Introduction

Lymphadenopathy is a common abnormal finding during the course of the physical exam in
general medical practice. Patients and physicians have varying degrees of associated anxiety
with the finding of lymphadenopathy as a small number of cases can be caused by neoplasm
or infections of consequence, for example, HIV or tuberculosis (TB). However, it is generally
recognized that the majority of lymphadenopathy, both localized and generalized, is of
benign, self-limited, etiology. A clear understanding of lymph node function, location,
description, and the etiologies of their enlargement is important in the clinical decisions of
which cases need rapid and aggressive workup, and which need only be observed.[1][2][3]
The lymph node functions as an antigen filter for the reticuloendothelial (RE) system of the
body. It consists of a multi-layered sinus that sequentially exposes B-cell lymphocytes, T-cell
lymphocytes, and macrophages to an afferent extracellular fluid. In this way, the immune
system can recognize and react to foreign proteins and mount an immune response or
sequester these proteins as appropriate. In the course of this reaction, there is
some multiplication of the responding immune cell line, and thus, the node itself increases in
size. It is generally held that a node size is considered enlarged when it is larger than 1 cm.
However, the reality is that "normal" and "enlarged" criteria vary depending on the location
of the node and the age of the patient. For example, children younger than 10 years of age
have more hypertrophic immune systems and nodes up to 2 cm can be considered normal in
some clinical situations yet, an epitrochlear node of above 0.5 cm is considered pathological
in an adult.
The pattern, distribution, and quality of the lymphadenopathy can provide much clinical
information in the diagnostic process. Lymphadenopathy occurs in 2 patterns: generalized
and localized. Generalized lymphadenopathy entails lymphadenopathy in 2 or more non-
contiguous locations. Localized adenopathy occurs in contiguous groupings of lymph nodes.
Lymph nodes are distributed in discrete anatomical areas, and their enlargement reflects the
lymphatic drainage of their location. The nodes themselves may be tender or non-tender,
fixed or mobile, and discreet or "matted" together. Concomitant symptomatology and the
epidemiology of the patient and the illness provide further diagnostic cues. A thorough
history of any prodromal illness, fever, chills, night sweats, weight loss, and localizing
symptoms can be very revealing. Additionally, the demographic particulars of the patient,
including age, gender, exposure to infectious disease, toxins, medications, and their habits
may provide further cues.
As evidenced above, the critical step in evaluation for adenopathy is a careful history
and focused physical exam. The extent of the history and physical is determined by the
clinical presentation of the patient. For example, a patient with posterior cervical adenopathy
sore throat and tremendous fatigue needs only a careful history, cursory examination and a
mono test, while a person with generalized lymphadenopathy and fatigue would require a
much more extensive investigation. Generally, the majority of the lymphadenopathy is
localized (some site a 3:1 ratio), with the majority of that being represented in the head and
neck region (again some site a 3:1 ratio). It also is accepted, that all generalized
lymphadenopathy merits clinical evaluation and the presence of "matted lymphadenopathy"
is strongly indicative of significant pathology.Examination of the patient's history, physical
examination, and the demographic in which they fall can allow the patient to be placed into 1
of several different accepted algorithms for workup of lymphadenopathy. The use of these
cues and selection of the correct arm of the algorithm allows for fairly rapid and cost-
effective diagnosis of lymphadenopathy including determination when it is safe to observe.
[4][5][6]
Algorithmic Analysis of Lymphadenopathy
After a history and physical examination are completed, lymphadenopathy is placed into 3
categories:
1. "Diagnostic" such as strep pharyngitis or upper respiratory tract disease in which case
the course of action is to treat the condition
2. "Suggestive" such as mononucleosis lymphoma or HIV wherein the history and
physical strongly suggestive diagnosis specific testing is performed and if positive the
action is to treat the condition
3. "Unexplained" where the lymphadenopathy is divided into generalized
lymphadenopathy and localized lymphadenopathy
 For unexplained localized lymphadenopathy, a review of history, a regional exam and
the epidemiological clues are used to separate patients into lower (no risk of
malignancy or serious disease) versus higher risk for serious disease or malignancy
categories. If the patient is at no risk for malignancy or serious illness, the reasonable
course of action is to observe the patient for 3 to 4 weeks to see if the
lymphadenopathy resolves or improves. In which case, the clinician is safely cleared
to follow the patient. If the lymphadenopathy does not resolve or improve, the next
step is to obtain a biopsy. If the patient is judged to have a risk for malignancy or
serious illness the procedure is to proceed immediately to biopsy.
 For unexplained generalized lymphadenopathy, the key to diagnosis is a history to
evaluate for suspected causes. Initial search would be questioning for a
mononucleosis-type syndrome such as evidenced by fever atypical lymphocytosis and
malaise included in these differentials would be Epstein-Barr virus, cytomegalovirus,
toxoplasmosis, and (especially in the case of a flu-like illness and her rash) the initial
stages of an HIV infection. The second step in the evaluation of unexplained
generalized lymphadenopathy involves a careful review of epidemiological cues.
Included in the epidemiological cues would be:
1. Infectious disease exposure
2. Animal exposure
3. Insect bites
4. Recent travel
5. Complete medication history
6. Personal habits-smoking, consumption of alcohol, consumption of drugs-special
attention to a history of IVTA, high-risk sexual behavior
7. Consumption of under-cooked food/untreated water
Although there is no "cookbook" for the laboratory evaluation of generalized
unexplained lymphadenopathy, initial steps are to obtain a complete blood count (CBC) with
a manual differential and EBV serology. If non-diagnostic, the next steps would be PPD
placement, RPR, chest x-ray, ANA, hepatitis B surface antigen, and HIV test. Again if any of
the above are positive, appropriate treatment can be initiated. In the presence of negative
serological examinations and radiological examinations and or significant symptomology, a
biopsy of the abnormal node is the gold standard for diagnosis.Statistics concerning
lymphadenopathy are not accurate as the great majority of lymphadenopathy is caused by a
non-reportable illness and thus not reported or taken into account. This results in a statistical
bias, or skew, toward the reportable causes of lymphadenopathy: malignancies, HIV,
tuberculosis, and sexually transmitted diseases (STDs). Citations in the recent literature for
general medical practice indicate that less than 1% of people with lymphadenopathy have
malignant disease most often due to leukemia and younger children Hodgkin disease in
adolescence non-Hodgkin disease and chronic lymphocytic leukemia (CLL) in adults. It has
been reported the general prevalence of malignancy is 0.4% in patients under 40 years and
around 4% in those older than 40 years of age seen in a primary care setting. It is reported
that the prevalence rate of neoplastic disease rises to near 20% in referral centers and rises to
50% or more in patients with initial risk factors.
Go to:

Etiology
The etiology of lymphadenopathy includes the following:
 Infectious disease
 Neoplasm
 Inflammatory disease
 Autoimmune disease
 Inborn metabolic storage disorder
 Exposure to toxic/medication
Infectious disease can be of viral, bacterial, mycobacterial, fungal or parasitic etiology:
 Viral etiologies of lymphadenopathy include HIV, mononucleosis caused by EBV or
CMV, roseola, HSV, varicella, and adenovirus.
 Bacterial etiologies of lymphadenopathy
include Staphylococcus, Streptococcus, Salmonella, Syphilis, and Yersinia
 Mycobacterial etiology of lymphadenopathy include tuberculosis and Mycobacterium
avium intracellulare (MAI)
 Fungal etiology of lymphadenopathy include coccidiomycosis and Candida
 Parasitic etiology of lymphadenopathy include toxoplasmosis, histoplasmosis,
Chagas, and many of the ectoparasites
 Neoplastic causes of lymphadenopathy include both primary malignancies and
metastatic malignancies: Acute lymphoblastic leukemia (ALL), Hodgkin lymphoma,
non-Hodgkin lymphoma, neuroblastoma, pediatric acute myelocytic leukemia,
rhabdomyosarcoma, metastatic carcinoma of the lung, metastatic carcinoma of the
viscera of the gastrointestinal (GI) tract, metastatic breast cancer, and metastatic
thyroid cancer and metastatic renal cancer.
  Autoimmune disease these causes of lymphadenopathy include sarcoidosis, juvenile
rheumatoid arthritis (JRA), serum sickness, systemic lupus erythematosus (SLE)
 Exposures to toxins and medications that are common causes of lymphadenopathy
include the medications allopurinol, atenolol, captopril, carbamazepine, many of the
cephalosporins, gold, hydralazine, penicillin, phenytoin, primidone, para
methylamine, quinidine, the sulfonamides, and sulindac. The lifestyle exposures to
alcohol, ultraviolet (UV) radiation, and tobacco can cause cancers with secondary
lymphadenopathy.
 Inborn metabolic storage disorders (including Niemann-Pick disease and Gaucher
disease) are possible additional causes of lymphadenopathy
Go to:

Epidemiology
Broad generalities can safely be made about the epidemiology of lymphadenopathy.[7][8][9]
First, both generalized and localized lymphadenopathies are fairly equally distributed without
regard to gender.
Second, lymphadenopathy is more prevalent in the pediatric population than in the adult
population secondary to the greater number of viral infections. It would follow that the
majority of the time, lymphadenopathy in the pediatric population is of less consequence
again secondary to the prevalence of viral and bacterial infections in that age group. Three-
quarters of all lymphadenopathy observed are localized, and of those three-quarters, half of
these is localized to the head and neck area. All remaining localized lymphadenopathy are
found in the inguinal area, and the remaining lymphadenopathy is found in the axilla in the
supraclavicular area. Of note, the differential diagnosis of lymphadenopathy changes
significantly with the age of the patient.
Third, the patient's location and circumstance are very revealing and lymphadenopathy. For
example, in the developing world (sub-Saharan Africa, Southeast Asia, Indian subcontinent),
exposure to parasites, HIV, and miliary TB are far more likely to be causes of generalized
lymphadenopathy then in the United States and Europe. Whereas, Epstein-Barr virus,
streptococcal pharyngitis, and some neoplastic processes are more likely candidates to cause
lymphadenopathy in the United States and the remainder of the localized industrial world. An
exposure history is very important for diagnosis.
 Exposure to blood and blood-borne products either through transfusion, unsafe sexual
practices, intravenous drug abuse, or vocation
 Exposure to infectious disease whether it be travel, in the workplace, or the home
 Medication exposure-prescription, nonprescription, or supplements
 Exposure to animal-borne illness either via pets or the workplace
 Exposure to arthropod bites

Pathophysiology
Lymphatic fluid represents the totality of the interstitial fluid of the body, and the lymphatic
channels conduct this fluid and label antigens with antigen-presenting cells. As the lymphatic
channels progress, they converge regionally to form discreet lymph nodes. The function of
the lymph node is to evaluate and when possible, process and initiate the immune response
to the presented antigens. Lymph nodes can be thought of like a mesh of reticular cells
containing lobules wherein the antigens are presented to the immune system. Lobules
anatomically contain 3 discreet compartments (cortex, paracortex, and medulla) in which B-
cells, T-cells, and macrophages are separately sequestered.
The appropriate cell line responds to the presented antigen by increasing its numbers.
Commonly the cell lines can multiply by 3 to 5 times in 6 to 24 hours. The reticular network
can stretch to contain the cell-swollen lobules. This increases the size of the lymph node and
causes the clinical phenomenon of lymphadenopathy.
Lymph nodules are integrated with afferent and efferent blood vessels which allow a rich
interface between intravascular and extravascular spaces. Macroscopically, the result is
antigenic "policing" of both intravascular and interstitial fluids and ready immune response to
threats. Microscopically, the decentralized hubs of antigen presentation and response allow
for prompt action with an economy of lymphoid resources.
Go to:

History and Physical

A history and physical examination are the cornerstones of time and cost-effective diagnosis
of adenopathy. The depth and the extent of the H&P conducted are proportional to the
obscurity of the etiology of the adenopathy. The obvious presence of strep pharyngitis and its
related localized anterior cervical adenopathy requires far less clinical brain-power
than generalized adenopathy secondary to sarcoidosis or a Gaucher disease.
The history itself involves gathering 5 important components: chronicity, localization,
concomitant symptoms, patient epidemiology, and pharmacological exposure.
1. Chronicity: The accepted definition of "chronic adenopathy" is a duration of greater
than 3 weeks and the observation that duration of fewer than 2 weeks or greater than 1
year is usually associated with benign causality.
2. Localization: The first determination is if the adenopathy can be viewed as localized
or generalized. The accepted definition of generalized lymphadenopathy is clinical
lymphadenopathy in 2 or more non-contiguous areas. Generalized adenopathy may be
indicative of systemic illness, and the workup is typically more laboratory and
imaging-intensive and pursued more rapidly. Localized beds of enlarged nodes reflect
possible localized pathology in the areas in which they drain.
3. Physical characterization of the node itself
4. Concomitant symptoms: The presence or absence of constitutional symptoms is a
major cue in the determination of the pace and depth of the workup in
lymphadenopathy when taken in the clinical context. For example fever, chills, night
sweats, weight loss and fatigue are worrisome in the setting of generalized
lymphadenopathy. However, similar symptoms are acceptable in the setting of
localized cervical lymphadenopathy and a concomitant Flu or Strep.
 5. Epidemiology: Included in the epidemiological search for lymphadenopathy, will be
questions pertaining to: Dietary exposure, pet exposure, insect bite, recent blood
exposure, high risk sexual behavior or intravenous drug use, occupational exposure to
animals, and travel related epidemiology especially attention to travel to third world
or the Southwest in the United States.
6. Pharmacological exposure: A thorough medical history is necessary including
prescription medications, over-the-counter medications, supplements and herbal
medicines.
Physical examination can be quite revealing especially with the location of the adenopathy
and consideration of the lymphatic drainage of the related areas. Once the determination has
been made that the lymphadenopathy is either localized or general, strict attention to the
localized area must be paid. For example:
 Submandibular nodes typically drain the tongue the lips and the mouth and the
conjunctiva
 Submental nodes typically drain the lower lip portions of the oropharynx and the
cheek
 Jugular lymphadenopathy typically drains the tongue, the tonsils, the pinna, and the
parotid gland
 Posterior cervical adenopathy typically is indicative of scalp, neck, skin of the arms
and legs
 Pectoral thoracic cervical and axillary drainage
 Suboccipital nodes reflect drainage of the scalp in the head, and preauricular nodes
reflect drainage the eyelids, conjunctiva temporal region, and pinna.
 Postauricular nodes reflect drainage at the scalp in the external auditory meatus.
 The right supraclavicular node represents drainage of the mediastinum the lungs in the
esophagus
 Axillary nodes typically creating the arm at the thoracic wall and the breast.
 The epitrochlear nerve roots typically drain the ulnar aspect of the forearm and the
hand.
 Inguinal nodes drain the penis, the scrotum, the vulva, vagina, the perineum, the
gluteal region, and the lower abdominal wall and portions of the lower anal canal
Characterization of the node morphology itself:
 Tenderness-pain may result from an inflammatory process or perforation and also
may result from hemorrhage into the necrotic center of a malignant node. (Presence or
absence of pain not a reliable differentiating factor for malignant nodes though.)
 Consistently firm rubbery nodes may suggest lymphoma; softer nodes are usually the
result of infection or inflammatory conditions; hard stonelike nodes are typically a
sign of cancer more commonly metastatic than primary.
  "Shotty" nodes refers to very small, scattered nodes that feel like shotgun pellets
under the skin. This configuration is typically is found in cervical nodes of children
with viral illnesses
 The designation of a "matting" configuration of nodes describes the pattern of
clustered, seemingly conjoined lymph nodes. This is indicative of, but not
pathognomonic, for malignancy.
Go to:

Evaluation
Laboratory Evaluation of Lymphadenopathy
 CBC with manual differential: This is a foundational test in the diagnosis of both
generalized and regional lymphadenopathy. The number and differential of the white
blood cells can indicate bacterial, viral, or fungal pathology. In addition, characteristic
white blood cell (WBC) patterns are observed with several of the hematological
neoplasms producing lymphadenopathy
 EBV serology: Epstein-Barr viral mono is present causing regionalized
lymphadenopathy
 Sedimentation rate: A measure of inflammation though not diagnostic, it can
contribute to diagnostic reasoning
 Cytomegalovirus titers: This viral serology is indicative of possible of CMV
mononucleosis
 HIV serology: This serology can be used to diagnose acute HIV syndrome related
lymphadenopathy or to infer the diagnosis of secondary HIV-elated pathologies
causing lymphadenopathy.
 Bartonella henselae serology: Serology that may be indicative of the diagnosis of cat
scratch lymphadenopathy
 FTA\RPR: These tests can establish if syphilis is a cause of lymphadenopathy
 Herpes simplex serology: Serological testing to discern if herpes-related,
mononucleosis-like syndrome is present or if regionalized inguinal adenopathy is
secondary to herpes simplex exposure
 Toxoplasmosis serology: These serological tests can lead to a diagnosis of acute
toxoplasmosis as a cause of lymphadenopathy
 Hepatitis B serology: Serological tests for hepatitis B to establish it as a contributing
factor for lymphadenopathy
 ANA: A serological screening test for SLE that can help establish it as a cause for
generalized lymphadenopathy
Diagnostic Radiological Testing
 Chest x-ray: This radiological imaging modality can reveal tuberculosis, pulmonary
sarcoidosis, and pulmonary neoplasm.
  Chest CAT scan: This modality of radiological imaging can define the above
processes and revealing of hilar adenopathy.
 Abdominal and pelvic CAT scan: These images, in combination with chest CAT scan,
can be revealing in cases of supraclavicular adenopathy and the diagnosis
of secondary neoplasm.
 Ultrasonography: This imaging modality can be used in the assessment of number,
size, site, shape, the marginal definition, and internal structures in patients with
lymphadenopathy. Of note, color Doppler ultrasonography is of use in distinguishing
the vascular pattern between older pre-existing lymphadenopathy and recent (newly
active) lymphadenopathy. Studies have indicated that a low long axis to short axis
ratio of lymphadenopathy as measured by ultrasound can be a significant indicator of
lymphoma and metastatic cancer as a cause of lymphadenopathy.
 MRI scanning: As with CAT scanning, this modality of diagnostic imaging has great
utility in the evaluation of thoracic, abdominal, and pelvic masses.
PPD
Tuberculosis is among the leading cause of both regional and generalized adenopathy in
the non-industrialized world
Go to:

Treatment / Management
The management and treatment of lymphadenopathy are dependent on its etiology. For
example:
1. Lymphadenopathy caused by a primary neoplasm: Treatment of the neoplasm
2. Lymphadenopathy caused by metastasis-diagnosis of the primary: Treatment of the
metastasis and primary
3. Lymphadenopathy caused by bacterial disease: Supportive care, antibiotics, and
elimination of nidus of infection if applicable
4. Lymphadenopathy caused by viral disease: Observation and supportive care or
treatment of the virus if particular antiviral medications exist
5. Lymphadenopathy caused by a toxin or medication exposure: Removal of offending
medication if possible or avoidance of toxin
Go to:

Differential Diagnosis
The differential diagnosis of the etiology of lymphadenopathy can be thought of in the
following algorithm:After a thorough history and physical examination, lymphadenopathy
can be initially categorized as:
 Diagnostic-where in the practitioner has a proximal cause for the lymph nodes and
can go on to treat them. Examples would be strep pharyngitis or localized cellulitis.
  The lymphadenopathy pattern history and physical examination can be suggestive an
example would be mononucleosis wearing the practitioner has strong clinic index of
suspicion can perform a confirmatory test which if positive he can go on and treat the
patient.
 Unexplained lymphadenopathy.
 Unexplained lymphadenopathy can be generalized into localized or generalized
lymphadenopathy.
Unexplained localized lymphadenopathy (after careful review of the history and
epidemiology) is further divided into patterns at no risk for malignancy or serious illness in
which case the patient can be observed for 3 to 4 weeks and if response or improvement can
be followed. The other alternative is if the patient is found to have a risk for malignancy or
serious illness biopsy is indicated
Unexplained generalized lymphadenopathy can be approached after review of
epidemiological clues and medications with initial testing with a CBC with manual
differential and mononucleosis serology if either is positive and diagnostic proceed to
treatment. If both are negative, the second workup approach would be a PPD, and RPR, a
chest x-ray, and ANA, hepatitis BS antigen serology, and HIV. Additional testing modalities
and lab tests may be indicated depending on clinical cues. If the results of this testing are
conclusive, the practitioner can proceed on to diagnosis and treatment at the illness. If the
results of the testing are still not clear, proceed onto biopsy of the most abnormal if the
nodes.The most functional way to investigate the differential diagnosis of lymphadenopathy
is to characterize it by node pattern and location, obtained pertinent history including careful
evaluation of epidemiology, and place the patient in the appropriate arm of the algorithm to
evaluate lymphadenopathy.
Generalized Lymphadenopathy
Common Infective Causation
 Mononucleosis
 HIV
 Tuberculosis
 Typhoid fever
 Syphilis
 Plague
Malignancies
 Acute leukemia
 Hodgkin's lymphoma
 Non-Hodgkin's lymphoma
Metabolic Storage Disorders
 Gaucher disease
  Niemann-Pick disease
Medication Reactions
 Allopurinol
 Atenolol
 Captopril
 Carbamazepine
 Cephalosporin(s)
 Gold
 Hydralazine
 Penicillin
 Phenytoin
 Primidone
 Pyrimethamine
 Quinidine
 Sulfonamides
 Sulidac
Autoimmune Disease
 Sjogren syndrome
 Sarcoidosis
 Rheumatoid arthritis
 Systemic lupus erythematosus
Localized Peripheral Lymphadenopathy
Head and Neck Lymph Nodes
Viral infection
 Viral URI
 Mononucleosis
 Herpes virus
 Coxsackievirus
 Cytomegalovirus
 HIV
Bacterial infection
 Staphylococcal aureus
 Group A Streptococcus pyogenes
 Mycobacterium
 Dental abscess
 Cat scratch disease
Malignancy
 Hodgkin disease
 Non-Hodgkin lymphoma
 Thyroid cancer
 Squamous cell carcinomas of the head and neck
Inguinal Peripheral Lymphadenopathy
Infection
 STDs
 Cellulitis
Malignancy
 Lymphoma
 Squamous cell carcinoma of genitalia
 Malignant melanoma
Axillary Lymphadenopathy
Infection
 Localized Staphylococcal aureus
 Cat-scratch disease
 Brucellosis
Malignancy
 Lymphoma
 Breast cancer
 Melanoma
Reaction to breast implants
Supraclavicular Adenopathy
Infections
  Mycobacteria
 Fungi
Malignancy
 Thoracic and abdominal neoplasms
 Hodgkin disease
 Non-Hodgkin lymphoma
Go to:

Prognosis
The prognosis of lymphadenopathy, whether localized or generalized, is entirely dependent
on the etiology of the enlarged lymph nodes. Most adenopathy in the general medicine
office is caused by a treatable bacterial or treatable viral illness. However, HIV, active
tuberculosis, and neoplasm all have more guarded prognoses. Generalities include the
majority of localized lymphadenopathy has a better prognosis than the majority of
generalized lymphadenopathy secondary to etiologies. Etiologies that are established earlier
in a clinical setting will tend to have better prognoses than those established later.
Go to:

Complications
Pitfalls and pearls of the diagnosis and treatment of lymphadenopathy include:
 There is no substitute for a thorough history and careful physical examination in the
workup of lymphadenopathy.
 The majority of both localized and generalized lymphadenopathy have a relatively
benign treatable cause.
 All generalized lymphadenopathy merits careful evaluation and workup.
 The gold standard for diagnosis of lymphadenopathy remains tissue diagnosis of the
node by incisional biopsy.
 A careful review of the patient's epidemiological and personal medical history
provides daily clues as to when lymphadenopathy can be safely observed for change
or resolution over the period of 2 to 4 weeks.
 Supraclavicular lymphadenopathy is almost universally indicative of underlying
thoracic or abdominal malignancy.
Go to:

Deterrence and Patient Education

Patient education plays a significant role in the deterrence of the processes that can cause
pathological lymphadenopathy.
 1. Smoking cessation, alcohol moderation, modification of unsafe sexual practices, and
avoidance of drug use can significantly decrease the rate of cancers, HIV, hepatitis B
and C, and sexually transmitted diseases.
2. Appropriate vaccination, good hygiene, good public sanitation, and careful infectious
disease protocols can significantly decrease the rate of recurrence, and transmission of
infections causing lymphadenopathy.
Go to:

Pearls and Other Issues

 Seventy-five percent of all lymphadenopathies are localized, with more than
50% seen in the head and neck area.
 Most supraclavicular lymphadenopathies are associated with malignancy.
 The most powerful tool in the diagnosis of lymphadenopathy is a careful history and
physical examination.
 The gold standard for diagnosis of lymphadenopathy is tissue obtained either by fine-
needle aspiration or excisional biopsy.
 All generalized lymphadenopathy needs to be carefully worked up and the diagnosis
established.
Go to:

Enhancing Healthcare Team Outcomes

The primary physician and nurse practitioner can diagnose a significant number of the causes
of lymphadenopathy after a careful workup. However, when the diagnosis is in question
varied, consultants can be utilized to clarify the situation. For example:
 Interventional radiology: Examination of the tissue specimen remains the gold
standard for diagnosis of lymphadenopathy.
 General surgery, otorhinolaryngology, urological, thoracic surgery: Clinical
circumstance may dictate the need for an excisional biopsy as opposed to a biopsy
sample examination
 Infectious disease: For the provision of input on both diagnosis and treatment of
infectious causes of lymphadenopathy
 Rheumatology: For the provision of input on both diagnosis and treatment of
rheumatologic diseases causing lymphadenopathy
 Allergy and immunology: For the provision of input on both diagnosis and treatment
of autoimmune, toxicological exposure, and medication-related exposure causes of
lymphadenopathy
 Hematology and oncology: For the provision of input on both diagnosis and treatment
of neoplastic causes of lymphadenopathy