Overview
Lymphadenopathy refers to enlargement of the lymph nodes, which is often painful. It is important to carefully assess for lymph node enlargement, this suggests infective, inflammatory or malignant pathology.
How to Elicit
- 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
- Infection - bacterial, viral, fungal, protozoal
- Inflammatory disorders - lupus, rheumatoid arthritis
- Malignancy - leukaemia, lymphoma, solid organ malignancies
- Medications - allopurinol, atenolol, cephalosporins, penicillin, phenytoin
- Benign idiopathic
Cervical Lymph Nodes
Submental nodes - immediately below chinTeeth, oral mucosa, tongue
Submandibular nodes - Along angle of mandibleFloor of mouth
Anterior cervical nodes - over sternocleidomastoidPosterior pharynx, tonsils, parotid
Posterior cervical nodes - posterior to sternocleidomastoidsScalp, posterior neck
Suboccipital nodes - below occiputInferior scalp
Preauricular nodes - Anterior to pinnaEyelids, conjunctivae
Postauricular nodes - posterior to pinnaExternal auditory meatus, pinna, scalp
Right supraclavicular node - in right supraclavicular fossaMediastinum, lungs, oesophagus
Left supraclavicular node (Virchow's node) - in left supraclavicular fossaChest, abdomen
Axillary Lymph Nodes
Pectoral nodes - anteriorly, behind pectoralis major muscleAnterolateral chest wall, central / lateral breast
Subscapular nodes - posteriorly, in front of subscapularis musclePosterior neck and chest wall
Lateral nodes - lateral aspect of armpitMedial hand, forearm and arm
Central nodes - within centre of axillaDrainage from pectoral, subscapular and lateral nodes
Infraclavicular nodes - below distal aspect of clavicleLateral hand, forearm and arm
Apical nodes - medially, at lateral border of 1st ribDrainage from all axillary lymph nodes
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