With patients who have high-risk sexual behavior, clinicians should think about chancroid, HIV, lymphogranuloma venereum, and syphilis. For example, symptoms such as fever, night sweats, weight loss or node located in the supraclavicular, popliteal, or iliac region, bruising, splenomegaly should clue a clinician into diagnoses such as leukemia, lymphoma, solid tumor metastasis. In most cases, the history and the physical examination alone can identify the cause of lymphadenopathy. Red flag symptoms for lymphadenopathy include arthralgias, muscle weakness, rash, fever, chills, fatigue, and malaise.ĭifferential diagnosis for lymphadenopathy can be remembered with the MIAMI mnemonic : Generalized lymphadenopathy can also occur with leukemias, lymphomas, and advanced metastatic carcinomas. Concerning etiologies to generalized lymphadenopathy include acute HIV infection, activated mycobacterial infection, cryptococcus, cytomegalovirus, Kaposi sarcoma, and systemic lupus erythematosus. Risk factors for malignancy include age older than 40 years, male sex, white race, supraclavicular location of the nodes, and presence of systemic symptoms such as fever, night sweats, and unexplained weight loss. Benign causes include self-limited viral illnesses, such as infectious mononucleosis or medications. There are benign and malignant causes that could cause generalized lymphadenopathy. Generalized lymphadenopathy, defined as two or more involved regions, often indicates underlying systemic disease. Localized refers to a specific lymph node region. We can also classify lymphadenopathy as localized or generalized. ■ Tuberculous, atypical mycobacteria, toxoplasmosis, syphilis ■ Example: tularemia, yersinia, cat-scratch, lymphogranuloma Granulomatous versus non-granulomatous Įxamples of granulomatous lymph nodes include the below subcategories Looking back at the ultrasound that was performed on our patient, there are various lymph nodes that were abnormal based solely on size (highlighted below). Retroperitoneal lymph nodes> 10 mm are abnormal Retrocrural lymph nodes> 6 mm are abnormal Lymph nodes greater than 1 cm are abnormal (although sizing varies based on anatomic location)Īny palpable supraclavicular, popliteal, and iliac nodes are considered abnormalĪbdominal lymph nodes >10 mm are abnormal Subacute lymphadenopathy: lasts for 4-6 weeks Below are a few important categories that you can use:ĭuration: How long has it been present? Īcute lymphadenopathy: lasts up to two weeks There are many ways to further classify lymph nodes. They are connected to each other by lymphatic vessels. There are hundreds of lymph nodes throughout the body. Lymph nodes contain lymphocytes that help the body fight infection and disease. A lymph nodes’ role is to filter substances that travel through the lymphatic fluid. It is an important part of the body’s immune system. No other pertinent findings.Ī lymph node is a small bean-shaped structure. His physical exam is notable for a 3-4 cm by 2 cm left inguinal node that is slightly firm, nontender, and mobile. This patient was sent to the emergency department for immediate evaluation of the results. No fevers, no chills, no nausea, no vomiting, no recent travel history. The patient denied any associated symptoms. The patient was sent for an outpatient ultrasound to further evaluate this lymph node.ģ.7 x 1.1 x 3.1 cm anterior mesenteric node at the level the umbilicusġ.7 x 0.5 x 0.8 cm right lower quadrant lymph nodeģ.4 x 1.5 x 1.9 cm left internal iliac nodeĢ.4 x 1.6 x 2.4 cm left internal iliac node” His PCP felt a large left inguinal lymph node. The patient had a primary care appointment several days prior. As such, to be a successful emergency room practitioner, it is vital to have a defined approach and know when to tune into high risk features.Ī 12-year-old boy with no significant medical history presented to the emergency department due to an abnormal lymph node. The differential is broad and the etiology ranges from benign to life threatening, and is most commonly benign. The goal of this post is to give you a systematic approach to a pediatric patient with lymphadenopathy.
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