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Lymphadenopathy: A. Suryaveda Aakanksha Sangwaan Aishwarya Alankar Parashar
Lymphadenopathy: A. Suryaveda Aakanksha Sangwaan Aishwarya Alankar Parashar
A. Suryaveda
Aakanksha Sangwaan
Aishwarya
Alankar Parashar
The body has approximately 600 lymph nodes, but only those in the submandibular,
axillary or inguinal regions may normally be palpable in healthy people.
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• The left subclavicular LN receives drainage from Thoracic Duct, so Virchows
node can be present in any GI, Genitourinary malignancies
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Causes of Lymphadenopathy
Generalized lymphadenopathy
TB Lymphadenitis
• Lymphadenitis is the most common clinical presentation of extrapulmonary
tuberculosis.
• Primary TB spreads from lung tissue(gohn focus) to hilar, paratracheal LN. The
Ghon focus and related hilar lymphadenopathy form the primary complex.
• Hilar, mediastinal and paratracheal lymphnodes are the first site of spread of
infection from the lung parenchyma.
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• The onset of delayed hypersensitivity is accompanied by marked hyperemia, swelling,
necrosis and caseation of the centre of the nodes. Adhesion to the adjacent skin may result
in induration and purplish discolouration.
• This can be followed by progressive swelling and matting with other nodes within a group.
The centre of the enlarging gland becomes soft and caseous material may rupture into
surrounding tissue or through skin with sinus formation.
• Tuberculous mediastinal lymphadenitis may enlarge and cause compression of major blood
vessels, phrenic or recurrent laryngeal nerves. Mediastinal lymph node involvement include
dysphagia, oesophago-mediastinal fistula and tracheo-oesophageal fistula.
• Upper abdominal and mediastinal lymph nodes may cause thoracic duct obstruction and
chylothorax, chylous ascites or chyluria. Cardiac tamponade has also been reported due to
mediastinal lymph node tuberculosis.
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Tb lymphadenitis staging
• Multiplicity, matting and caseation are features of TB lymphadenitis.
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Malignancy
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Infectious Vs NonInfectious
USG - Soft tissue edema and nodal matting on B-mode imaging suggest tubercular
cervical lymphadenopathy.
FNAC - abscess, acid fast staining, Frei’s intradermal test for lymphogranuloma inguinale,
atypical cells.
Radiology - calcified LN can be seen in X-ray, CT for mediastinal LN, Can Detect TB and
Carcinoma in X-ray.