Lymphadenopathy

Published on 23/05/2015 by admin

Last modified 22/04/2025

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Lymphadenopathy

Lymphadenopathy is a common presenting condition. It may be localised or generalised. The causes are multiple but a careful history and clinical examination will often simplify the diagnosis. Lymphadenopathy, especially cervical, is extremely common in children who are otherwise healthy. Painful tender nodes are usually associated with infection. Firm or hard, painless nodes are commonly the seat of malignancy. Only the commoner causes, which the student would be expected to know, are described in this section.

Causes

Primary Infection

Viral

• Infectious mononucleosis

• HIV

• CMV

• Rubella

• Measles

Bacterial

• TB • (common in parts of the world where TB is endemic)

• Syphilis

• Brucellosis

• Cat scratch disease

• Septicaemia

Protozoal

• Toxoplasmosis

Parasitic

• Filariasis • (common in tropical regions of Asia, Africa)

Secondary Infection

• e.g. tonsillitis with cervical lymphadenitis, abscess with regional lymphadenitis

Primary Malignancy

• Acute lymphoblastic leukaemia

• Chronic lymphatic leukaemia

• Hodgkin’s disease

• Non-Hodgkin’s lymphoma

• Myeloproliferative disorders

Secondary Malignancy

• Metastases from local malignancy

• Metastases from distant malignancy

Others

• Sarcoidosis

• SLE

• Rheumatoid arthritis

History

Infection

Local infections will be usually obvious, e.g. dental abscess with cervical lymphadenopathy. With generalised lymphadenopathy, there may be a history of malaise, lethargy and fever. Check for exposure to TB, which may be a cause of lymphadenopathy in the immunocompromised patient. Check for visits abroad. Check if there are animals in the household, e.g. cats (cat scratch fever) or dogs (toxoplasmosis). In the case of cat scratch fever, the scratches are often healed before the patient presents. Note any history of local trauma.

Primary malignancy

There will normally be a history of malaise, fever or night sweats. The patient may have noticed lumps at several sites. Spontaneous bruising and bleeding associated with thrombocytopenia may also be present.

Secondary malignancy

The primary may be obvious or may be very small and have not been noticed by the patient (e.g. a malignant melanoma in an inaccessible site). There may be a history of malignancy that has been treated several years previously with metastases presenting late (e.g. axillary lymphadenopathy or cervical lymphadenopathy occurring several years after an apparently curative operation for carcinoma of the breast). Occasionally the lymph node swelling is distant from the primary, e.g. cervical lymphadenopathy (left supraclavicular fossa) from testicular cancer; Virchow’s node in gastric cancer.

Other conditions

Sarcoidosis causes bilateral hilar lymphadenopathy but may present with lymphadenopathy at other sites. Check for a history of SLE or rheumatoid arthritis.