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Haem Exam
 
 
 
 
Haem Exam
When examining a patient's haematologic system, remember the three key cell lines and the major manifestations that can result from their derangement: anaemia, infection and bleeding / bruising. The haematology exam is also used to identify signs of malignancy, such as lymphadenopathy and splenomegaly.
 

Axillary Lymphadenopathy

 
 

Overview

  • The axillary lymph nodes drain from the neck, chest wall, breast and upper limbs. Enlargement of these lymph nodes can suggest pathology affecting these regions or a systemic process that is infective, inflammatory or malignant.
    • How to Assess

    • Using the pulps of the fingers, gently palpate each of the lymph node groups within axillary region.
    • Feel For

    • Size - normally <10mm
    • Tenderness
    • Consistency - hard (metastasis), rubbery (lymphoma), soft (reactive)
    • Mobility - mobile or tethered to underlying structures
    • Causes of Lymphadenopathy

    • Bacterial infection - localised infection, skin infection, tuberculosis / MAC, syphilis, cat-scratch disease
    • Viral infection - EBV, CMV, HIV, herpez simplex, rubella
    • Parasitic infection - toxoplasmosis
    • Malignancy - lymphoma, leukaemia, metastasis
    • Inflammatory disorders - lupus, rheumatoid arthritis
    • Sarcoidosis
    • Medications - allopurinol, atenolol, cephalosporins, penicillin, phenytoin, carbemazepine
    • Storage disorders
    • Benign idiopathic lymphadenopathy

Axillary Lymph Nodes

  • Pectoral nodes - anteriorly, behind the pectoralis major muscleAnterolateral chest wall, central / lateral breast
  • Subscapular nodes - posteriorly, in front of the subscapularis musclePosterior neck and chest wall
  • Lateral nodes - lateral aspect of armpitMedial hand, forearm and arm
  • Central nodes - within the centre of the axillaDrainage from pectoral, subscapular and lateral nodes
  • Infraclavicular nodes - below the distal aspect of the clavicleLateral hand, forearm and arm
  • Apical nodes - medially, at the lateral border of the 1st ribDrainage from all axillary lymph nodes
Last updated on January 1st, 2017
 
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