Lymphadenopathy

lymphadenopathy or adenopathy is disease of the lymph nodes, in which they are abnormality in size, character and consistency

1. LYMPHADENOPATHY DR Ndayisaba Corneille

2. lympadenopathy lymphadenopathy  or adenopathy is disease of the lymph nodes, in which they are abnormality in size, character and consistency .  Lymphadenopathy of an inflammatory type (the most common type) is lymphadenitis, producing swollen or enlarged lymph nodes According to Davidsons “lymphadenopathy can be caused by benign or malignant disease” The clinical site of lymphadenopathy DR Ndayisaba Corneille

3. CLASSIFICATION Localised Lymphadenopathy : this is due to a localized spot of infection(if only one area is involved) e.g : 1. an infected spot on the the scalp, ear, mouth, face or teeth will cause lymph nodes in the neck on that same side to swell up. 2. an infected spot on the breast will cause lymph nodes in the axillary to enlarge 3. an infected spot on the perineum or external genitalia will cause lymph nodes in inguinal region on that same side to swell up. Generalised Lymphadenopathy: this is due to systemic infections of the body (if lymph node are enlarge two or more area involves )e.g. influenza, secondary syphilis. DR Ndayisaba Corneille

4. Cause of lymphadenopathy I nfective • bacterial eg : streptococcal, tuberculosis, brucellosis • viral eg : cmv , viral hepatitis, mumps virus, adenovirus, measles , rubella, influenza virus, human immunodeficiency virus ( hiv ) • protozoal eg : toxoplasmosis • fungal eg : coccidiodomycosis ,histoplasmosis, coccidioidomycosis • parasitic e.g. toxoplasmosis, filariasis , pediculosis etc. Neoplastic • primary: lymphomas, leukaemias , neuroblastoma • secondary: lung, breast, thyroid, stomach DR Ndayisaba Corneille

5. .Autoimmune; e.g juvenile rheumatoid arthritis, systemic lupus erythematosus, langerhans cell histiocytosis , dermatomyositis. .Miscellaneous/ unusual; e.g. kawasaki disease ( mucocutaneous lymph node syndrome), sarcoidosis.etc . Latrogenic e.g. serum sickness, medications like; captopril, carbamazepine, phenytoin, etc. DR Ndayisaba Corneille

6. the signs and symptoms of lymphadenopathy Painful, warm, or red lump under your skin. More tired than usual. S kin rash. U nexplained weight loss. E nlarged spleen (organ that filters blood) F ever or night sweats. DR Ndayisaba Corneille

7. Diagnosis of lymphadenopathy Careful history and physical examination are the core of the evaluation. in most cases, a careful history and physical examination will identify a readily diagnosable cause of the lymphadenopathy, such as upper respiratory tract infection, pharyngitis, periodontal disease, conjunctivitis, lymphadenitis, tinea, insect bites, recent immunization, cat-scratch disease or dermatitis, and no further assessment is necessary. DR Ndayisaba Corneille

8. PHYSICAL EXAMINATION when lymphadenopathy is localized, the clinician should examine the region drained by the nodes for evidence of infection, skin lesions or tumors  other nodal sites should also be carefully examined to exclude the possibility of generalized rather than localized lymphadenopathy.  careful palpation of the submandibular, anterior and posterior cervical, supraclavicular, axillary and inguinal nodes can be accomplished in a short time and will identify patients with generalized lymphadenopathy DR Ndayisaba Corneille

9.  if lymph nodes are detected, the following five characteristics should be noted and described: 1.size 4.matting 7.tissue invasion 2.pain/tenderness ; 5.location 3.consistency ; 6.mobility ; Matting: a group of nodes that feels connected and seems to move as a unit is said to be “matted.” nodes that are matted can be either benign (e.g., tuberculosis, sarcoidosis or lymphogranuloma venereum ) or malignant (e.g., metastatic carcinoma or lymphomas) DR Ndayisaba Corneille

10. Mobility : fixed or matted nodes suggest metastatic carcinoma, whereas freely movable nodes may occur in infections, collagen vascular disease and lymphoma. Tissue Invasion :lymphovascular invasion ( LVI or lymphovascular space invasion ) is spread of a cancer to the blood vessels and/or lymphatics. It has got prognostic significance in some cancers Consistency : stony-hard nodes are typically a sign of cancer, usually metastatic. very firm, rubbery nodes suggest lymphoma. softer nodes are the result of infections or inflammatory conditions Pain/Tenderness : when a lymph node rapidly increases in size, its capsule stretches and causes pain DR Ndayisaba Corneille

11. Head and Neck lymphadenopathy C ervical lymphadenopathy: this includes posterior cervical nodes, which drain the scalp, neck and upper thoracic skin. the anterior cervical nodes drain the larynx, tongue, oropharynx and anterior neck . S ub-maxillary and submental lymphadenopathy: these affected nodes drain the teeth, tongue, gums and buccal mucosa. enlargement is usually due to pharyngitis, herpetic gingivostomatitis and dental abscess . P reauricular lymphadenopathy: affected nodes drain the eyelids, skin of cheeks and temporal region of the scalp. SITE AND DIFFERENTIAL DIAGNOSIS OF LYMPHADENOPATHY DR Ndayisaba Corneille

12. AXILLARY LYMPHADENOPATHY T he affected axillary nodes drain the breast and upper extremity of the thoracic wall. Epitrochlear lymphadenopathy : the affected lymph nodes drain the ulnar, forearm and hand. Mediastinal lymphadenopathy : the affected nodes drain the thoracic viscera, that is the lungs, thymus gland, heart ant thoracic oesophagus . Supraclavicular and infraclavicular lymphadenopathy. the affected nodes drain the git , genitourinary tract and pulmonary region. common etiologies include; tb , coccidiodomycosis , histoplasmosis, etc. Abdominal lymphadenopathy : the affected nodes drain the lower extremities, pelvis and abdominal organs. DR Ndayisaba Corneille

13. Iliac and inguinal lymphadenopathy: the affected nodes include the horizontal node group and vertical node group. these groups drain the lower abdomen, external genitalia skin, anal canal, lower third of the vagina and lower extremity. DR Ndayisaba Corneille

14. References Harrison's Principles of Internal Medicine, 18th Edition Davidson's Principles and Practice of Medicine,18th Edition DR Ndayisaba Corneille

15. THANKS FOR YOUR ATTENTION DR Ndayisaba Corneille