evaluation of lymph node enlrgment

EVALUATION OF LYMPHADENOPATHY

Nearly 600 lymphnodes

Normally palpable

Sub mandibularAxillary

inguinal

Pathophysiology

React to threat

Hyperplastic response that usually resolves within 1 month

1.Size & quality

Palpable nodes in other regionsAny node >1cm

abnormal

Nodes >3cm neoplasm

2.Accompanying symptoms2.Accompanying symptoms

r/c fever >38.5 C,night sweats,weigt loss

LYMPHOMAS

Lymphngectic streaking

splenomegaly

3.Distribution

GENERALISED

METABOLIC •Hyper thyroidism•Lipidoses

Castleman’s disease

Rare,idiopathic,Localised/multicentric,mimic lymphoma/HIV,systemic symptoms,increased risk of infection

LOCALISED

ANT. AURICULAR POST. AURICULAR

SUB MANDIBULAR CERVICAL B/L

RIGHT SUPRA CLAVICULAR LEFT SUPRA CLAVICULAR

AXILLARY LYMPHADENOPATHY

EPITROCHLEAR LYMPHADENOPATHY

INGUINAL LYMPHADENOPATHY

UNILATERAL HILAR LYMPHADENOPATHYBILATERAL HILAR LYMPHADENOPATHY

GASTRIC CA

SISTER MARY JOSEPH NODULE

CAT SCRATCH D/S

4.other lymphatic abnormalitiesLymphangitisLymphadenitisKikuchi’s diseaselymphedema

1.Is the palpable mass indeed a lymph node????

Enlarged parotidThyroglossal cystAbscessBranchial cyst

2.Acute or chronic ??

3.Character of enlarged node???tender.,mobile

Firm,rubbery,nontenderPainless,stonehard,fixed&matted

4.Localized or generalised??

5.Are there associated systemic/localizing symptoms/signs???

6.Are there unusual epidemiological clues???

Exposure to catsTravelExposure to bird droppingsLacerations during gardeningExposure to TBSexual exposure

1.Complete blood cell count with differential….

Atypical lymphocytosisEosinophiliaPancytopenia

2.Serum uric acid

3.Serum liver chemistries

Localised adenopathy

1.Throat culture

2.Urethral/cervical swabs

3.Blood culture

4.biopsy

5.Abdominal CT

6.Bone marrow biopsy

Heterophile testVDRLAntibody titres of viruses,fungi,toxoplasmosisAnti nuclear antibodiesRheumatoid factor

1.Serological tests

Generalised adenopathy

Hilar adenopathy

1.Mantoux test

3.ACE enzyme determination

4.Bronchoscopy

5.mediastinoscopy

2.chest X-RAY,CT

Lymph node biopsyMost direct approach

Indications

Approaches & yeild Excitional biopsy

prefferedFNACNeedle aspiration

Choice of nodeLargest nodeAvoid inguinal & axillarySupra clavicular-highest diagnostic yield

complicationsFollow up/empiric treatment

THANKZZZZZZZZ…..ZZZZZZ…..ZZZZ