Lymphadenopathy is a noticeable enlargement of lymph nodes ? 1. The diagnosis is made clinically. treating the causative disease.
Lymph nodes are found throughout the body, but in particular there are accumulations in the neck, in the armpits and in the groin; a few small (<1 cm) nodes in these areas in healthy people often palpable (overview of the lymphatic system).
Lymphadenopathy is a noticeable enlargement of lymph nodes ? 1. The diagnosis is made clinically. treating the causative disease. Lymph nodes are found throughout the body, but in particular there are accumulations in the neck, in the armpits and in the groin; a few small (<1 cm) nodes in these areas in healthy people often palpable (overview of the lymphatic system). Lymphadenopathy is the significant expansion (> 1 cm) of ? 1 lymph nodes; it is categorized as a Localized: If Generalized only in a body portion, if in ? 2 body regions lymphadenopathy with pain and / or signs of inflammation (e.g. redness, tenderness.) Other symptoms may be present, depending on the underlying disorder. Pathophysiology Some plasmas and cells (eg., Cancer cells, infectious microorganisms) in the interstitial space penetrate together with certain cellular material, antigens and foreign bodies in lymphatic vessels and will lymph fluid. filter the lymph nodes, lymph fluid on their way to the central venous circulation and remove cells and other material. Through the filtering process also antigens to the information contained in the node lymphocytes enter. The immune response of these lymphocytes includes cellular proliferation, by which the nodes can enlarge (reactive lymphadenopathy). Pathogenic microorganisms, which are carried in the lymph fluid, the nodes can directly infect, thus lymphadenitis formed. It can settle cancer cells in the nodes and reproduce well. Etiology Since lymph nodes are involved in the body’s immune response, a large number of infectious and inflammatory diseases and cancers cause of lymphadenopathy (see table: Some causes of lymphadenopathy). Only the most common causes are discussed here. The causes are likely to vary depending on the age of the patient, so that composites findings and risk factors, but overall, the most common causes are idiopathic, self-limited infection of the upper respiratory tract (URI) Local soft tissue infections, the most dangerous causes are cancer HIV infection TB However, most cases are made due benign diseases or clinically apparent local infections. Probably there is a cancer in <1% of undifferentiated cases in primary care. Some causes of lymphadenopathy cause Indicative findings Diagnostic procedure infections URI Cervical adenopathy with little or no sensitivity sore throat, runny nose, cough Clinical evaluation Oropharyngeal infection (z. B. pharyngitis, stomatitis, dental abscess) Only cervical lymphadenopathy (often sensitive) Clinically obvious oropharyngeal infection Klinis che Rating mononucleosis Symmetrical adenopathy, typically cervical but sometimes in the armpits and / or the groins fever, sore throat, severe fatigue often splenomegaly Typically, in adolescence or young adulthood Test (heterophile antibody Sometimes serological test for the Epstein-Barr virus TB extrapulmonary -Lymphknotentuberkulose) Typically, cervical or supraklävikuläre adenopathy, sometimes ignites or emptying often in patients with HIV infection tuberculin skin test or interferon-gamma release assays Usually aspiration or biopsy of the node HIV (primary infection) generalized lymphadenopathy Usually fever, malaise, rash, arthralgia often a history of exposure to HIV, or risky behavior HIV antibody test Sometimes HIV-RNA test (if an early primary infection is suspected) Sexually transmitted diseases (STD particular herpes simplex, chlamydial infections and syphilis) inguinal adenopathy, except for the secondary syphilis (fluctuating or draining nodal point to lymphogranuloma venereum out) often urinary symptoms, discharge of the urethra or cervix Sometimes genital lesions in secondary syphilis often widespread mucocutaneous lesions, generalized lymphadenopathy For herpes simplex cultures for chlamydia infections nucleic acid-based tests for syphilis serologic testing skin and soft tissue infections (eg. B. cellulitis, abscesses, cat scratch disease), including direct lymph nodes infection Normally, a visible local lesion (or recent history of a lesion) distal to the site of adenopathy Sometimes only redness, sensitivity of an isolated node (often cervical) no apparent primary point of entry Usually clinical evaluation for cat scratch disease, toxoplasmosis serum antibody titers Bilateral, non-sensitive cervical or axillary adenopathy Sometimes flu-like syndrome, hepatosplenomegaly often a history of exposure to cat feces Serological tests Other infections (eg. as, brucellosis, Zyt omegalie, histoplasmosis, paracoccidioidomycosis, plague, rat-bite fever, tularemia) often varies risk factors (eg. As geographical location, exposure) Varies cancers Leukämi (chronic usually, sometimes acute lymphoblastic leukemia) fatigue, fever, weight loss, splenomegaly In acute leukemia often easy bruising and / or bleeding blood count, peripheral smear, flow cytometry, bone marrow examination lymphoma Painless adenopathy (local or generalized), often rubbery, sometimes matted often fever, night sweats, weight loss, splenomegaly, lymph node biopsy or flow cytometry Metastatic cancers (often on the head and neck, thyroid, breast or lung) one or more non-painful local node node are firmly often, sometimes fixed to adjacent tissue Usually assessment to identify the primary tumor connective tissue disease Systemic lupus erythematosus (SLE) generalized lymphadenopathy Typically arthritis or Sometimes joint pain rash cheekbone, other skin lesions Clinical criteria antibody test Sarcoidosis Painless adenopathy (local or generalized) Often cough and / or shortness of breath, fever, malaise, muscle weakness, weight loss, joint pain Chest radiographs (X-ray or CT) If the results of the imaging are positive, lymph node biopsy Kawasaki Syndrome A pressure-sensitive cervical lymphadenopathy in children fever (usually> 39 ° C), rash on the torso, strawberry tongue, periungual, palmar and plantar desquamation Clinical criteria other connective tissue diseases (eg. B. juvenile idiopathic arthritis, Kikuchi lymphadenopathy RA, Sjögren’s syndrome) Varies Varies Other causes medications such as allopurinol, antibiotics (eg. As cephalosporins, penicillin, sulfonamides), atenolol, captopril, carbamazepine, phenytoin, pyrimethamine, and quinidine use of a initiating drug in the history Except phenytoin, a serum sickness-reaction (eg., skin rashes, arthritis and / or joint pain, muscle pain, fever) Clinical evaluation silicone breast implants Localized Adenopathy in patients with breast implants exclusion of other causes of adenopathy assessment A adenopathy may be the reason for the presentation of the patient or be discovered in the investigation because of other ailments. History In the history of the current disease should determine location and duration of the adenopathy, and whether it is accompanied by pain. Current cutaneous injuries (especially scratches from cats and rat bites) and infections in the area that is drained from affected nodes are noted. A review of organ systems should identify possible causes symptoms such as a runny, stuffy nose (URI); Sore throat (pharyngitis, mononucleosis); Mouth, gums or dental pain (oral-dental infection); Cough and / or dyspnea (sarcoidosis, lung cancer, tuberculosis, some fungal infections); Fever, fatigue and malaise (mononucleosis and other infections, cancer and diseases of the connective tissue); Genital lesions or discharge (herpes simplex, chlamydia, syphilis); Joint pain and / or swelling (SLE or other connective tissue diseases); light bleeding and / or bruising (leukemia) and dry, irritated eyes (Sjogren’s syndrome). The history should identify risk factors for (or known) TB or HIV infection and cancer (particularly due to alcohol and / or tobacco use). Patients are to contacts with sick people questioned (to reduce the risk of TB or viral disease such. B. Epstein-Barr virus) assess over preceded Gone sex life (to assess the risk of sexually transmitted diseases), about traveling to areas with endemic infections (eg. B. Middle East for brucellosis, American southwest for plague) and possible exposure (eg. as cat feces for toxoplasmosis, livestock for brucellosis, wild animals for tularemia) queried. The drug history is checked in relation to known triggering substances überprüft.Körperliche examination Vital signs are fever to go. Areas with a high concentration of lymph nodes in the neck (including okkzipitaler and supraclavicular areas), in the armpits and in the groin be felt. The size of the node, the sensitivity and the consistency to be detected; Also, if the nodes are freely movable or fixed on adjacent tissue. The skin is examined for skin rashes and lesions, with special attention to areas that are drained from the affected nodes. The oropharynx is inspected and scanned for signs of infection, and all potentially cancerous lesions out. The thyroid gland is sampled to detect an increase or nodules. The breasts (inclusive in men) are sampled on the node. The lungs are listened to hear a crackling sound (indicating sarcoidosis or infection). The abdomen is scanned for hepatomegaly and splenomegaly. The genitals are examined for chancre, vesicles and other lesions and for discharge from the urethra. The joints are signs of inflammation untersucht.Warnzeichen node> 2 cm nodes that drain are fixed or are fixed to underlying tissue Supraclavicular nodes risk factors for HIV or TB fever and / or weight loss splenomegaly interpretation of the results patients with generalized lymphadenopathy have in the usually a systemic disease. However, patients with localized adenopathy have a local or systemic disorder (including one that is often generalized lymphadenopathy caused). Sometimes have history and physical examination to a cause (see Table: Some causes of lymphadenopathy) and may be diagnostic in patients with a clear viral URI or local soft tissue or dental infection. In other cases, results are (like the serious findings) of concern, but do not point to a single cause. Nodes which determine significantly increased (> 2 to 2.5 cm), and / or are fixed to adjacent tissue, in particular node in the supraclavicular area, or in patients who have tobacco longer and / or consumed alcohol, are evidence of cancer. Significant tenderness, redness and heat in a single enlarged node to a node purulent infection point (eg., By staphylococci or streptococci). Fever may occur in the course of many infectious diseases, malignant diseases and connective tissue diseases. Splenomegaly may occur in the course of mononucleosis, toxoplasmosis, leukemia and lymphoma. Weight loss is associated with TB and cancer. Risk factors and a history of travel and exposure are at best suggestive. Ultimately, in patients who have no other manifestation of a disease adenopathy sometimes a serious Ursache.Tests If a particular disease is suspected (eg. As mononucleosis in a young patient with fever, sore throat and splenomegaly) has, are the first tests on these state oriented (see table: Some causes of lymphadenopathy). If the history and physical examination found no probable cause, further evaluation depends on which nodes are affected and the possible other findings. In patients with serious findings and those with generalized lymphadenopathy CBC and chest x-ray should be performed. If abnormal white blood cell count can be seen in the blood, a peripheral smear and flow cytometry are performed to test for leukemia or lymphoma. For generalized lymphadenopathy, most doctors also perform a tuberculin skin test (or interferon-gamma release assay) and serological tests for HIV, mononucleosis, and perhaps toxoplasmosis and syphilis. Patients with joint pain or rash should be subjected to an antinuclear antibody test for SLE. Most doctors believe that patients with localized lymphadenopathy and without further findings are safely observed for 3 to 4 weeks, unless it is suspected cancer. If cancer is suspected, the patient should undergo usually a lymph node biopsy (patients with a lesion on the neck require further assessment before the biopsy). A biopsy is also possible when isolated or generalized lymphadenopathy does not resolve within 3 to 4 weeks. Treatment The primary treatment is directed to the cause; the adenopathy itself is not treated. The attempt by the administration of corticosteroids is not performed at adenopathy of unknown etiology, as corticosteroids can reduce the adenopathy due to leukemia and lymphoma, and thus delay the diagnosis; Also corticosteroids TB can worsen. The administration of antibiotics is not indicated unless a purulent lymph node infection is suspected. Summary Most cases are idiopathic and self-limited, or as a result of clinically manifest local causes Initial tests should be performed when serious findings are present when other manifestations or risk factors point to a specific disease or if a generalized lymphadenopathy has no apparent cause , Patients with acute localized lymphadenopathy and without other findings can be observed for 3 to 4 weeks, after a time should be taken into consideration biopsy.