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2. EVALUATION OF LYMPHADENOPATHY
Nearly 600
lymphnodes

3. Normally palpable
Sub mandibular
Axillary
inguinal

4. Pathophysiology
React to threat
Hyperplastic response that
usually resolves within 1 month

6. 1.Size & quality
Palpable nodes
in other regions abnormal
Any node >1cm

7. Nodes >3cm neoplasm

8. 2.Accompanying symptoms
r/c fever >38.5 C,night sweats,weigt
loss
LYMPHOMAS
Lymphngectic streaking

9. splenomegaly

10. 3.Distribution
GENERALISED

11. • IMN
• AIDS
infections • AIDS related complex
• Toxoplasmosis
• Secodary syphilis
• LEUKEMIA
Neoplasia • HODGKIN’S DISEASE
• NHL
• Serum sickness
Hypersensitivity • Phenytoin
• Vasculitis,lupus,RA

12. METABOLIC •Hyper thyroidism
•Lipidoses

13. Castleman’s disease
Rare,idiopathic,Localised/multicentric,mim
ic lymphoma/HIV,systemic
symptoms,increased risk of infection

14. LOCALISED
• Viral Conjunctivitis
• Trachoma
ANT.AURICULAR
• Tularemia
• Sarcoidosis
• Rubella
POST.AURICLAR • Scalp infection

15. ANT. AURICULAR POST. AURICULAR

16. • Buccal cavity infection
SUB • Pharyngitis
• Nasopharyngeal tumour
MANDIBULAR • Thyroid malignancy
• IMN
CERVICAL • Sarcoidosis
B/L • Toxoplasmosis
• pharyngitis

17. SUB MANDIBULAR CERVICAL B/L

18. Right • Pulmonary malignancy
• Mediastinal malignancy
Supra • Esophageal malignancy
clavicular
Left • Intra abdominal malignancy
supra • Renal ca
• Testicular or ovarian
clavicular malignancy

19. RIGHT SUPRA CLAVICULAR LEFT SUPRA CLAVICULAR

20. • Ca breast / infection
axillary • Upper extremity infection
• Syphilis(b/l)..Sailor’s handshake
• CLL
Epitrochlear • IMN
• Lymphoma
• Hand infection(u/l)

21. EPITROCHLEAR
AXILLARY LYMPHADENOPATHY LYMPHADENOPATHY

22. • Syphilis
• Genital herpes
• Lympho granuloma
Inguinal venereum
• Chancroid
• Lower extremity/local
infection

23. INGUINAL LYMPHADENOPATHY

24. • Lymphoma
• Bronchogenic ca
Hilar(u/l) •
•
TB
sarcoidosis
• Sarcoidosis
• Fungal(histoplasmosis,coccidiomycosis)
Hilar(b/l) •
•
Lymphoma
Bronchogenic ca
• TB

25. UNILATERAL HILAR LYMPHADENOPATHY BILATERAL HILAR LYMPHADENOPATHY

26. • Adeno ca of gut
• Hodgkin’s d/s
• TB
ABDOMINAL • Bladder ca
• Gastric ca

27. GASTRIC CA
SISTER MARY
JOSEPH NODULE

28. • Cat scratch fever
• Hodgkin’s d/s
• NHL
ANY • Leukemia
REGION • Metastatic ca
• Sarcoidosis
• Granulomatous infection

29. CAT SCRATCH D/S

30. other lymphatic abnormalities
4.
Lymphangitis
Lymphadenitis
Kikuchi’s disease
lymphedema

31. 1.Is the palpable mass indeed a
lymph node????
Enlarged parotid
Thyroglossal cyst
Abscess
Branchial cyst

32. 2.Acute or chronic ??
3.Character of enlarged node???
tender.,mobile
Firm,rubbery,nontender
Painless,stonehard,fixed&
matted

33. 4.Localized or generalised??
5.Are there associated
systemic/localizing symptoms/signs???

34. 6.Are there unusual epidemiological
clues???
Exposure to cats
Travel
Exposure to bird droppings
Lacerations during gardening
Exposure to TB
Sexual exposure

35. 1.Complete blood cell count
with differential….
Atypical lymphocytosis
Eosinophilia
Pancytopenia

36. 2.Serum uric acid
3.Serum liver chemistries

37. Localised adenopathy
1.Throat culture
2.Urethral/cervical swabs
3.Blood culture
4.biopsy

38. 5.Abdominal CT
6.Bone marrow biopsy

39. Generalised adenopathy
1.Serological tests
Heterophile test
VDRL
Antibody titres of
viruses,fungi,toxoplasmosis
Anti nuclear antibodies
Rheumatoid factor

40. Hilar adenopathy
1.Mantoux test 2.chest X-RAY,CT
3.ACE enzyme determination
4.Bronchoscopy
5.mediastinoscopy

41. Lymph node biopsy
Most direct approach

42. Indications
Approaches & yeild
Excitional biopsy preffered
FNAC
Needle aspiration

43. Choice of node
Largest node
Avoid inguinal & axillary
Supra clavicular-highest diagnostic
yield
complications
Follow up/empiric treatment

44. THANKZZZZZZZZ…..ZZZZZZ…..ZZZZ