lymphadenopathy

(lim″fad″ĕ-nop′ă-thē )

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[ lymph- + adenopathy ]
Enlargement of lymph nodes (LN), typically to greater than 1.5 cm. The increased size is caused by activation and proliferation of lymphocytes and phagocytic white blood cells within the node or by invasion of the node by cancer. Common causes of lymph node enlargement are local, regional, or systemic infections, or occasionally vaccine injections. Lymphadenopathy may also result from less common illnesses, including thyroiditis, thyrotoxicosis, autoimmune diseases, e.g., rheumatoid arthritis, sarcoidosis, and drug reactions, e.g., phenytoin.

CERVICAL LYMPHADENOPATHY Squamous cell carcinoma of the neck
Enlarged LNs may be tender or not; tenderness often is present when lymph nodes swell rapidly, e.g., in response to infections, hypersensitivity reactions, or some fulminant lymphomas. Rock-hard, enlarged, and immobile LNs are typical of metastatic cancer, whereas rubbery LNs are found in lymphomas. LNs that do not resolve spontaneously within 4 to 6 weeks, or for which no obvious explanation exists, usually are sampled by biopsy or aspiration.
SEE TABLE: Causes of Swollen Glands
Causes of Swollen Glands

Category	Examples	Location	Age of patient	Texture	Size	Associated signs or symptoms	Diagnostic tests	Necessity for biopsy or aspirate
Bacterial infection	Strep throat; cat scratch disease	Angle of the jaw; axilla, neck	Child or preteen; any	Relatively soft and tender; relatively soft and tender	1 sq. cm;>1 cm	Fever, sore throat, tonsillar exudate, malaise, headache, difficulty swallowing; may have fever, night sweats, weight loss	Can be diagnosed clinically; antibody blood tests	No; not usually
Granuloma	Tuberculosis; sarcoidosis	Neck, chest; hilum of the lung and other locations	Any; usually adults	Relatively soft and tender; rubbery	>1 cm;>1 cm, sometimes massive	May have fever, night sweats, weight loss, productive sputum; cough, shortness of breath, may have systemic illness, or be asymptomatic	Tuberculin (purified protein derivative), interferon blood test, sputum for acid-fast bacilli; blood for ACE levels	Occasionally; often
Metastatic cancer	Breast cancer	Axilla next to the breast	Adults	Rock hard	Especially likely if>2 cm	Lump in the breast	Mammography, ultrasound, other imaging techniques	Yes
Lymphoma	Hodgkin lymphoma	Chest, neck, axilla, groin, or all of these	Young adult	Rubbery	>1 cm	May have fever, night sweats, weight loss, enlarged spleen	Radiologic imaging	Yes
Viral infection	Mononucleosis; HIV/AIDS	Head and neck, spleen; generalized	Young adult; any, but most often young adult or adult	Rubbery; firm	About 1 cm; variable	May have fever, night sweats, weight loss; fever, night sweats, weight loss, or symptoms of opportunistic infection	Tests for Epstein-Barr virus, heterophile antibody; antibody blood tests	No; not usually

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