Evaluation Of Peripheral Lymphadenopathy In Adults

Evaluation Of Peripheral Lymphadenopathy In Adults

Question. Write a short note on the approach to investigate a case of Lymphadenopathy.
Or
How will you investigate a case of Lymphadenopathy?
Or
Write short answer on Lymphadenopathy.

Answer. History

• Age: Tuberculous lymphadenitis in childhood, secondary carcinoma in old age.
• Occupation: Tularemia in hunters and butchers; sporotrichosis in farmers and gardeners.
• Duration
• Acute swelling of a few days duration mostly pyogenic.
• Subacute lymphadenitis of 3–4 weeks duration may be due to streptococcal infection, tuberculosis, secondary syphilis, infectious mononucleosis or tularemia.
• Chronic lymphadenopathies include tuberculosis,lymphomas, leukemia, primary lymphatic tumours and secondary carcinoma. History of previous radiation treatment or operative removal.

Evaluation of Peripheral Lymphadenopathy in Adults

Lymphadenopathy Physical examination

local
1. Number ofglands: Single gland may appear to be affcted for some time in tuberculosis, Hodgkin’s and secondary carcinoma. Multiple in tuberculosis, Hodgkin’s disease, leukemia.

2. Site:

• Neck usual site for tuberculous lymphadenitis, lymphosarcoma, and most other lymphadenopathies.
• Inguinal gland enlargements may be due to syphilis, lymphogranuloma inguinale or chancroid.
• The infraclavicular glands are seldom so enlarged as to be palpable except in secondary cancer or Hodgkin’s disease.
• Supratrochlear (epitrochlear) lymphadenopathy in non­
• Hodgkin’s lymphoma, chronic lymphocytic leukemia, infectious mononucleosis, secondary
  syphilis, sarcoidosis, IV drug abuse.
• Hilar and superior mediastinal lymphadenopathy in tuberculosis, histoplasmosis, sarcoidosis,pneumoconiosis, malignancy and cryptococcosis.

Causes of Peripheral Lymphadenopathy in Adults

3. Character: Discrete in Hodgkin’s disease and leukemia,primary tumors of lymphatic tissue and so called “lymphadenoid” form of tuberculous lymphadenitis.
Moveable, discrete and painless in sarcoidosis. Mattd together in tuberculosis and lymphogranuloma.

4. Cold abscess: In tuberculosis, lymphogranuloma, tularemia and sporotrichosis. Tuberculous glands may break through to give a typically indolent ulcer with undermined edges.

5. Primary cause: In the area drained by the enlarged glands; e.g. scalp if occipital or posterior auricular glands, fauces and pharynx in upper anterior cervical group, etc. Healed scar at portal of entry, scar of operative removal, or of radiation treatment.

Lymphadenopathy Systemic

1. Skin:

• Cutaneous tumors mostly on the face, usually in chronic lymphatic leukemia. Sometimes generalized erythroderma, polymorphic rashes and purpura.
• Rash of secondary syphilis.
• Painless papules without surrounding erythema may be found on face, arms and legs in sarcoidosis.
• Eruption of lupus erythematosus.

2. Lungs: Pulmonary or mediastinal tuberculosis, lesions of sarcoidosis or metastatic or primary deposits in carcinoma.

3. Abdomen: Abdominal glands may be palpable in tuberculosis. Enlargement of spleen and liver in leukemia and Hodgkin’s disease.

4. Genitalia: Scar of primary sore of syphilis, or “chancre” in lymphogranuloma.

5. Icterus: Jaundice with lymphadenopathy may be met with in viral hepatitis (cervical glands), lymphoma, acute lymphocytic leukemia, disseminated TB.

6. (f) Temperature: Raised in Hodgkin’s disease, infectious mononucleosis and tularemia.

Diagnosis of Peripheral Lymphadenopathy in Adults

Lymphadenopathy Investigations

• Blood picture: For diagnosis of leukemia and infectious mononucleosis. Positive ANA and reduced complement C4 levels in SLE.
• Special tests: Serologic tests for syphilis. Paul­Bunnell or monospot test for infectious mononucleosis,Agglutination reaction and animal inoculation in tularemia. Autoantibodies in SLE.
• Liver biopsy useful in sarcoidosis and infectious mononucleosis. Serological tests for HIV infection.
• Radiography of lungs and gastrointestinal tract. Skeletal changes in Boeck’s sarcoid and sporotrichosis (multiple small areas of decalcifiation).
• Biopsy: Needle aspiration biopsy is useful for initial evaluationofsuperfiiallymphadenopathy. Itis howevernot helpful in diagnosis of lymphomas and other hematologic malignancies. Lymph­node biopsy tissue should be processed for culture of appropriate organisms, frozen in
  liquid nitrogen for lymphocyte typing or special studies for malignant cell types, and for routine histological studies.
• CT scan of abdomen in lymphoma.
• Lymphangiography of value in diagnosing site, extent,and, in certain cases, even the nature of primary lymph node enlargement.