Lymphadenopathy or adenopathy is a disease of the , in which they are abnormal in size or consistency. Lymphadenopathy of an inflammation type (the most common type) is lymphadenitis,
Lymphadenopathy is a common and nonspecific medical sign. Common causes include (from minor causes such as the common cold and post-vaccination swelling to serious ones such as HIV/AIDS), autoimmune diseases, and cancer. Lymphadenopathy is frequently idiopathy and self-limiting.
Causes
Lymph node enlargement is recognized as a common sign of infectious, autoimmune, or malignant disease. Examples may include:
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Reactive: acute infection (e.g., bacterial, or virus), or chronic infections (tuberculous lymphadenitis,
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The most distinctive sign of bubonic plague is extreme swelling of one or more lymph nodes that bulge out of the skin as "buboes". The buboes often become Necrosis and may even rupture.
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Infectious mononucleosis is an acute viral infection usually caused by Epstein-Barr virus and may be characterized by a marked enlargement of the cervical lymph nodes.
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It is also a sign of cutaneous anthrax
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Toxoplasmosis, a parasitic disease, gives a generalized lymphadenopathy ( Piringer-Kuchinka lymphadenopathy).
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Plasma cell variant of Castleman's disease - associated with HHV-8 infection and HIV infection
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Mesenteric lymphadenitis after viral systemic infection (particularly in the GALT in the appendix) can commonly present like appendicitis.
Infectious causes of lymphadenopathy may include bacterial infections such as cat scratch disease,
tularemia,
brucellosis, or
prevotella, as well as fungal infections such as paracoccidioidomycosis.
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Tumoral:
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Primary: Hodgkin lymphoma
[Status and anamnesis, Anders Albinsson. Page 12]
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Secondary: metastasis, Virchow's node, neuroblastoma,
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Autoimmune: systemic lupus erythematosus
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]
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Immunocompromised: AIDS. Generalized lymphadenopathy is an early sign of infection with human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS).
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Bites from certain such as the pit viper
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Unknown: Kikuchi disease,
Benign (reactive) lymphadenopathy
lymphadenopathy is a common biopsy finding, and may often be confused with malignant lymphoma. It may be separated into major morphologic patterns, each with its own differential diagnosis with certain types of lymphoma. Most cases of reactive follicular hyperplasia are easy to diagnose, but some cases may be confused with follicular lymphoma. There are seven distinct patterns of benign lymphadenopathy:
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Follicular hyperplasia: This is the most common type of reactive lymphadenopathy.
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Paracortical hyperplasia/Interfollicular hyperplasia: It is seen in viral infections, skin diseases, and nonspecific reactions.
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Sinus histiocytosis: It is seen in lymph nodes draining limbs, inflammatory lesions, and malignancies.
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Nodal extensive necrosis
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Nodal granulomatous inflammation
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Nodal extensive fibrosis (Connective tissue framework)
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Nodal deposition of interstitial substance
These morphological patterns are never pure. Thus, reactive follicular hyperplasia can have a component of paracortical hyperplasia. However, this distinction is important for the differential diagnosis of the cause.
Diagnosis
In cervical lymphadenopathy (of the
neck), it is routine to perform a throat examination including the use of a
head mirror and an
endoscope.
On ultrasound, B-mode imaging depicts lymph node morphology, whilst power Doppler can assess the vascular pattern.
Fine-needle aspiration cytology (FNAC) has sensitivity and specificity percentages of 81% and 100%, respectively, in the histopathology of malignant cervical lymphadenopathy.
Classification
Lymphadenopathy may be classified by:
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Size, where lymphadenopathy in adults is often defined as a short axis of one or more lymph nodes is greater than 10mm.
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By extent:
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Localized lymphadenopathy: due to localized spot of infection; e.g., an infected spot on the scalp will cause lymph nodes in the neck on that same side to swell up
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Generalized lymphadenopathy: due to a systemic infection of the body; e.g., influenza or secondary syphilis
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Persistent generalized lymphadenopathy (PGL): persisting for a long time, possibly without an apparent cause
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By localization:
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Hilar lymphadenopathy.
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Mediastinal lymphadenopathy
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Bilateral hilar lymphadenopathy
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Dermatopathic lymphadenopathy: lymphadenopathy associated with skin disease.
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By malignancy: Benign lymphadenopathy is distinguished from malignant types which mainly refer to or lymph node metastasis.
Size
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By size, where lymphadenopathy in adults is often defined as a short axis of one or more lymph nodes is greater than 10mm.
| +Upper limit of lymph node sizes in adults |
10 mm |
10[ Last updated: Last updated: Feb 16, 2017] |
10 mm for ovoid lymph nodes, 8 mm for rounded |
|
10 mm[ Page 432 in: ] |
11mm[ or 15 mm] |
8 mm[
]
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Lateral retropharyngeal: 5 mm
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|
10 mm |
7mm |
11 mm |
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6 mm |
8 mm |
8 mm |
9 mm |
10 mm |
7 mm |
11 mm |
Lymphadenopathy of the axillary lymph nodes can be defined as solid nodes measuring more than 15 mm without fatty hilum.[ Page 559 in: ] Axillary lymph nodes may be normal up to 30 mm if consisting largely of fat.[
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In children, a short axis of 8 mm can be used.[ Page 942 in: ] However, inguinal lymph nodes of up to 15 mm and cervical lymph nodes of up to 20 mm are generally normal in children up to age 8–12.[ Last checked: 24 March 2014]
Lymphadenopathy of more than 1.5–2 cm increases the risk of cancer or granulomatous disease as the cause rather than only inflammation or infection. Still, an increasing size and persistence over time are more indicative of cancer.
See also
External links
