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Evaluation of Peripheral Lymphadenopathy In Adults
(Last Updated in 2009 for Resident Education Week of 08/31 – 09/04)
Information summarized from Habermann et al unless otherwise specified.1
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
Important History Elements (Table 1 from Habermann et al.)1
o Age
 Lymphoproliferative do not have age predilection.2
 Cardinomas much more common age > 50.2
o Location of LN
o Length of time LN present
o Associated systemic signs and symptoms
 Fever
 “B” Symptoms3
 Temp > 38C
 Drenching Night Sweats
 Unexplained >10% weight loss
 Lymphangitic streaking associated with cutaneous infection.
 Qualitative characteristics of LN not particularly helpful in distinguishing benign
from malignant lesions.
o Generalized lymphadenopathy
o Extranodal associations
o Splenomegaly4
Differential Diagnosis
Differential Diagnosis Categories of LN (Table 3, Habermann et al.)1
Alphabet Listing of LN Differential Diagnosis (Table 4, Habermann et al.)1
Regnional Differential Diagnosis of LN (Table 5, Habermann et al.)1

Workup
o “B” Symptoms associated with lymphoproliferative disorders and infectious conditions.
o Biopsy Indication for LN without an obvious diagnosis
 outside of the inguinal region
 present for greater than 1 month
 measuring 1x1cm or larger
o Biopsy Location
 If more than one LN found then:
 Inguinal region least helpful, but OK if only accessible ones.
 Preferred is largest peripheral node outside of the inguinal region.
 If no peripheral nodes, then mediastinal
 For generalized LN (in descending order):
 Supraclavicular
 Cervical
 Axillary
 Epitrochlear
 Inguinal
o Generalized LN
 HIV and/or Hepatitis B/C evaluation
 PPD if high risk or hx of exposure
 Sexual history, STD eval if high risk
 CBC with manual peripheral smear
 CRP, Sed Rate if immunologic hx given.
 With alarm features (such as wt loss, fever, weakness, etc): CT Chest/ABD/Pelvis
 Mainly for abdominal LN detection: suggestive of malig.
o Mediastinal and Hilar LN evaluation
 Evaluation of old chest x-ray films
 Tailored use of lab studies (fungal, serum ACE, etc)
 Cultures when appropriate
 Biopsy
 CT Scan Chest
o Special Clinical and Laboratory Associations.
Historical and Laboratory Associations with LN (Table 6, Habermann et al.)1

Treatment
o Empiric treatment of LN with antibiotics or corticosteroids is not recommended.4
REFERENCES
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Habermann TM, Steensma DP. Lymphadenopathy. Mayo Clin Proc. Jul 2000;75(7):723-732.
Lee Y, Terry R, Lukes RJ. Lymph node biopsy for diagnosis: a statistical study. J Surg Oncol.
1980;14(1):53-60.
Lister TA, Crowther D. Staging for Hodgkin's disease. Semin Oncol. Dec 1990;17(6):696-703.
Pangalis GA, Vassilakopoulos TP, Boussiotis VA, Fessas P. Clinical approach to lymphadenopathy.
Semin Oncol. Dec 1993;20(6):570-582.