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Julian Thomas
Julian Thomas


Your outlook will vary depending on the cause of your swollen nodes. If your adenopathy is the result of a minor infection, your lymph nodes will go back to normal soon after the infection clears. If your adenopathy is caused by a more serious condition, your doctor will work with you on a treatment plan.


When you think of swollen glands, you may be thinking of swollen lymph nodes on one or both sides of your neck. But you can develop painful swollen lymph nodes in your armpits too. The medical terms for swollen lymph nodes in your armpits are axillary adenopathy or axillary lymphadenopathy. You may be able to move them slightly with your fingers. You may have swollen lymph nodes under your jaw and in your groin too.

Cancer cells in the lymph may not spread as fast as cancer cells distributed through the bloodstream. If cancer cells get into the lymph, nearby lymph nodes often get affected first, and secondary tumors and adenopathy may follow.

Adenopathy can vary from person to person. If adenopathy is caused by a minor infection, it will go away as soon as the infection has cleared up. More serious conditions may require a specialized treatment plan.

That said, you cannot diagnose the cause of adenopathy by physical characteristics alone. In some cases, a cancerous node may press on a nearby nerve and cause pain. In others, a benign node may be hard and relatively painless (such as those that can happen with persistent generalized lymphadenopathy seen in HIV).

Lymphadenopathy is a common abnormal finding during the physical exam in general medical practice. Patients and physicians have varying degrees of associated anxiety with the finding of lymphadenopathy as a small number of cases can be caused by neoplasm or infections of consequence, for example, HIV or tuberculosis (TB). However, it is generally recognized that most lymphadenopathy, both localized and generalized, is of benign, self-limited etiology. A clear understanding of lymph node function, location, description, and the etiologies of their enlargement is important in the clinical decisions of which cases need rapid and aggressive workup and which need only be observed.

The pattern, distribution, and quality of the lymphadenopathy can provide much clinical information in the diagnostic process. Lymphadenopathy occurs in 2 patterns: generalized and localized. Generalized lymphadenopathy entails lymphadenopathy in 2 or more non-contiguous locations. Localized adenopathy occurs in contiguous groupings of lymph nodes. Lymph nodes are distributed in discrete anatomical areas, and their enlargement reflects the lymphatic drainage of their location. The nodes themselves may be tender or non-tender, fixed or mobile, discreet or "matted" together. Concomitant symptomatology and the epidemiology of the patient and the illness provide further diagnostic cues. A thorough history of any prodromal illness, fever, chills, night sweats, weight loss, and localizing symptoms can be very revealing. Additionally, the demographic particulars of the patient, including age, gender, exposure to infectious disease, toxins, medications, and their habits, may provide further cues.

As evidenced above, the critical step in evaluation for adenopathy is a careful history and focused physical exam. The extent of the history and physical is determined by the clinical presentation of the patient. For example, a patient with posterior cervical adenopathy, sore throat, and tremendous fatigue need only a careful history, cursory examination, and a mono test. In contrast, a person with generalized lymphadenopathy and fatigue would require more extensive investigation. Generally, the majority of the lymphadenopathy is localized (some site a 3:1 ratio), with the majority of that being represented in the head and neck region (again, some site a 3:1 ratio). It also is accepted that all generalized lymphadenopathy merits clinical evaluation, and the presence of "matted lymphadenopathy" is strongly indicative of significant pathology.Examination of the patient's history, physical examination, and the demographic in which they fall can allow the patient to be placed into 1 of several different accepted algorithms for workup of lymphadenopathy. The use of these cues and selection of the correct arm of the algorithm allows for a fairly rapid and cost-effective diagnosis of lymphadenopathy, including determination when it is safe to observe.

For unexplained localized lymphadenopathy, a review of history, a regional exam, and epidemiological clues are used to separate patients into lower (no risk of malignancy or serious disease) versus higher risk for serious disease or malignancy categories. If the patient is at no risk for malignancy or serious illness, the reasonable course is to observe the patient for 3 to 4 weeks to see if the lymphadenopathy resolves or improves. In which case, the clinician is safely cleared to follow the patient. If the lymphadenopathy does not resolve or improve, the next step is to obtain a biopsy. If the patient is judged to have a risk for malignancy or serious illness, the procedure is to proceed immediately to biopsy.

For unexplained generalized lymphadenopathy, the key to diagnosis is a history to evaluate for suspected causes. The initial search would be questioning for a mononucleosis-type syndrome evidenced by fever atypical lymphocytosis and malaise included in these differentials would be Epstein-Barr virus, cytomegalovirus, toxoplasmosis, and (especially in the case of a flu-like illness and her rash) the initial stages of an HIV infection. The second step in evaluating unexplained generalized lymphadenopathy involves a careful review of epidemiological cues. Included in the epidemiological cues would be:

Although there is no "cookbook" for the laboratory evaluation of generalized unexplained lymphadenopathy, the initial steps are to obtain a complete blood count (CBC) with a manual differential and EBV serology. If non-diagnostic, the next steps would be PPD placement, RPR, chest x-ray, ANA, hepatitis B surface antigen, and HIV test. Again if any of the above are positive, appropriate treatment can be initiated. In the presence of negative serological examinations and radiological examinations, and or significant symptomology, a biopsy of the abnormal node is the gold standard for diagnosis.Statistics concerning lymphadenopathy are not accurate as the great majority of lymphadenopathy is caused by a non-reportable illness and thus not reported or taken into account. This results in a statistical bias, or skew, toward the reportable causes of lymphadenopathy: malignancies, HIV, tuberculosis, and sexually transmitted infections (STIs). Citations in the recent literature for general medical practice indicate that less than 1% of people with lymphadenopathy have malignant disease most often due to leukemia and younger children Hodgkin disease in adolescence non-Hodgkin disease and chronic lymphocytic leukemia (CLL) in adults. It has been reported the general prevalence of malignancy is 0.4% in patients under 40 years and around 4% in those older than 40 years of age seen in a primary care setting. It is reported that the prevalence rate of neoplastic disease rises to near 20% in referral centers and rises to 50% or more in patients with initial risk factors.

Conclusions: In suspected nonsmall cell lung cancer, endobronchial ultrasound may be preferred in the histologic sampling of paratracheal and subcarinal mediastinal adenopathy because the diagnostic yield can surpass mediastinoscopy. 041b061a72


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