INFO - Lymphadenopathy: differential diagnosis and evaluation

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American Family Physician

15 Oct 1998

Lymphadenopathy: Differential Diagnosis and Evaluation

ROBERT FERRER, M.D., M.P.H.,

University of Texas Health Sciences Center at San ,

San , Texas

Although the finding of lymphadenopathy sometimes raises fears about

serious illness, it is, in patients seen in primary care settings,

usually a result of benign infectious causes. Most patients can be

diagnosed on the basis of a careful history and physical examination.

Localized adenopathy should prompt a search for an adjacent

precipitating lesion and an examination of other nodal areas to rule

out generalized lymphadenopathy. In general, lymph nodes greater than

1 cm in diameter are considered to be abnormal. Supraclavicular nodes

are the most worrisome for malignancy. A three- to four-week period of

observation is prudent in patients with localized nodes and a benign

clinical picture. Generalized adenopathy should always prompt further

clinical investigation. When a node biopsy is indicated, excisional

biopsy of the most abnormal node will best enable the pathologist to

determine a diagnosis.

The cause of lymphadenopathy is often obvious: for example, the child

who presents with a sore throat, tender cervical nodes and a positive

rapid strep test, or the patient who presents with an infection of the

hand and axillary lymphadenopathy. In other cases, the diagnosis is

less clear. Lymphadenopathy may be the only clinical finding or one of

several nonspecific findings, and the discovery of swollen lymph nodes

will often raise the specter of serious illness such as lymphoma,

acquired immunodeficiency syndrome or metastatic cancer. The

physician's task is to efficiently differentiate the few patients with

serious illness from the many with self-limited disease. This article

reviews the evaluation of patients with a central clinical finding of

lymphadenopathy, emphasizing the identification of patients with

serious illness.

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Read the full article here:

http://www.aafp.org/afp/981015ap/ferrer.html

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