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Haem Exam

Cervical Lymphadenopathy



  • Lymphadenopathy refers to enlargement of the lymph nodes, which is often painful. It is important to carefully assess for lymph node enlargement, as this suggests infective, inflammatory or malignant pathology.
    • How to Perform

    • Using the pulps of the fingers, gently palpate each of the lymph node groups within the cervical and axillary regions.
    • 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, herpes 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

Cervical Lymph Nodes

  • Submental nodes - immediately below the chinTeeth, oral mucosa, tongue
  • Submandibular nodes - Along the angle of the mandibleFloor of mouth
  • Anterior cervical nodes - over the sternocleidomastoidPosterior pharynx, tonsils, parotid
  • Posterior cervical nodes - posterior to sternocleidomastoidsScalp, posterior neck
  • Suboccipital nodes - below the occiputInferior scalp
  • Preauricular nodes - Anterior to the pinnaEyelids, conjunctivae
  • Postauricular nodes - posterior to the pinnaExternal auditory meatus, pinna, scalp
  • Right supraclavicular node - in the right supraclavicular fossaMediastinum, lungs, oesophagus
  • Left supraclavicular node (Virchow's node) - in the left supraclavicular fossaChest, abdomen
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