nih.gov/pubmed/22195694

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Initial work-up for cervical lymphadenopathy: back to basics. 


Dec 2011

Jeong WJ, Park MW, Park SJ, Ahn SH.

Source

Department of Otorhinolaryngology, Head & Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, 463-707, Korea.

Abstract

Keywords  Cervical lymphadenopathy – Complete blood count – Fine needle aspiration – Tuberculosis – Polymerase chain  reaction

The aim of this study was to evaluate the value of FNA, Tb-PCR, and CBC as an initial work-up protocol for cervicallymphadenopathy to reiterate the importance of CBC in terms of predicting the clinical course. In this consecutive case series, 158 patients with cervical lymphadenopathy were enrolled. All patients underwent FNA and CBC, with or without Tb-PCR. The validity of combined FNA ± Tb-PCR and CBC in the diagnosis of diseases requiring definitive treatment was evaluated. Final diagnoses were self-limiting disease in 110 (69.6%), malignancy in 19 (12.0%), and tuberculosis in 26 (16.5%). Sensitivity of FNA ± Tb-PCR was 66.7% and of added CBC profile was 97.9%. Patients with neutropenia or lymphocytosis were found to have a higher chance of spontaneous recovery than patients with a normal WBC profile. FNA and Tb-PCR were found to be important in patients aged more than 20. The results indicate that FNA, Tb-PCR, and CBC are basic and essential in initial work-up for cervical lymphadenopathy. In particular, CBC was found to aid in detecting criticaldiseases and predicting the likelihood of open biopsy in patients with negative FNA and Tb-PCR. Patient age was also found to be an important determinant of the work-up protocol. 

SpringerLink

http://www.springerlink.com/content/gll795173464371x/

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Cotton-ball granuloma mimicking axillary lymphadenopathy in a breast cancer patient.

July 2011
Hashim H, Alli K, Faridah Y, Rahmat K.

Source

Radiology Department, Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Malaysia.

Abstract


Foreign body granuloma is a reaction to either a biodegradable substance or inert material. In a breast cancer patient who had undergone an excision or mastectomy with axillary clearance, a foreign body granuloma in the axilla may be misinterpreted as an axillary lymph node. We report our experience with a case of cotton-ball granuloma of the axilla in a breast cancer patient, which mimics a lymph node radiologically from the CT scan, mammogram and ultrasonography. Following biopsy and excision, the mass was diagnosed histologically as a foreign body granuloma.

Full text article

PubMedCentral

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Lymph node enlargement in pulmonary arterial hypertension due to chronic thromboembolism.

J Med Imaging Radiat Oncol. 2008 Feb

Bergin CJ, Park KJ.

Department of Anatomy with Radiology, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand. c.bergin@auckland.ac.nz

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.

PubMed

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Early diagnosis of Kawasaki disease in patients with cervical lymphadenopathy.

Pediatr Int. 2008 Apr

Yanagi S, Nomura Y, Masuda K, Koriyama C, Sameshima K, Eguchi T, Imamura M, Arata M, Kawano Y.

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.

Blackwell Synergy

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Abscess-forming lymphadenopathy and osteomyelitis in children with Bartonella henselae infection.

J Med Microbiol. 2008 Apr

Ridder-Schröter R, Marx A, Beer M, Tappe D, Kreth HW, Girschick HJ.

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.

Journal of Medical Microbiology

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Lymphadenopathy of IgG4-related Sclerosing Disease.

Am J Surg Pathol. 2008 Mar

Cheuk W, Yuen HK, Chu SY, Chiu EK, Lam LK, Chan JK.

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.

PubMed

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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

Malami SA.

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.

PubMed

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External Links:

Lymphadenopathy: Differential Diagnosis and Evaluation

http://www.aafp.org/afp/981015ap/ferrer.html

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Lymphadenopathy and Malignancy

http://www.aafp.org/afp/20021201/2103.html

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Lymphadenopathy (1)

http://www.emedicine.com/ped/topic1333.htm

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Lymphadenopathy

MedLine Plus

http://www.nlm.nih.gov/medlineplus/ency/article/003097.htm

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Thorax - Lymphadenopathy

http://www.meddean.luc.edu/lumen/MedEd/Radio/sarc/xrynodes.htm

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Lymph Follicular Hypertrophy

Alternate Names : Lymphadenopathy

Definition
Lymph follicular hypertrophy is increased size of the lymph follicles. Lymph nodes act as filters keeping organisms, especially bacteria, from entering the bloodstream.

http://health.allrefer.com/health/lymph-follicular-hypertrophy-info.html

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Lymphadenopathy

http://scinfo.org/problem-oriented-clinical-guidelines/specific-problems-lymphadenopathy

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Spectrum of cytological findings in patients with neck lymphadenopathy - experience in a tertiary care hospital in pakistan. 2011

http://www.ncbi.nlm.nih.gov/pubmed/22126582

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Nontuberculous lymphadenopathy in children: using the evidence to plan optimal management. 2011

http://www.springerlink.com/content/r712685r4t504658/

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Fever, Cervical Lymphadenopathy, and Erythematous-Violaceous Facial Plaques. Nov 2011

http://www.elsevier.es/en/node/2505605

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Mid-arm and epitrochlear lymphadenopathy: a clinico-radiological surprise. Nov 2011

http://www.jidc.org/index.php/journal/article/view/22112738

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Etiological and clinical characteristics of lymphadenopathy at child age in Tuzla Canton. 2011

http://www.ncbi.nlm.nih.gov/pubmed/22073855

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Diagnostic Codes - ICD10 - ICD 9

ICD-10 I88. 
Nonspecific lymphadenitis
Excludes: acute lymphadenitis, except mesenteric ( L04.- )
enlarged lymph nodes NOS ( R59.- )
human immunodeficiency virus [HIV] disease resulting in generalized lymphadenopathy ( B23.1 )
I88.0 Nonspecific mesenteric lymphadenitis
Mesenteric lymphadenitis (acute)(chronic)
I88.1 Chronic lymphadenitis, except mesenteric
Adenitis
Lymphadenitis
}
}
chronic, any lymph node except mesenteric
I88.8 Other nonspecific lymphadenitis
I88.9 Nonspecific lymphadenitis, unspecified
Lymphadenitis NOS
ICD-9 289.1-289.3

2008 ICD-9-CM Diagnosis 289.1

Chronic lymphadenitis

  • 289.1 is a specific code that can be used to specify a diagnosis
  • 289.1 contains 12 index entries
  • View the ICD-9-CM Volume 1 289.* hierarchy

289.1 also known as:

  • Chronic:
    • adenitis any lymph node, except mesenteric
    • lymphadenitis any lymph node, except mesenteric

289.1 excludes:

  • acute lymphadenitis (683)
  • enlarged glands NOS (785.6)
DiseasesDB 22225
eMedicine ped/1333 
MeSH D008206

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Diagnostic Images

Yahoo

http://images.search.yahoo.com/search/images?p=lymphadenopathy&fr=yfp-t-501&toggle=1&cop=mss&ei=UTF-8

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Related Lymphedema People Medical Blogs and Pages:

Bacterial Infections

http://bacteriainfections.blogspot.com

Antibiotics

http://antibioticinformation.blogspot.com/

Cellulitis

http://cellulitisinfections.blogspot.com/

MRSA Information

http://mrsainformation.blogspot.com/

Antibiotic Glossary

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=34

Antibiotic Therapy, Types of Antibiotics

http://www.lymphedemapeople.com/thesite/lymphedema_antibiotics.htm

=================

Join us as we work for lymphedema patients everywehere:

Advocates for Lymphedema

Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.

http://health.groups.yahoo.com/group/AdvocatesforLymphedema/

Subscribe: AdvocatesforLymphedema-subscribe@yahoogroups.com

Pat O'Connor

Lymphedema People / Advocates for Lymphedema

=================

For information about Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema\

For Information about Lymphedema Complications

http://www.lymphedemapeople.com/wiki/doku.php?id=complications_of_lymphedema

For Lymphedema Personal Stories

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=3

For information about How to Treat a Lymphedema Wound

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound

For information about Lymphedema Treatment 

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment

For information about Exercises for Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema

For information on Infections Associated with Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema

For information on Lymphedema in Children

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children

Lymphedema Glossary

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing

=================

Lymphedema People - Support Groups

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Children with Lymphedema

The time has come for families, parents, caregivers to have a support group of their own. Support group for parents, families and caregivers of chilren with lymphedema. Sharing information on coping, diagnosis, treatment and prognosis. Sponsored by Lymphedema People.

http://health.groups.yahoo.com/group/childrenwithlymphedema/

Subscribe: childrenwithlymphedema-subscribe@yahoogroups.com

......................

Lipedema Lipodema Lipoedema

No matter how you spell it, this is another very little understood and totally frustrating conditions out there. This will be a support group for those suffering with lipedema/lipodema. A place for information, sharing experiences, exploring treatment options and coping.

Come join, be a part of the family!

http://health.groups.yahoo.com/group/lipedema_lipodema_lipoedema/?yguid=209645515

Subscribe: lipedema_lipodema_lipoedema-subscribe@yahoogroups.com

......................

MEN WITH LYMPHEDEMA

If you are a man with lymphedema; a man with a loved one with lymphedema who you are trying to help and understand come join us and discover what it is to be the master instead of the sufferer of lymphedema.

http://health.groups.yahoo.com/group/menwithlymphedema/

Subscribe: menwithlymphedema-subscribe@yahoogroups.com

......................

All About Lymphangiectasia

Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.

http://health.groups.yahoo.com/group/allaboutlymphangiectasia/

Subscribe: allaboutlymphangiectasia-subscribe@yahoogroups.com

......................

Lymphatic Disorders Support Group @ Yahoo Groups

While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.

DISCRIPTION

Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of information available through sister site Lymphedema People.

http://health.groups.yahoo.com/group/lymphaticdisorders/

Subscribe: lymphaticdisorders-subscribe@yahoogroups.com

=================

Lymphedema People New Wiki Pages

Have you seen our new “Wiki” pages yet?  Listed below are just a sample of the more than 140 pages now listed in our Wiki section. We are also working on hundred more.  Come and take a stroll! 

Lymphedema Glossary 

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing 

Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema 

Arm Lymphedema  

http://www.lymphedemapeople.com/wiki/doku.php?id=arm_lymphedema 

Leg Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=leg_lymphedema 

Acute Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=acute_lymphedema 

The Lymphedema Diet 

http://www.lymphedemapeople.com/wiki/doku.php?id=the_lymphedema_diet 

Exercises for Lymphedema  

http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema 

Diuretics are not for Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=diuretics_are_not_for_lymphedema 

Lymphedema People Online Support Groups 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_people_online_support_groups 

Lipedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=lipedema 

Treatment 

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment 

Lymphedema and Pain Management 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pain_management 

Manual Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT)

http://www.lymphedemapeople.com/wiki/doku.php?id=manual_lymphatic_drainage_mld_complex_decongestive_therapy_cdt 

Infections Associated with Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema 

How to Treat a Lymphedema Wound 

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound 

Fungal Infections Associated with Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=fungal_infections_associated_with_lymphedema 

Lymphedema in Children 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children 

Lymphoscintigraphy 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphoscintigraphy 

Magnetic Resonance Imaging 

http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging 

Extraperitoneal para-aortic lymph node dissection (EPLND) 

http://www.lymphedemapeople.com/wiki/doku.php?id=extraperitoneal_para-aortic_lymph_node_dissection_eplnd 

Axillary node biopsy 

http://www.lymphedemapeople.com/wiki/doku.php?id=axillary_node_biopsy

Sentinel Node Biopsy 

http://www.lymphedemapeople.com/wiki/doku.php?id=sentinel_node_biopsy

 Small Needle Biopsy - Fine Needle Aspiration 

http://www.lymphedemapeople.com/wiki/doku.php?id=small_needle_biopsy 

Magnetic Resonance Imaging 

http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging 

Lymphedema Gene FOXC2

 http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_foxc2

 Lymphedema Gene VEGFC

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_vegfc

 Lymphedema Gene SOX18

 http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_sox18

 Lymphedema and Pregnancy

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pregnancy

Home page: Lymphedema People

http://www.lymphedemapeople.com

Page Updated: Feb. 7, 2012