Lymphadenopathy

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Lymphadenopathy is the presence of enlarged lymph nodes although the may be a misnomer as the underlying process may not be pathological. It can be regional, e.g. in the axillary drainage in an upper limb infection, or generalised, e.g. HIV. The are several causes (see below).

Causes

Enlargement of the lymph node may be due expansion of lymphoid tissue normally found within the lymph node, as frequently occurs in response to inflammation or infection in the region served by the lymph nodes.

These changes are termed reactive. Histological analysis can reveal which compartment of the lymph node is expanded which may help to identify the underlying cause. Alternatively, the lymph nodes may be enlarged due to infiltration by malignant cells, infectious agents and other pathological processes.

Causes of lymphadenopathy

  • Reactive including bacterial, viral and trauma/infection
  • Neoplastic metastases. Tumour necrosis can result in reactive lymphadenopathy in the absence of viable lymphatic tumour cells.
  • Lymphoma
  • Tuberculosis
  • Sarcoidosis

Examination

  • Inspection
    • neck
      • JVP
  • Palpation
    • patient to sit forward
    • each of neck areas
      1. submental
      2. submandibular
      3. tonsillar
      4. pre-auricular
      5. post-auricular
      6. occipital
      7. superificial cervical
      8. posterior cervical
      9. deep cervical
      10. supraclavicular
      11. Epitrochlear (at elbow)
      12. Axillary
      13. Inguinal
      14. Popliteal

Signs of Malignancy

  • enlarged
  • rubbery texture
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