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DESCRIPTION
lymphadenopathy
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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