Overview
- 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
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
