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LYMPHADENOPATHY & SPLENOMEGALY

LYMPHADENOPATHY & SPLENOMEGALY. Martin H. Ellis MD Meir Hospital. CLINICAL ANATOMY OF THE LYMPH NODES. Head & Neck – occipital, postauricular, preauricular, anterior cervical chain, posterior cervical chain, submandibular, submental, Waldeyer ’ s ring Clavicular – supra and infra

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LYMPHADENOPATHY & SPLENOMEGALY

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  1. LYMPHADENOPATHY &SPLENOMEGALY Martin H. Ellis MD Meir Hospital

  2. CLINICAL ANATOMY OF THE LYMPH NODES • Head & Neck –occipital, postauricular, preauricular, anterior cervical chain, posterior cervical chain, submandibular, submental, Waldeyer’s ring • Clavicular – supra and infra • Axillary –lateral, medial, posterior, apical • Epitrochlear • Inguinal • Femoral

  3. Femoral Femoral Femoral

  4. RADIOLOGICAL ANATOMY OF LYMPH NODES • Mediastinal • Perihilar • Retroperitoneal • Mesenteric • Iliac

  5. Hilar adenopathy (sarcoidosis) Mediastinal adenopathy (lymphoma, sarcoma, teratoma)

  6. DIAGNOSIS • History & Physical diagnosis • Laboratory testing • CT scanning • MRI • Isotope scanning • PET-CT scanning • Histologic diagnosis

  7. APPROACH TO DIAGNOSIS • Localized vs. generalized (including splenomegaly) • History • Physical exam • Special investigations

  8. CHARACTERISTICS OF ENLARGED NODES • Size • < 1cm=normal • Pain/Tenderness • inflammation/rapid growth • Consistency • stony, rubbery, firm, soft, fluctuant • Matting • a group of nodes that seem joined • Mobility • Location

  9. DIFFERENTIAL DIAGNOSIS • Congenital • Acquired • Infectious –bacterial,viral,fungal,parasitic,mycobacterial • Inflammatory –autoimmune, allergic, vasculitic • Neoplastic –benign, malignant (primary,secondary) • Toxic & Metabolic –storage diseases, hyperthyroidism • Drug– hydantoin, gold • Traumatic • Idiopathic –sarcoidosis, Castleman disease • Iatrogenic –silicone implants

  10. SITE-DISEASE ASSOCIATIONS • Occipital – rubella • Supraclavicular – TB (scrofula), lung ca, gastric ca (Virchow node- Trousseau sign) • Axillary – breast ca • Inguinal – STDs • Umbilical – ovarian ca (Sister Joseph’s node)

  11. Hx/ PE DIAGNOSTIC eg local infection,tumor UNEXPLAINED SUGGESTIVE eg mono,HIV,lymphoma SPECIFIC TESTING POSITIVE TREAT CONDITION GENERALIZED LOCALIZED Review epidemiology Review medications POSITIVE No serious illness apparent Serious illness apparent DIAGNOSTIC MONONUCLEOSIS SEROLOGY PPD,HIV,HBV,CXR Observe 3-4 weeks POSITIVE Biopsy NEGATIVE Resolved Biopsy BIOPSYABNORMALNODE

  12. SPLENOMEGALY: DIAGNOSIS • History & Physical diagnosis • Laboratory testing • CT scanning • MRI • Isotope scanning • PET-CT scanning • Histologic diagnosis

  13. DIFFERENTIAL DIAGNOSIS • Congenital • Acquired • Infectious –bacterial,viral,fungal,parasitic,mycobacterial • Inflammatory –autoimmune (SLE, Felty syndrome) • Neoplastic –benign, malignant (primary,secondary) • Toxic & Metabolic - (storage diseases eg Gaucher) • Congestive splenomegaly –portal hypertension • “Work” hyperplasia- chronic hemolytic anemias

  14. MASSIVE SPLENOMEGALY • Tumors • Lymphoma, myeloproliferative disorders, Hairy cell leukemia • Infections • Kala-azar (trypanosomiasis) • Portal hypertension • Gaucher disease

  15. Approach to diagnosis-splenomegaly • Known illnesses • eg lymphoma, SLE • Current clinical context • Fever, recent travel, murmers • Imaging studies • Size, focal lesions • Histologic diagnosis • Splenectomy, ?splenic biopsy

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