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Lymphadenitis
Lymphadenitis
Pathophysiology of Lymphadenopathy
Initial Infection
Lymphatic drainage
Presentation to T cells
Activation of B cells
Immunoglobulin release
Pathophysiology Contd
Cellular Hyperplasia
Leukocyte Infiltration
Tissue Edema
Vasodilation and Capillary Leak
Tenderness due to capsule distension
DD
Congenital Masses
Malignancies
Other
Differential Diagnosis
Congenital Masses
Dermoid Cyst
Sternocleidomastoid Tumor
Mass is presents after birth, rapidly grows, plateaus, and is red or bluish
in color
Cystic Hygroma
Hemangioma
Laryngocele
Cervical Ribs
Malignancies
Lymphoma
Hodgkin's
lymphoma
Non-Hodgkin's lymphoma
Leukemia
CLL
Lung (mediastinal)
Metastatic: breast, melanoma
(Usually axillary), SCC
Differential Diagnosis
Systemic diseases
Adenovirus
Other
Differential Diagnosis
Systemic diseases
Bartonella
Toxoplasmosis
STDs
Kawasaki disease
MUMPS
Painful swelling,
superior to jaw line
Uni or bilateral
Epidemic
Vaccinated?
Sometimes meningitis
Infectious Mononucleosis
EBV, CMV
Fever
Sore throat
Hepatosplenomegaly
Lymphocytosis
Suppurative Bacterial
Lymphadenitis
Anaerobes
Subacute Lymphadenitis
2-6 weeks
DD:
Atypical Mycobacteria
Toxoplasmosis
TB
Atypical Mycobacteria
Species involved:
Mycobacterium avium-intrucellulare
Mycobacterium scrofulaceum
Diagnosis: acid fast stain and culture, can take weeks. PCR.
Tuberculosis
lymphadenitis (Scrofula)
Presenting Signs and Symptoms
Cervical nodes most commonly involved
Firm, discrete nodes
Fluctuant nodes
Tuberculosis (Scrofula)
Approach to lymphadenitis
History
Insect Bites
Exposure to animals
Immunizations
Medications
Physical Exam
General
Skin
Size
Unilateral vs Bilateral
Tender vs Nontender
Mobile vs Fixed
Hard vs Soft
Lungs
Neck
ENT
Consolidations suggesting TB
Abdomen
Hepatosplenomegaly
Laboratory Workup
ESR
Throat culture
Serology
PPD
Imaging Workup
Ultrasound
EKG/ECHO
Abscess?
Benign vs. malignant
Sometimes CT/MRI
Biopsy
FNA or Excisional
Summary
Sometimes Biopsy
The end