Cervical lymphadenopathy

Differential diagnosis

  • Infection
    • URTI – reactive lymphadenitis
    • Infectious mononucleosis
    • HIV infection – risk factors e.g. MSM, IV drug use
    • Hepatitis
    • Syphilis
    • Dengue fever
    • TB – risk factors e.g. exposure, travel
  • Malignancy
    • Metastatic disease – breast lumps, cough, haemoptysis, smoker
    • Lymphoma
    • Acute leukaemia
  • Autoimmune
    • SLE

 

Data gathering

  • Red flags
    • duration > 6weeks
    • rapidly increasing
    • weight loss
    • night sweats
    • exposure to TB
  • Others – see above
  • Examine
    • Lump – size, shape, consistency, mobile, tender, transillumination
    • Other LN
    • Lung, Breast, ENT examinations
    • Abdominal examination

 

Clinical management

  • Investigations
    • Bloods – FBC, U+E, LFTs, ESR, Monospot test, HIV, Hepatitis, Syphilis
    • Xray – CXR
    • USS Abdomen – if suspecting organomegaly
  • Treatment
    • As per cause
  • Follow-up / Safety-net
    • Refer if red flags (>6/52 duration, >2cm in size, rapidly enlarging, generalised lympadenopathy, organomegaly)