Transcript
LYMPHADENOPATHY
Ehsan Hasanpour
Lymphadenopathy :• Refers to nodes that are abnormal in :1. Size 2. Number 3. Consistency (soft ,firm ,rubbery ,hard
matted ,tender ,movable or fixed)• Soft ,flat ,submandibular nodes (<1cm)are often palpable in
healthy children and young adult ; healthy adults may have palpable inguinal nodes of up to 2cm
Lymphadenopathy :
• Generalized lymphadenopathy (enlargement of > 3 noncontiguous node regions) is often caused by systemic disease
• Localized (regional) lymphadenopathy is most frequently the result of infection in the involved node and/or its drainage area
Generalized lymphadenopathy :
• G L is frequently associated with nonmalignant disorders such as :
Infection : mononucleosis (EBV or CMV , toxoplasmosis, AIDS, other viral infections)
Immunologic disease : SLE , RA , juvenile RA , shugrens , serum sickness
Malignant lymphoma : AML , CML , ALL , CLL
Localized lymphadenopathy :
Viral bacterial malignancy Endocrine Lipid storage D
Others
EBVCMVHBV
HSV-6Varicella
zosterRubellaMeasles
AdenovirusHIV
HSV-8others
StreptococciSataphilococBrucellosis
TuberculosisTularemiaChancroid
SyphilisDiphtheria
others
Hodgkin’sNon-
Hodgkin’sHairy cell leukemia
Amyloidosismetastatic
hyperthyroidism
Gaucher’sFabry
tangier
SarcoidosisCastleman’s
Disease………
Regional adenopathy : Occipital adenopathy → infection of the
scalp Preauricular adenopathy → conjuctival
infections & cat-scratch Disease(Bartonella henselae)
Neck adenopathy → mostly benign ,upper respiratory infections ,oral & dental lesions ,EBV & CMV & other viral D
Supraclavicular & scalene nodes → mostly abnormal , Lymphomas ,others cancers(metastasis from lung , breast , testis or ovarian cancers) or infections( tuberculosis , toxoplasmosis & … ) or sarcoidosis
Regional adenopathy :
Inguinal adenopathy → infections or trauma of lower E , STD , syphilis , Genital herpes or chancroid , metastatic cancers
Axillary adenopathy → injuries , localized infection ,melanoma ,lymphoma , breast cancer
Virchow’s node :
Enlarged left supraclavicular node infiltrated with Metastatic cancer from GI primary
Lab investigation :
• The most common are CBCPBSThroat culture Chest X-rayMonospot test (R/O EBV) Lymph node biopsy
Spleen : • The spleen is a reticuloendothelial organ
that is attached to the stomach via the gastrolienal ligament and to the kidney via the lienorenal ligament.
• It abuts ribs 9-12 and its normal weights is 150 g and is approximately 13 cm in craniocaudal length.
• Usually not palpable , however ,an enlarged or palpable spleen isn’t necessarily of the clinical significance.
Function of spleen :
I. Removal of the abnormal red blood cell(RBCs)II. Synthesis of antibodies in the white pulp ,properdin ,tuftsinIII. Removal of antibody-coated bacteria and antibody-coated
blood cells from the circulationAdaptive functions :IV. Clearance of bacteria and particulates from the bloodV. The generation of immune responses to certain pathogensVI. Extramedullary hematopoiesis in certain disease
Splenomegaly :
• The most common symptoms : pain ,heavy sensation in the LUQ & early satiety.
On examination
• The major physical sign : palpable spleen (middleton maneuver)• temprature• Signs of cirrhosis(e.g jaundice,telangiectasias ,caput
medusa ,ascites)• Heart mur mur (endocarditis , congestive heart failure )• Petechiae ( any cause of thrombocytopenia )• Percussion for splenic dullness → Nixon ,Castell ,Barkun • Techniques : radionuclide scan ,CT ,MRI or ultrasonography
Splenomegaly :
1. Hyperplasia or hypertrophy (↑ splenic functions)
2. Passive congestion (↓ blood flow)
3. Infiltrative disease
Enlargement due to increased demand for splenic functions
Removing of defective
erythrocytes
Response to infection
Disordered immunoregulation
Extramedullary hematopoiesis
SpherocytosisEarly sickle cell
anemiaOvalocytosis
Thalassemia majorHemoglobinopathies
PNH
AIDSViral hepatitis
CMVSubacute bacterial
endocarditisBacterial septicemia
Splenic abscessTB
HistoplasmosisCongenital syphilis
Malaria
RASLE
Collagen vascular DSerum sickness
Immune hemolytic anemiaImmune
thrombocytopeniasSarcoidosis
Drug reactions
MyelofibrosisMarrow damage by
toxins ,radiationMarrow infiltration
by tumors ,leukemias,
gaucher’s D
Enlargement due to abnormal splenic or portal blood flow
CirrhosisHepatic vein obstructionPortal vein obstructionSplenic vein obstruction
Splenic artery aneurysmHepatic schistosomiasisCongestive heart failurePortal hypertension
Infiltration of the spleenIntracellular or extracellular
depositionsBenign and malignant cellular
infiltrationsAmyloidosisGaucher’s D
Niemann-pick DTangier D
HyperlipidemiasHurler’s syndrome
LeukemiaLymphomaHodgkin’s D
Myleoproliferative SAngiosarcomas
Metastatic tumorsHamartomashemangioma
Massive splenomegaly :• More than 8 cm below the left costal margin• Has drained weight of >1000 g
Lab assessment :
CBC diffPBS LFTs Rheumatoid factorUrine culture
Splenectomy : Diagnostic purpose Splenic rupture ( trauma or iatrogenic ) Malignancy Hereditary spherocytosis (at the age of 4 years) Staging for hodgkin’s disease Splenic abcess Pyruvate kinase deficiency If other treatment fails with :
– thrombotic thrombocytopenic purpura(TTP)– Autoimmune hemolytic anemia
Splenectomy as palliative measure only :– angiosarcoma– sickle cell crisis
Post splenectomy care :
Pneumococcal immunization Reimmunisation every 5 years
Haemophilus influenza type B (HIB) vaccine Meningococcal group C vaccine Meningococcal group A vaccine Influenza vaccine yearly
Life-long prophylactic antibiotics aren’t recommended (because of resistant)
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