Lymphadenopathy Là Gì

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StatPearls . Treasure Island (FL): StatPearls Publishing; 2021 Jan-.


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Continuing Education Activity

Lymphadenopathy is a common abnormal finding during the course of the physical exam in general medical practice. Adenopathy can be caused by neoplasm, inflammatory conditions, or infection. This activity details the algorithmic analysis of lymphadenopathy and highlights the role of the interprofessional team in evaluating patients with adenopathy.

Objectives:
Identify interprofessional team strategies khổng lồ improve sầu care coordination and outcomes for patients with adenopathy.

Introduction

Lymphadenopathy is a comtháng abnormal finding during the course of 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 the majority of lymphadenopathy, both localized and generalized, is of benign, self-limited etiology. A clear understanding of lymph node function, location, description, và the etiologies of their enlargement is important in the clinical decisions of which cases need rapid and aggressive sầu workup và which need only be observed.<1><2><3>

The lymph node functions as an antiren filter for the reticuloendothelial (RE) system of the body toàn thân. It consists of a multi-layered sinus that sequentially exposes B-cell lymphocytes, T-cell lymphocytes, và macrophages lớn an afferent extracellular fluid. In this way, the immune system can recognize và react to lớn foreign proteins & mount an immune response or sequester these proteins as appropriate. In the course of this reaction, there is some multiplication of the responding immune cell line, and thus, the node itself increases in kích cỡ. It is generally held that a node kích cỡ is considered enlarged when it is larger than 1 centimet. However, the reality is that "normal" & "enlarged" criteria vary depending on the location of the node and the age of the patient. For example, children younger than 10 years of age have sầu more hypertrophic immune systems, and nodes up to lớn 2 cm can be considered normal in some clinical situations yet, an epitrochlear node of above 0.5 cm is considered pathological in an adult.

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The pattern, distribution, & 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, & their enlargement reflects the lymphatic drainage of their location. The nodes themselves may be tender or non-tender, fixed or mobile, và discreet or "matted" together. Concomitant symptomatology & the epidemiology of the patient & the illness provide further diagnostic cues. A thorough history of any prodromal illness, fever, chills, night sweats, weight loss, và localizing symptoms can be very revealing. Additionally, the demographic particulars of the patient, including age, gender, exposure to lớn infectious disease, toxins, medications, và 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 và physical is determined by the clinical presentation of the patient. For example, a patient with posterior cervical adenopathy, sore throat, & tremendous fatigue need only a careful history, cursory examination, & a mono thử nghiệm, while a person with generalized lymphadenopathy and fatigue would require a much 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 và neck region (again, some site a 3:1 ratio). It also is accepted that all generalized lymphadenopathy merits clinical evaluation, và the presence of "matted lymphadenopathy" is strongly indicative sầu of significant pathology.Examination of the patient"s history, physical examination, và the demographic in which they fall can allow the patient khổng lồ be placed into 1 of several different accepted algorithms for workup of lymphadenopathy. The use of these cues và selection of the correct arm of the algorithm allows for a fairly rapid & cost-effective sầu diagnosis of lymphadenopathy, including determination when it is safe khổng lồ observe sầu.<4><5><6>

Algorithmic Analysis of Lymphadenopathy

After a history and physical examination are completed, lymphadenopathy is placed inkhổng lồ 3 categories: 


"Diagnostic" such as strep pharyngitis or upper respiratory tract disease, in which case the course of action is to treat the condition
"Suggestive" such as mononucleosis lymphoma or HIV wherein the history & physical strongly suggestive sầu diagnosis specific testing is performed và if positive the action is khổng lồ treat the condition
"Unexplained" where the lymphadenopathy is divided inkhổng lồ generalized lymphadenopathy và localized lymphadenopathy
For unexplained localized lymphadenopathy, a Đánh Giá of history, a regional exam, and epidemiological clues are used khổng lồ separate patients inlớn 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 of action is khổng lồ observe sầu the patient for 3 lớn 4 weeks to lớn see if the lymphadenopathy resolves or improves. In which case, the clinician is safely cleared khổng lồ follow the patient. If the lymphadenopathy does not resolve or improve sầu, the next step is to obtain a biopsy. If the patient is judged to lớn have sầu a risk for malignancy or serious illness, the procedure is to proceed immediately lớn biopsy.

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For unexplained generalized lymphadenopathy, the key lớn diagnosis is a history lớn evaluate for suspected causes. The initial tìm kiếm would be questioning for a mononucleosis-type syndrome such as evidenced by fever atypical lymphocytosis và malaise included in these differentials would be Epstein-Barr vi khuẩn, cytomegalovi khuẩn, toxoplasmosis, & (especially in the case of a flu-like illness & her rash) the initial stages of an HIV infection. The second step in the evaluation of 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 lớn obtain a complete blood count (CBC) with a manual differential & EBV serology. If non-diagnostic, the next steps would be PPD placement, Rlăng xê, chest x-ray, ANA, hepatitis B surface antigen, and HIV demo. Again if any of the above sầu are positive, appropriate treatment can be initiated. In the presence of negative serological examinations and radiological examinations, & 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 & thus not reported or taken inlớn account. This results in a statistical bias, or skew, toward the reportable causes of lymphadenopathy:  malignancies, HIV, tuberculosis, & 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 & chronic lymphocytic leukemia (CLL) in adults. It has been reported the general prevalence of malignancy is 0.4% in patients under 40 years & 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 khổng lồ near 20% in referral centers and rises lớn 1/2 or more in patients with initial risk factors.