Lymphadenopathy

History

  • Infection – eyes, throat, skin, genital sores
  • Metastatic malignancy – dysphagia, hoarseness, cough, haemoptysis
  • Constitutional (B) symptoms – fever, night sweats, weight loss, (bleeding)
  • Medications

Examination

  • Site – cervical, axillary, clavicular, inguinal, abdomen
  • Size
  • Consistency (soft, regular)
  • Mobility

Interpretation of LN findings

  • Benign
    • 1cm
    • smooth, round, non-tender, mobile
  • Reactive
    • as per benign but tender
  • Haematological malignancy
    • rubbery
  • Metastases
    • hard, firm, irregular, tethered

Clinical management

  • Borderline LN
    • Consider ultrasound
      • If suspicious, refer to appropriate speciality
  • Generalised LN
    • 2ww Haematology
    • Bloods: FBC, HIV, EBV, CMV, Toxo
  • Localised concerning features
    • Head and neck –> 2ww ENT + CXR
    • Axilla –> 2ww Breast
    • Groin or abdomen –> 2ww Haematology
    • Mediastinal or hilar –> 2ww Respiratory
Reference
https://www.wirralccg.nhs.uk/media/5587/gp-lymph-node-pathway.pdf 

https://geekymedics.com/lymphoreticular-examination-osce-guide/