Axillary Lymph Nodes Examination.pptx

Lymph nodes

1. Axillary Lymph Nodes Examination Section 1

2. Examination of the Lymphatic System Utilizes inspection and palpation. Generally examined region by region during the examination of the other body systems. Always ask patients if they are aware of any “lumps”.

3. Examination of the Lymphatic System Inspect: any visible nodes for: edema erythema Palpate: the superficial nodes compare side to side for: size consistency mobility discrete borders or matted tenderness warmth

4. Nodal Character and Size Hard and painless nodes have higher suspicion of malignancy or granulomatous disease. Viral infection typically produces hyperplastic nodes that are bilateral, mobile, nontender , and clearly demarcated. Increasing size and persistence over time are of greater concern for malignancy than a specific level of nodal enlargement.

5. Differential Diagnosis of Nodes CANCER Firm, hard Non-movable No fever Not painful INFECTION Soft Movable Fever Painful

6. Examination of the Lymphatic System If an enlarged lymph node is found, examine: P P rimary site A A ll associated nodes L L iver S S pleen

7. Palpable Lymph Node Groups Head/neck Axillary Epitroclear Inguinal/femoral

8. Examination of Lymph Nodes Small, mobile, discrete, nontender nodes are common and termed shotty Nodes are abnormal if greater than 1 cm and/or present greater than one month Hard nodes suggest malignancy Tender nodes suggest infection Rubbery nodes suggest lymphoma

9. Age Related Variations Infants and Children Commonly find small, discreet, firm, movable nodes in occipital, postauricular, cervical and inguinal chains . . . should not be warm or tender shape usually ovoid or globular often referred to as “shotty nodes” May find enlarged postauricular and occipital nodes in children < 2 years old

10. Axillary Lymph Nodes

11. CENTRAL LATERAL PECTORAL INFRACLAVICULAR SUBSCAPULAR Axillary Lymph Nodes

12. Axillary lymphatics and the structures that they drain

13. Axillary Lymph Nodes

14. Axillary Lymph Nodes

15. Palpation of Axillary Lymph Nodes When examining the left axilla, grasp the patient's left wrist or elbow with your left hand and lift their arm up and out laterally. Then use your right hand to examine the axillary region as described above. This technique permits the patient's arm to remain completely relaxed, minimizing tension in surrounding tissues that can mask otherwise enlarged lymph nodes.

16. Palpation of Axillary Lymph Nodes When examining the right axilla, grasp the patient's right wrist or elbow with your right hand and lift their arm up and out laterally. Then use your left hand to examine the axillary region as described above.

17. Left Axillary Adenopathy

18. Axillary Lymphadenopathy Most of cases are nonspecific or reactive to local injury/infection in etiology. Persistent lymphadenopathy is less commonly found in the axillary nodes than in the inguinal chain. Breast adenocarcinoma often metastasis initially to the anterior and central axillary nodes, which may be palpable before discovery of the primary tumor.

19. Generalized Lymphadenopathy Generalized lymphadenopathy : lymphadenopathy found in two or more distinct anatomic regions More likely to result from serious infections, autoimmune diseases, and disseminated malignancies. Specific testing is usually required. Generalized adenopathy infrequently occurs in pt ’ s with neoplasms, but it is occasionally seen in patients with leukemias and lymphomas, or advanced disseminated metastatic solid tumors.

20. Causes of Generalized Lymphadenopathy Malignancy: lymphoma, leukemia or metastases. Autoimmune: SLE, RA or Sjogren’s syndrome. Infectious: Brucellosis, Cat-scratch disease, CMV, HIV, EBV, Rubella, Tuberculosis, Typhoid Fever, Syphilis or viral hepatitis. Other: Kawasaki’s disease, sarcoidosis, amyloidosis, lipid storage diseases or hyperthyroidism

21. Drugs which induces Lymphadenopathy Allopurinol Atenolol Captopril Carbamazepine Gold Hydralazine Penicillins Phenytoin Primidone Pyrimethamine Quinidine Trimethoprim / Sulfamethozole

22. Cervical nodes most commonly involved Usual course of lymph node disease is as follows: Firm, discrete nodes  fluctuant nodes matted together  skin breakdown, abscesses, chronic sinuses  healing and scarring Tuberculosis lymphadenopathy

23. Sarcoidosis Bilateral symmetric hilar and is the most common pattern of lymphadenopathy in sarcoidosis.

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