Download LYMPHADENOPATHY & HEPATOSPLENOMEGALY

LYMPHADENOPATHY &
SPLENOMEGALY
Martin H. Ellis MD
Meir Hospital
CLINICAL ANATOMY OF
THE LYMPH NODES
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Head & Neck – occipital, postauricular,
preauricular, anterior cervical chain, posterior
cervical chain, submandibular, submental,
Waldeyer’s ring
Clavicular – supra and infra
Axillary – lateral, medial, posterior, apical
Epitrochlear
Inguinal
Femoral
Femoral
Femoral
Femoral
RADIOLOGICAL ANATOMY
OF LYMPH NODES
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Mediastinal
Perihilar
Retroperitoneal
Mesenteric
Iliac
Hilar adenopathy (sarcoidosis)
Mediastinal adenopathy
(lymphoma, sarcoma, teratoma)
DIAGNOSIS
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History & Physical diagnosis
Laboratory testing
CT scanning
MRI
Isotope scanning
PET-CT scanning
Histologic diagnosis
APPROACH TO DIAGNOSIS
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Localized vs. generalized (including
splenomegaly)
History
Physical exam
Special investigations
CHARACTERISTICS OF
ENLARGED NODES
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Size
– < 1cm=normal
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Pain/Tenderness
– inflammation/rapid growth
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Consistency
– stony, rubbery, firm, soft, fluctuant
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Matting
– a group of nodes that seem joined
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Mobility
Location
DIFFERENTIAL DIAGNOSIS
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Congenital
Acquired
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Infectious – bacterial,viral,fungal,parasitic,mycobacterial
Inflammatory – autoimmune, allergic, vasculitic
Neoplastic – benign, malignant (primary,secondary)
Toxic & Metabolic – storage diseases, hyperthyroidism
Drug – hydantoin, gold
Traumatic
Idiopathic – sarcoidosis, Castleman disease
Iatrogenic – silicone implants
SITE-DISEASE ASSOCIATIONS
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Occipital – rubella
Supraclavicular – TB (scrofula), lung ca,
gastric ca (Virchow node- Trousseau sign)
Axillary – breast ca
Inguinal – STDs
Umbilical – ovarian ca (Sister Joseph’s node)
Hx / PE
DIAGNOSTIC
eg local infection,tumor
SUGGESTIVE
eg mono,HIV,lymphoma
UNEXPLAINED
SPECIFIC TESTING
POSITIVE
TREAT CONDITION
GENERALIZED
LOCALIZED
Review epidemiology
Review medications
POSITIVE
DIAGNOSTIC
POSITIVE
MONONUCLEOSIS SEROLOGY
PPD,HIV,HBV,CXR
No serious illness
apparent
Observe 3-4 weeks
Biopsy
NEGATIVE
Resolved
BIOPSY ABNORMAL NODE
Serious illness
apparent
Biopsy
SPLENOMEGALY:
DIAGNOSIS
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History & Physical diagnosis
Laboratory testing
CT scanning
MRI
Isotope scanning
PET-CT scanning
Histologic diagnosis
DIFFERENTIAL DIAGNOSIS
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Congenital
Acquired
– Infectious –
bacterial,viral,fungal,parasitic,mycobacterial
– Inflammatory – autoimmune (SLE, Felty syndrome)
– Neoplastic – benign, malignant (primary,secondary)
– Toxic & Metabolic - (storage diseases eg Gaucher)
– Congestive splenomegaly – portal hypertension
– “Work” hyperplasia- chronic hemolytic anemias
MASSIVE SPLENOMEGALY
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Tumors
– Lymphoma, myeloproliferative disorders,
Hairy cell leukemia
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Infections
– Kala-azar (trypanosomiasis)
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Portal hypertension
Gaucher disease
Approach to diagnosissplenomegaly
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Known illnesses
– eg lymphoma, SLE
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Current clinical context
– Fever, recent travel, murmers
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Imaging studies
– Size, focal lesions
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Histologic diagnosis
– Splenectomy, ?splenic biopsy