Enlarged lymph nodes (generally larger than 1 cm).  for inguinal, its larger than  1.5 cm.  for epitrochlear (located above the elbow cease on the medial side), its larger than .5 cm.

How do lymph nodes get enlarged? 

3 main ways:
1) reactive hyperplasia (cells in the lymph node react to an antigen / inflammation)
2) cells in the lymph node transform
3) malignant cells invade the lymph node

History:

  • 2 main types of lymphadenopathy:  regional and generalized
  • if regional: ask about regional symptoms (ex: cervical –> any pharyngeal symptoms, dental problems, hoarseness?)
  • if generalized:  could be a number of things (infection, immunologic, metabolic, malignant); is often associated with splenomegaly
  • fever, weight loss –> cancer, systemic infection, connective tissue disease
  • rashes, arthralgias, pharyngeal symptoms, pet exposure –> connective tissue disease, viral illness, cat scratch fever
  • contact with sheep –> brucellosis
  • location –> coccidioidomycosis (west texas, desert west), histoplasmosis (mississippi river valley)
  • animal bites –> Franciesella tularensis (rabbits), Pasteurella (domestic pet bites).

Physical Exam:

  • malignant:  hard, fixed, nontender, greater than 3 cm
  • infectious: warm, erythematous, fluctuant
  • reactive: discrete, rubbery, mobile
  • red streaks from an inflammed node –> lyphangitis and lymphadenitis

Diagnosing:

  • most are self-limited / benign
  • can do monospot or strep screen to start, CBC, serology
  • if supraclavicular –> can be serious and may need to do a biopsy
  • supraclavicular or pulmonary symptoms –> chest xray
  • various titers: EBV, toxoplasomosis, CMV,
  • other serologic tests:  HIV antibodies, ANA, rheumatoid factor
  • inguinal:  can do urethral or cervical cultures
  • unusual cases (bites):  blood cultures
  • US, CT, MRI can be done later on to delineate involved area
  • anemia, thrombocytopenia, malignant cells on peripheral smear –> bone marrow examination

 Treatment:

  • Cat scratch:  TMP/SMX
  • Atypical mycobacteria: surgical excision + antituberculosis meds (Isoniazid, Rifampin, ethambutol)
  • Lymphadenitis: treat with antibiotics that take care of strep and staph (Cephalosporin, Erythromycin, Dicloxacillin)
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