Ultrasonography may be helpful in evaluating the extent of lymph node involvement in patients with lymphadenopathy and may be more sensitive than CT scanning in some instances.CXR: sarcoidosis, TB, primary or secondary malignancy.Autoantibody screen: SLE, rheumatoid arthritis.Investigations for tuberculosis, syphilis serology, toxoplasma screen.Viral titres - eg, Epstein-Barr virus, HIV, hepatitis.Swabs from any site of infection for culture and sensitivities.įurther investigations will depend on the individual presentation but may include:.Renal function, as reduced renal function may limit/affect the dose of any chosen therapy.LFTs to look for liver metastases from a malignancy.Investigation of patients with unexplained lymphadenopathy should include FBC, blood film and ESR, plasma viscosity or CRP (according to local policy).Investigations may not be required in cases of obvious cause and quick resolution with or without treatment. These will be governed by the history and examination and likely cause of lymphadenopathy. However, in the event of a worrying history or suspicious findings, the following investigations may be indicated. In the vast majority of cases, once the history and physical examination are completed, the clinician will be able to determine that the condition is self-limiting and requires no further investigation. Drug reactions (eg, phenytoin, allopurinol, primidone).African trypanosomiasis (sleeping sickness).Īutoimmune disorders and hypersensitivity states.Toxoplasmosis, leishmaniasis, American trypanosomiasis (also known as Chagas' disease).Roseola infantum - human herpesvirus type 6 (HHV-6).Infectious mononucleosis, cytomegalovirus (CMV).Generalised lymphadenopathy may be caused by a wide range of conditions, as follows: What causes general lymphadenopathy? (Aetiology) Nodes that are firm, non-tender and matted together increase the possibility of malignancy.Erythema, warmth, tenderness and fluctuance of a node suggest lymphadenitis of infective origin.Epitrochlear nodes (just above the elbow crease) can signify Hodgkin's disease. Supraclavicular nodes of any size at any age warrant further investigation, as they can be associated with malignancy in the chest and abdomen.

Axillary nodes up to 1 cm, neck nodes up to 2cm and inguinal nodes up to 1.5 cm in diameter are also usually normal.Bilateral anterior cervical lymph nodes up to 2 cm in diameter often are found in older healthy children or in those experiencing or recently recovering from an upper respiratory tract infection.Perform a systematic examination to exclude signs of obvious malignancy and especially the abdomen to exclude hepatomegaly or splenomegaly. Measure body temperature to exclude pyrexia and check for any local sources of infection, including the scalp, skin, ears, nose, pharynx and chest. These are most prominent in the anterior cervical, inguinal and axillary regions and continue to increase in size until the age of 8-12, after which atrophy occurs. Most children have palpable lymph nodes, the relative size of which could qualify for lymphadenopathy in an adult. Presenting symptoms of more indolent diseases (eg, tuberculosis, malignancy) may occur some time after the development of the initial lymphadenopathy.Ī sexual history and history of intravenous drug use should also be elicited. īearing in mind the extensive list of differential diagnoses, it is important to keep the patient under review if spontaneous recovery does not occur. Supraclavicular and infraclavicular lymph nodes are always suspicious of an underlying malignancy, particularly in those aged over 40 years. Persistent fever, night sweats, general malaise or weight loss may be pointers to significant disease. General lymphadenopathy symptoms (presentation) HistoryĪ history should include the duration of the lymphadenopathy, whether any other household members are acutely ill and whether there are any accompanying symptoms. 4% of patients aged 40 years or older who present with unexplained lymphadenopathy are found to have an underlying cancer, but for those younger than 40 years this falls to 0.4%. In primary care unexplained lymphadenopathy has an annual incidence of 0.6%.įewer than 1 in 100 of these cases have a malignant aetiology, but this increases as the age of the patient increases.

Shotty lymph nodes normal