Lymphadenopathy

Iatrogneic Causes Allopurinol, phenytoin, primidone, INH, anti-thyroid agents, pheylbutazone, hydralazine.

History:

• • Location

  • Mode of onset

    • Sudden

    • Gradual

  • Character

    • Tender, painful

    • Painless, non-tender

    • Growth rapidity

  • Precipitating cause or aggravating factors: Tonsillitis, sinusitis, pharyngitis, dental infections (30% of all inflammatory causes of neck masses), infectious mononucleosis.

  • Associated features:

    • Skin rash.

    • Fever, chills, malaise, fatigue, night sweats, weight loss, anorexia.

    • Sore throat, nasal congestion, rhinorrhea, otalgia, cough, wheezing, dyspnea, hoarseness.

    • Dysphagia, diarrhea.

    • Easy bruising, bleeding

    • Pain in enlarged lymph nodes following alcohol ingestion: Hodgkin's disease

    • Draining fistula from neck

  • Iatrogenic: See causes above

  • Social history:

    • Age of patient

    • Pets - cats, rabbits

    • Occupation

    • Travel

    • IVDA

    • STIs

    • Sexual activity and preferences

Physical Exam:

• • Tender, assymetrically enlarged, soft, warm, erythematous nodes (matted together): local infectious process.

  • Firm, rubbery, nontender mobile nodes: lymphoma

  • Hard, painless, fixed to underlying tissue: metastatic carcinomatous nodes

  • Sinus tract in the neck: TB, aspergillosis, actinomycosis

  • Location:

    • Occipital: infection of the scalp, malignancy unlikely. Lymphoma possible

    • Postauricular: Rubella, lymphoma

    • Preauricular: Infection of eyelid, conjunctivae, scalp, or lymphoma.

    • Anterior cervical: Infection of oral cavity and phaynx

    • Unilateral cervical or submandibular: TB, catscratch, oral inf, dental inf, paotitis, otitis externa, soft tissue inf of face, pharyngitis, metastatic, Hodgkin's, histiocytic, or lymphocytic lymphoma.

    • Left supraclavicular: Virchow's node: metastatic tumor usually from occult abdominal neoplasm.

    • Deep cervical or submandibular: Lymphoma, head and neck malignancy, partoid gland tumor or infection.

    • Bilateral cervical: TB, coccidioidomycosis, infectious mononucleosis, toxoplasmosis, sarcoidosis, pharyngitis, lymphoma, leukemia.

    • Unilateral axillary: Breast cancer, lymphomas, upper extremity inf, cat-scratch disease, sporotrichosis, tularemia, brucellosis.

    • Epitrochlear: Sarcoidosis, tularemia, secondary syphilis, hand inf

    • Inguinal: LGV, syphilis, lower extremity inf, lymphoma, cellulitis.

    • Generalized; malignancy, CLL, Hodgkin's lymphoma, non-Hodgkin's lymphoma, HIV, EBV, CMV, histoplasmosis, toxoplasmosis

  • Nasopharyngeal exam: primary tumor with cervical metastases.

  • Dental caries

  • Pharyngitis

  • Fever: infection, neoplasm

  • Skin rash: viral inf

  • Ecchymoses; petechiae: Bleeding tendency, leukemia, lymphoma

  • Sternal tenderness: Leukemia

  • Hepatomegaly: Malignancy, hepatitis

  • Splenomegaly: Infectious mononucleosis, sarcoidosis, leukemias, lymphomas, Hodgkin's lymphoma.

  • Swelling of the neck, face, or arms (SVC syndrome): Compression of SVC or sublcavian vein by hilar or mediastinal lymph node enlargement.

Lab Tests:

CBC, HIV, EBV, CMV, toxo, RPR, VDRL, CXR, PPD, Bx, CT.