Lymphadenopathy

Lymphadenopathy
Synonyms Adenopathy
Neck lymphadenopathy associated with infectious mononucleosis
Classification and external resources
Specialty Infectious disease
ICD-10 I88, L04, R59.1
ICD-9-CM 289.1-289.3, 683, 785.6
DiseasesDB 22225
MedlinePlus 001301
eMedicine ped/1333
MeSH D008206

Lymphadenopathy or adenopathy is disease of the lymph nodes, in which they are abnormal in size, number, or consistency.[1] Lymphadenopathy of an inflammatory type (the most common type) is lymphadenitis,[2] producing swollen or enlarged lymph nodes. In clinical practice, the distinction between lymphadenopathy and lymphadenitis is rarely made and the words are usually treated as synonymous. Inflammation of the lymphatic vessels is known as lymphangitis.[3] Infectious lymphadenitides affecting lymph nodes in the neck are often called scrofula.

The term comes from the word lymph and a combination of the Greek words αδένας, adenas ("gland") and παθεία, patheia ("act of suffering" or "disease").

Lymphadenopathy is a common and nonspecific sign. Common causes include infections (from minor ones such as the common cold to dangerous ones such as HIV/AIDS), autoimmune diseases, and cancers. Lymphadenopathy is also frequently idiopathic and self-limiting.

Classification

Micrograph of dermatopathic lymphadenopathy, a type of lymphadenopathy. H&E stain.
CT scan of axillary lymphadenopathy in a 57 year old man with multiple myeloma.
Upper limit of lymph node sizes in adults
Generally 10 mm[4][5]
Inguinal 10[6] – 20 mm[7]
Pelvis 10 mm for ovoid lymph nodes, 8 mm for rounded[6]
Neck
Generally (non-retropharyngeal) 10 mm[6][8]
Jugulodigastric lymph nodes 11mm[6] or 15 mm[8]
Retropharyngeal 8 mm[8]
  • Lateral retropharyngeal: 5 mm[6]
Mediastinum
Mediastinum, generally 10 mm[6]
Superior mediastinum and high paratracheal 7mm[9]
Low paratracheal and subcarinal 11 mm[9]
Upper abdominal
Retrocrural space 6 mm[10]
Paracardiac 8 mm[10]
Gastrohepatic ligament 8 mm[10]
Upper paraaortic region 9 mm[10]
Portacaval space 10 mm[10]
Porta hepatis 7 mm[10]
Lower paraaortic region 11 mm[10]

Lymphadenopathy of the axillary lymph nodes can be defined as solid nodes measuring more than 1.5 cm without fatty hilum.[11] Axillary lymph nodes may be normal up to 3 cm if consisting largely of fat.[11]

In children, a short axis of 8 mm can be used.[12] However, inguinal lymph nodes of up to 1.5 and cervical lymph nodes of up to 2 cm are generally normal in children up to age 8–12.[13]

Causes

Retroperitoneal lymphadenopathies of testicular seminoma, embrace the aorta. Computed tomography image.

Lymph node enlargement is recognized as a common sign of infectious, autoimmune, or malignant disease. Examples may include:

Less common infectious causes of lymphadenopathy may include bacterial infections such as cat scratch disease, tularemia, brucellosis, or prevotella.

Benign (reactive) lymphadenopathy

Benign lymphadenopathy is a common biopsy finding, and may often be confused with malignant lymphoma. It may be separated into major morphologic patterns, each with its own differential diagnosis with certain types of lymphoma. Most cases of reactive follicular hyperplasia are easy to diagnose, but some cases may be confused with follicular lymphoma. There are seven distinct patterns of benign lymphadenopathy:[17]

These morphological patterns are never pure. Thus, reactive follicular hyperplasia can have a component of paracortical hyperplasia. However, this distinction is important for the differential diagnosis of the cause.

Localization

See also

References

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  2. "lymphadenitis" at Dorland's Medical Dictionary
  3. "lymphangitis" at Dorland's Medical Dictionary
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