Lymph nodes examination

Lymph nodes examination

1. lymph Node Examination Dr. Abeer A bdulkareem

2. Examination of the lymph nodes forms a portion of the routine exam for: General Examination Most Body Regions: e.g. ENT, thyroid and breast examination Normally, lymph nodes should be nonpalpable. Remember that the liver and spleen are often enlarged in the presence of generalized lymphadenopathy ,These should be examined Introduction

3. Several groups of lymph nodes are accessible for physical examination. In the head and neck , these are located along the anterior and posterior aspects of the neck and on the underside and angle of the jaw . In the upper limb and trunk , lymph nodes are located in the epitrochlear and axillary regions In the lower limbs nodes can be examined in the inguinal and popliteal regions.

4. Cervical lymph nodes Submental Submandibular Tonsillar Pre-auricular Post-auricular Occipital Anterior cervical ( Deep and Superficial cervical) Posterior cervical Supraclavicular

5. AXILLARY LYMPH NODES

6. Inguinal LYMPH NODES There are two chains of superficial inguinal lymph nodes: a horizontal chain that runs just below the inguinal ligament, and a vertical chain that runs along the saphenous vein

7. lymph Node Examination

8. R W I I P P P E E

9. General inspection General appearance Cachexia – underlying malignancy Rashes – cutaneous manifestations of lymphoma Evidence of bleeding or bruising – thrombocytopenia Vital signs – pyrexia

10. The IPPA Sequence of local examination Inspection Palpation Percussion Auscultation There is no need to percuss or auscultate, Examination involves inspection and palpation.

11. Inspection Large nodes are often clearly visible on inspection, particularly if the enlargement is asymmetrical. If nodes are infected, the overlying skin may be red and inflamed . scars- masses- skin changes

12. Cervical L.N. Examination

13. Submental: in the midline behind the tip of the mandible Submandibular: midway and along the inner surface of the inferior margin of the mandible Tonsillar: at the angle of the jaw Pre-auricular: in front of the ear opposite the tragus Post-auricular: over the mastoid process (behind the ear) Positions in order usually examined

14. Occipital: back of the head at the base of the skull Posterior cervical: run along the anterior border of the trapezius muscle Superficial cervical: along the body of the sternomastoid Deep cervical: deep to the lateral border of the sternomastoid Supraclavicular: lie on the top of the clavicle Infraclavicular: lie along the inferior border of the clavicle Positions in order usually examined

15. Axillary L.N. Examination

16. Examination of axilla should cover the anterior, central , posterior, lateral, and apical groups of lymph nodes. An example : With your palm facing towards you , palpate behind the lateral edge of pectoralis major ( anterior ). Turn your palm medially and with your fingertips at the apex of the axilla palpate against the wall of the thorax ( central ). Facing your palm away from you now, feel inside the lateral edge of latissimus dorsi ( posterior ). Palpate the inner aspect of the arm in the axilla ( lateral ). Reach upwards into apex of the axilla with fingertips.

17. Inguinal Lymph Nodes Ask your patient to lower their trousers and underwear to expose the inguinal region . Lower the couch so the patient is lying flat . Inspect for any obvious swellings or irregularities. Palpate immediately inferior to the inguinal ligament (horizontal group) , which runs between the anterior superior iliac spine (ASIS) and pubic tubercle. Palpate 3cm lateral to the pubic tubercle , vertically down over the saphenous opening and the proximal portion of the great saphenous vein (vertical group)

18. Epitrochlear Lymph Nodes This is rare, but usually very obvious when lymphadenopathy is present here (the patient will often point this out if present). Place the palm of your right hand under the patient’s slightly flexed right elbow and feel with your fingers in the groove above and posterior to the medial epicondyle of the humerus .

19. Describing masses

20. Interpretation of lymph node findings: Benign:   Smooth , rounded, non-tender and mobile . Reactive:   Associated infective symptoms , smooth, rounded, tender and mobile. Metastases:  Regional lymphadenopathy present in areas of drainage from affected organ. Typically hard, firm and irregular .