Lymphadenopathy
Prof. Emad Allam
Al azhar university
Lymph nodes are present throughout the body.
They are an important part of your immune
system. Lymph nodes help your body
recognize and fight germs, infections, and
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other foreign substances.
Lymphadenopathy (swollen glands) refers to
enlargement of one or more lymph nodes.
Lymph nodes distributions
• Common areas where the lymph nodes can be felt (with the fingers) include:
• Groin
• Armpit
• Neck (there is a chain of lymph nodes on either side of the front of the neck,
both sides of the neck, and down each side of the back of the neck)
• Under the jaw and chin
• Behind the ears
• On the back of the head
Etiology of lymphadenopathy
• Infectious diseases
• Neoplasm
• Inflammatory disease
• Autoimmune disease
• Inborn metabolic storage disorder
• Exposure to toxic/medication
Infectious disease
• Viral etiologies of lymphadenopathy include HIV, mononucleosis
caused by EBV or CMV, varicella, and adenovirus.
• Bacterial etiologies of lymphadenopathy
include Staphylococcus, Streptococcus, Salmonella,
and Yersinia.
• Mycobacterial etiology of lymphadenopathy includes
tuberculosis and Mycobacterium avium intracellular.
• Fungal etiology of lymphadenopathy includes
coccidioidomycosis, histoplasmosis, and Candida.
• Parasitic etiology of lymphadenopathy includes toxoplasmosis,
Chagas,
Neoplasm
Neoplastic causes of lymphadenopathy include
both primary malignancies and metastatic
malignancies: Acute lymphoblastic leukemia,
Hodgkin lymphoma, non-Hodgkin lymphoma,
neuroblastoma, pediatric acute myelocytic
leukemia, rhabdomyosarcoma, metastatic
carcinoma of the lung, metastatic carcinoma
• Autoimmune diseases include:-
sarcoidosis, juvenile rheumatoid arthritis, serum
sickness, and systemic lupus erythematosus.
• Exposures to toxins and medications include:-
gold, hydralazine, penicillin, phenytoin,
primidone, para methylamine, quinidine, the
sulfonamides, and carbamazepine.
History and Physical Ex.
• Chronicity: The accepted definition of "chronic adenopathy"
is a duration of greater than 3 weeks.
• Acute: < 3 weeks.
• Localization:
Localized: Common with local infection.
*Submandibular nodes typically drain the tongue, the lips, the
mouth.
*Posterior cervical adenopathy is typically indicative of the
scalp, neck.
Generalized: in 2 or more non-contiguous areas. Generalized
adenopathy may indicate systemic illness.
Characterization of the node morphology:
• Tenderness or pain may result from an inflammatory process (Presence
or absence of pain is not a reliable differentiating factor for malignant
nodes, though.)
• Consistently firm, rubbery nodes may suggest lymphoma; softer nodes
are usually the result of infection or inflammatory conditions; hard,
stonelike nodes are typically a sign of cancer more commonly metastatic
than primary.
• "Shotty" nodes are small, scattered nodes that feel like shotgun pellets
under the skin. This configuration is typically found in the cervical nodes
of children with viral illnesses.
• The designation of a "matting" configuration of nodes describes the
pattern of clustered, seemingly conjoined lymph nodes. This is indicative
of, but not pathognomonic, malignancy
Laboratory Evaluation of Lymphadenopathy
• CBC with manual differentian:
number and differential of the white blood cells can indicate bacterial, viral, or fungal pathology.
Characteristic white blood cell patterns are observed, with several hematological neoplasms
producing lymphadenopathy.
• Sedimentation rate: A measure of inflammation, though not diagnostic, can contribute to
diagnostic reasoning.
*Serology evaluation for viral infection ( EBV, HV, HIV, Cytomegalo)
*Autoimmune evaluations: SLE, sarcodosis,Rhmatoid.
*PPD,Tuberculosis is among the leading causes of both regional and generalized adenopathy
• Radiological Testing:
1-Chest x-ray: This radiological imaging modality can reveal tuberculosis, pulmonary sarcoidosis,
and pulmonary neoplasm.
2-Chest computed tomography (CAT) scan
3- Abdominal and pelvic CAT scan
4-Ultrasonography:
5- MRI scanning: As with CAT scanning, this diagnostic imaging modality has great utility in
evaluating thoracic, abdominal, and pelvic masses.
Treatment
The management and treatment of
lymphadenopathy are dependent on its
etiology.
Fatigue
• Fatigue is a feeling of constant exhaustion,
burnout or lack of energy. It can be physical,
mental or a combination of both.
types of fatigue
• social,
• emotional,
• physical,
• pain,
• mental,
• and chronic illness.
• Social fatigue :This is the fatigue one might feel after speaking to a
person (or many people) for an extended period. Fatigue might
occur after speaking in person, especially when going out or
traveling to meet up, which requires more energy.
• Emotional fatigue:
Felt sadness, anger, depression, or frustration for an extended period.
It’s like those times when we are sad and cry a lot, and our eyes
hurt afterward. The body is affected because so much energy is
used to experience those feelings, and it can leave us feeling pretty
wiped of energy.
• Physical fatigue:
This type of fatigue follows physical activity. It can come from having a
shower, prepping a meal, or going for a run. Many people like the
feeling of physical fatigue after doing an activity because it can
have benefits, such as better sleep.
• Pain fatigue:
Pain may have caused a bad night’s sleep, leading to fatigue the next day
• Mental fatigue:
This comes from expending a lot of mental energy and stress.
Chronic illness fatigue:
1- CKD,
2- CLD,
3- Neurological diseases: hemiplegia, MS, myopathy.
4- Malignant diseases.
5- Blood diseases, anemia.
6- Ch. Respiratory diseases.
7- Malnutrition.
Evaluations
• Adrenal insufficiency
• Amyotrophic lateral sclerosis (ALS)
• Anemia
• Anxiety disorders
• Cancer
• Chronic infection or inflammation
• Chronic kidney disease
• COPD — a long-term lung disease that causes trouble with breathing.
• Depression (major depressive disorder)
• Diabetes
• Fibromyalgia
• Heart failure — a condition in which the heart doesn't pump blood as well as it should.
• Hyperthyroidism (overactive thyroid)
• Hypothyroidism
• Inflammatory bowel disease (IBD)
• Liver disease
• Medicines and treatments, such as chemotherapy, radiation therapy, pain medicines, heart medicines and antidepressants
• Obesity
• Parkinson's disease
• Physical or emotional abuse
• Polymyalgia rheumatica
• Pregnancy
• Rheumatoid arthritis
• Sleep apnea — a condition in which breathing stops and starts many times during sleep.
• Stress
