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1. Confirm the presence of a lymph node

Please confirm the nature of your finding by direct clinical examination by your physician. It is probably a lymph node it occurs in a lymph node region, however this must be confirmed by your physician.
Palpation is the first step to confirm the presence of a lymph node enlargement, followed by ultrasonography and CT scan. PET scans have been reported in some studies to yield better results than CT scan but they are very expensive and not always available.

Palpation

In the case of cervical lymph node enlargement palpation has a low sensitivity and specificity 60-70%.

Supraclavicular lymph node palpation: In one study examining the presence of supraclavicular lymph node enlargement in nonsmall cell lung cancer patients - Nodes had to have a diameter of 22.3 mm or greater to be palpated in 50% of cases. [1]

References:
=========
1. Hans van Overhagen, MD, PhD, Koen Brakel, MD, PhD, Mark W. Heijenbrok, MD, Jan H. L. M. van Kasteren, MD, Cees N. F. van de Moosdijk, MD, Albert C. Roldaan, MD, PhD, Ad P. van Gils, MD, PhD and Bettina E. Hansen, MSc. Metastases in Supraclavicular Lymph Nodes in Lung Cancer: Assessment with Palpation, US, and CT. Radiology 2004;232:75-80.

Ultrasonography

Ultrasound is a useful imaging modality in assessment of cervical lymph nodes. Distribution of nodes, grey scale and power Doppler sonographic features are useful to identify the cause of cervical lymphadenopathy. Useful grey scale features include size, shape, status of echogenic hilus, echogenicity, micronodular appearance, intranodal necrosis and calcification. Adjacent soft tissue edema and matting are particularly useful to identify tuberculosis. Useful power Doppler features include vascular pattern and displacement of vascularity.
Ultrasonography can be combined with fine needle aspiration cytology in which a sample of cells from the lymph node is aspirated using a needle and examined under the microscope.

- Cervical lymph nodes: Ultrasound is a useful imaging modality in evaluation of cervical lymphadenopathy because of its high sensitivity (98%) and specificity (95%) when combined with fine-needle aspiration cytology (FNAC). [1]

References:
=========
Baatenburg de Jong RJ, Rongen RJ, Verwoerd CD, van Overhagen H, Lameris JS, Knegt P. Ultrasound-guided fine-needle aspiration biopsy of neck nodes. Arch Otolaryngol Head Neck Surg 1991;117:402-4.

CT scan

CT scans can detect the presence of enlarged lymph nodes in the neck with a short-axis diameter of 5 mm or greater.

- Supraclavicular lymph node: In one study examining the presence of supraclavicular lymph node enlargement in nonsmall cell lung cancer patients - The sensitivities of US and CT did not differ significantly.[1]

References:
=========
1. Hans van Overhagen, MD, PhD, Koen Brakel, MD, PhD, Mark W. Heijenbrok, MD, Jan H. L. M. van Kasteren, MD, Cees N. F. van de Moosdijk, MD, Albert C. Roldaan, MD, PhD, Ad P. van Gils, MD, PhD and Bettina E. Hansen, MSc. Metastases in Supraclavicular Lymph Nodes in Lung Cancer: Assessment with Palpation, US, and CT. Radiology 2004;232:75-80.

2. Clinical significance

Nodes are generally considered to be normal if they are up to 1 cm in diameter; however, some authors suggest that epitrochlear nodes larger than 0.5 cm or inguinal nodes larger than 1.5 cm should be considered abnormal [1,2].

Little information exists to suggest that a specific diagnosis can be based on node size. However, in one series [3] of 213 adults with unexplained lymphadenopathy, no patient with a lymph node smaller than 1 cm2 had cancer, while cancer was present in 8 percent of those with nodes from 1 cm2 to 2.25 cm2 in size, and in 38 percent of those with nodes larger than 2.25 cm2. These studies were performed in referral centers, and conclusions may not apply in primary care settings.

In children, lymph nodes larger than 2 cm in diameter (along with an abnormal chest radiograph and the absence of ear, nose and throat symptoms) were predictive of granulomatous diseases (ie, tuberculosis, cat-scratch disease or sarcoidosis) or cancer (predominantly lymphomas) [4].

An increase in nodal size on serial examinations is significant. Hence nodes that continue to grow in size are important and those that regress in size tend to be more reassuring.

References:
==========
1. Libman H. Generalized lymphadenopathy. J Gen Intern Med 1987;2:48-58.
2. Morland B. Lymphadenopathy. Arch Dis Child 1995; 73:476-9.
3. Pangalis GA, Vassilakopoulos TP, Boussiotis VA, Fessas P. Clinical approach to lymphadenopathy. Semin Oncol 1993;20:570-82.
4. Slap GB, Brooks JS, Schwartz JS. When to perform biopsies of enlarged peripheral lymph nodes in young patients. JAMA 1984;252:1321-6.

5. Clinical features

Abnormal lymph node enlargement tends to commonly result from infection / immune response, cancer and less commonly due to infiltration of macrophages filled with metabolite deposits (eg, storage disorders).

Infected Lymph nodes tend to be firm, tender, enlarged and warm. Inflammation can spread to the overlying skin, causing it to appear reddened.

Lymph nodes harboring malignant disease tend to be firm, non-tender, matted (ie, stuck to each other), fixed (ie, not freely mobile but rather stuck down to underlying tissue), and increase in size over time.

Sometimes, following infection lymph nodes occasionally remain permanently enlarged, though they should be non-tender, small (less the 1 cm), have a rubbery consistency and none of the characteristics described for malignancy or for infection. These are also known as 'Shotty Lymph nodes'.

 

3. Algorithm for diagnosis

Determine if the lymph node enlargement can be explained or is unexplained.

Only one study provides reliable population-based estimates. Findings from this Dutch study revealed a 0.6 percent annual incidence of unexplained lymphadenopathy in the general population [1].

References:
=========
1. Fijten GH, Blijham GH. Unexplained lymphadenopathy in family practice. An evaluation of the probability of malignant causes and the effectiveness of physicians' workup. J Fam Pract 1988;27: 373-6.

Figure 1:

4. Location of lymph node

The clinical presentation could be either localized or generalized lymph node enlargement: (Generalized lymphadenopathy is defined as two or more sites with abnormal lymph nodes).

The body has approximately 600 lymph nodes, but only those in the submandibular, axillary or inguinal regions may normally be palpable in healthy people [1].

References:
=========
1. Goroll AH, May LA, Mulley AG Jr. Primary care medicine: office evaluation and management of the adult patient. 2d ed. Philadelphia: Lippincott, 1987.

Submandibular lymph node enlargement

The submandibular lymph nodes are located along the underside of the jaw on either side. They drain the tongue, submaxillary gland, lips and mouth, conjunctivae. Common causes of enlargement include infections of head, neck, sinuses, ears, eyes, scalp, pharynx.

Salivary gland?

Submental lymph node enlargement

The submental lymph node is located just below the chin. It drains the lower lip, floor of mouth, teeth, submental salivary gland, tip of tongue, skin of cheek. Common causes of enlargement include mononucleosis syndromes, Epstein-Barr virus, cytomegalovirus, toxoplasmosis, dental pathology such as periodontitis.

Submental salivary gland.

Jugular lymph node enlargement

The jugular lymph nodes lie both on top of and beneath the sternocleidomastoid muscles (SCM) on either side of the neck, from the angle of the jaw to the top of the clavicle. They drain the tongue, tonsil, pinna, parotid. Common causes of enlargement include pharyngitis organisms, rubella.

Posterior cervical lymph node enlargement

The posterior cervical lymph nodes extend in a line posterior to the sternocleidomastoid muscles but in front of the trapezius, from the level of the mastoid bone to the clavicle (on the side of the neck near the back). They drain the scalp and neck, skin of arms and pectorals, thorax, cervical and axillary nodes. Common causes of enlargement include tuberculosis, lymphoma, head and neck malignancy.

Suboccipital lymph node enlargement

The suboccipital lymph node is located at the junction between the back of the head and neck. It drains the scalp and head. Common causes of enlargement include local infection from the scalp or surrounding tissue.

Postauricular lymph node enlargement

The postauricular lymph nodes are located behind the ears. They drain the external auditory meatus, pinna, scalp. Common causes of enlargement include local infection.

Preauricular lymph node enlargement

The preauricular lymph nodes are located in front of the ears. They drain the eyelids and conjunctivae, temporal region, pinna. Common causes of enlargement include diseases of the external auditory canal. This condition can be confused with some diseases of the parotid gland.

Right supraclavicular lymph node enlargement

The right supraclavicular lymph node is located on the right side in the hollow above the clavicle, just lateral to where it joins the sternum. It drains the mediastinum, lungs, esophagus. Common causes of enlargement include lung, retroperitoneal or gastrointestinal cancer.

Left supraclavicular lymph node enlargement

The left supraclavicular lymph node is located on the left side in the hollow above the clavicle, just lateral to where it joins the sternum. It drains the thorax, abdomen via thoracic duct. Common causes of enlargement include lymphoma, thoracic or retroperitoneal cancer, bacterial or fungal infection.

Axillary lymph node enlargement

The axillary lymph nodes are located in the axillae (arm pits). They drain the arm, thoracic wall, breast. Common causes of enlargement include infections, cat-scratch disease, lymphoma, breast cancer, silicone implants, brucellosis, melanoma.

Epitrochlear lymph node enlargement

The epitrochlear lymph nodes drain the ulnar aspect of forearm and hand. Common causes of enlargement include infections, lymphoma, sarcoidosis, tularemia, secondary syphilis.

Inguinal lymph node enlargement

The inguinal lymph nodes are situated in the crease between the leg and pelvis (more on the outside of that crease, ie, laterally). They drain the penis, scrotum, vulva, vagina, perineum, gluteal region, lower abdominal wall, lower anal canal. Common causes of enlargement include infections of the leg or foot, STDs (eg, herpes simplex virus, gonococcal infection, syphilis, chancroid, granuloma inguinale, lymphogranuloma venereum), lymphoma, pelvic malignancy, bubonic plague.

6. Size

Below is a repetition of the content included in clinical significance.

Nodes are generally considered to be normal if they are up to 1 cm in diameter; however, some authors suggest that epitrochlear nodes larger than 0.5 cm or inguinal nodes larger than 1.5 cm should be considered abnormal [1,2].

Little information exists to suggest that a specific diagnosis can be based on node size. However, in one series [3] of 213 adults with unexplained lymphadenopathy, no patient with a lymph node smaller than 1 cm2 had cancer, while cancer was present in 8 percent of those with nodes from 1 cm2 to 2.25 cm2 in size, and in 38 percent of those with nodes larger than 2.25 cm2. These studies were performed in referral centers, and conclusions may not apply in primary care settings.

In children, lymph nodes larger than 2 cm in diameter (along with an abnormal chest radiograph and the absence of ear, nose and throat symptoms) were predictive of granulomatous diseases (ie, tuberculosis, cat-scratch disease or sarcoidosis) or cancer (predominantly lymphomas) [4].

An increase in nodal size on serial examinations is significant. Hence nodes that continue to grow in size are important and those that regress in size tend to be more reassuring.

References:
==========
1. Libman H. Generalized lymphadenopathy. J Gen Intern Med 1987;2:48-58.
2. Morland B. Lymphadenopathy. Arch Dis Child 1995; 73:476-9.
3. Pangalis GA, Vassilakopoulos TP, Boussiotis VA, Fessas P. Clinical approach to lymphadenopathy. Semin Oncol 1993;20:570-82.
4. Slap GB, Brooks JS, Schwartz JS. When to perform biopsies of enlarged peripheral lymph nodes in young patients. JAMA 1984;252:1321-6.

7. Pain/Tenderness

Pain/Tenderness. When a lymph node rapidly increases in size, its capsule stretches and causes pain. Pain is usually the result of an inflammatory process or suppuration, but pain may also result from hemorrhage into the necrotic center of a malignant node. The presence or absence of tenderness does not reliably differentiate benign from malignant nodes.[1]

References:
=========
1. Fijten GH, Blijham GH. Unexplained lymphadenopathy in family practice. An evaluation of the probability of malignant causes and the effectiveness of physicians' workup. J Fam Pract 1988;27: 373-6.

8. Consistency

Stony-hard nodes are typically a sign of cancer, usually metastatic. Very firm, rubbery nodes suggest lymphoma. Softer nodes are the result of infections or inflammatory conditions. Suppurant nodes may be fluctuant. The term "shotty" refers to small nodes that feel like buckshot under the skin, as found in the cervical nodes of children with viral illnesses.

9. Matting

A group of nodes that feels connected and seems to move as a unit is said to be "matted." Nodes that are matted can be either benign (e.g., tuberculosis, sarcoidosis or lymphogranuloma venereum) or malignant (e.g., metastatic carcinoma or lymphomas).

10. Constitutional symptoms

Constitutional symptoms such as fever, weight loss, fatigue or night sweats could suggest disorders such as tuberculosis, lymphoma, collagen vascular diseases, unrecognized infection or malignancy. The presence of fever is commonly associated with infections.

Diseases that cause lymphadenopathy and rash are

Diseases that cause lymphedopathy and fever are

11. Evaluation of Unexplained Generalized Lymphadenopathy

Generalized lymphadenopathy is defined as two or more sites with abnormal lymph nodes.

There are many causes of generalized lymphadenopathy of which the mononucleosis type syndromes are the most common. They usually present with fatigue, malaise, fever and atypical lymphocytosis on examination of the blood picture.

Splenomegaly may be present in 50% of patients due to Epstein-Barr virus infection. These cases can be diagnosed using the monospot test, IgM EA or VCA.

 

1) Are there any constitutional symptoms that may hint at the possible cause?
Constitutional symptoms to be on the look out for are in patients with unexplained generalized lymph node enlargement are:

Fatigue, malaise, fever and atypical lymphocytosis which is commonly associated with Mononucleosis-type syndromes. Abdominal pain (especially on the left side) maybe due to splenomegaly which is common in 50% of patients with Epstein-Barr virus infection.

Toxoplasmosis is usually asymptomatic in 80 to 90% of patients, the diagnosis being made by a raised IgM toxoplasma antibody found on investigation.

Cytomegalovirus infection is often associated with mild symptoms; patients may have hepatitis and a raised IgM CMV antibody. CMV can also be detected by viral culture of urine or blood.

Initial stages of HIV infection presents with "flu-like" illness and rash and is confirmed by an HIV antibody test.

Cat-scratch disease presents with fever in one third of patients; cervical or axillary nodes are more commonly enlarged. It is usually diagnosed by clinical criteria; in some cases a biopsy may be necessary.

Pharyngitis due to group A streptococcus, gonococcus is suspected in the patient with fever, pharyngeal exudates, cervical lymph node enlargement and is diagnosed by throat culture.

Tuberculosis lymphadenitis presents with painless, matted cervical nodes. The diagnosis is confirmed by PPD, biopsy.

Secondary syphilis presents with rash and is diagnosed by RPR test.

Hepatitis B commonly manifests with fever, nausea, vomiting, jaundice. Liver function tests, HBsAg confirm the diagnosis.

Lymphogranuloma venereum presents with inguinal lymph nodes that are tender and matted. The diagnosis is made by serology.

Chancroid presents with a painful ulcer and painful inguinal nodes. Diagnosis is based on both clinical criteria and culture.

Lupus erythematosus manifests with arthritis, rash, serositis, renal, neurologic and hematologic disorders. Suspicion is confirmed by clinical criteria, antinuclear antibodies, complement levels.

Rheumatoid arthritis presents with typical arthritis and is diagnosed by clinical criteria and rheumatoid factor.

Lymphoma presents with fever, night sweats, weight loss in 20 to 30% of patients in addition to lymph node enlargement and is confirmed by biopsy.

Leukemia shows blood dyscrasias, bruising in addition to generalized lymphadenopathy. The diagnosis is made by blood smear, bone marrow examination.

Serum sickness presents with fever, malaise, arthralgia, urticaria in addition to a history of exposure to antisera or medications. Clinical criteria, complement assays are used to confirm the diagnosis.

Sarcoidosis presents with hilar nodes, skin lesions, dyspnea. A biopsy may be needed to confirm the diagnosis.

Kawasaki disease presents with fever, conjunctivitis, rash, mucous membrane lesions and is diagnosed using a set of clinical criteria.

Less common causes of generalized lymphadenopathy include Lyme disease, measles, rubella, tularemiala, brucellosis, plague, typhoid fever, Still's disease, dermatomyositis and amyloidosis.


 

, "flu-like" illness, rash, nausea, vomiting, jaundice, arthritis, renal, neurologic, hematologic disorders, bruising, conjunctivitis, sweat, shortness of breath and cough. It should be emphasized that these symptoms are a cause for concern if they are excessive in intensity or duration. Any of these symptoms can cause the doctor to suspect a specific disease entity causing generalized lymphadenopathy.

TABLE 4
Evaluation of Suspected Causes of Generalized Lymphadenopathy
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Disorder
Associated findings
Test
Mononucleosis-type syndromes Fatigue, malaise, fever, atypical lymphocytosis
Epstein-Barr virus* Splenomegaly in 50% of patients Monospot, IgM EA or VCA
Toxoplasmosis* 80 to 90% of patients are asymptomatic IgM toxoplasma antibody
Cytomegalovirus* Often mild symptoms; patients may have hepatitis IgM CMV antibody, viral culture of urine or blood
Initial stages of HIV infection* "Flu-like" illness, rash HIV antibody
Cat-scratch disease Fever in one third of patients; cervical or axillary nodes Usually clinical criteria; biopsy if necessary
Pharyngitis due to group A streptococcus, gonococcus Fever, pharyngeal exudates, cervical nodes Throat culture on appropriate medium
Tuberculosis lymphadenitis* Painless, matted cervical nodes PPD, biopsy
Secondary syphilis* Rash RPR
Hepatitis B* Fever, nausea, vomiting, icterus Liver function tests, HBsAg
Lymphogranuloma venereum Tender, matted inguinal nodes Serology
Chancroid Painful ulcer, painful inguinal nodes Clinical criteria, culture
Lupus erythematosus* Arthritis, rash, serositis, renal, neurologic, hematologic disorders Clinical criteria, antinuclear antibodies, complement levels
Rheumatoid arthritis* Arthritis Clinical criteria, rheumatoid factor
Lymphoma* Fever, night sweats, weight loss in 20 to 30% of patients Biopsy
Leukemia* Blood dyscrasias, bruising Blood smear, bone marrow
Serum sickness* Fever, malaise, arthralgia, urticaria; exposure to antisera or medications Clinical criteria, complement assays
Sarcoidosis Hilar nodes, skin lesions, dyspnea Biopsy
Kawasaki disease* Fever, conjunctivitis, rash, mucous membrane lesions Clinical criteria

Less common causes of lymphadenopathy
Lyme disease* Rash, arthritis IgM serology
Measles* Fever, conjunctivitis, rash, cough Clinical criteria, serology
Rubella* Rash Clinical criteria, serology
Tularemiala* Fever, ulcer at inoculation site Blood culture, serology
Brucellosis* Fever, sweats, malaise Blood culture, serology
Plague Febrile, acutely ill with cluster of tender nodes Blood culture, serology
Typhoid fever* Fever, chills, headache, abdominal complaints Blood culture, serology
Still's disease* Fever, rash, arthritis Clinical criteria, antinuclear antibody, rheumatoid factor
Dermatomyositis* Proximal weakness, skin changes Muscle enzymes, EMG, muscle biopsy
Amyloidosis* Fatigue, weight loss Biopsy

*--Causes of generalized lymphadenopathy.

EA=early antibody; VCA=viral capsid antigen; CMV=cytomegalovirus; HIV=human immunodeficiency virus; PPD=purified protein derivative; RPR=rapid plasma reagin; HBsAg=hepatitis B surface antigen; EMG=electromyelography.

2) Are there epidemiologic clues (Table 1) such as occupational exposures, recent travel or high-risk behaviors that suggest specific disorders?

Environmental risks include: tick bites, tuberculosis, recent blood transfusion or transplant, high-risk sexual behavior, intravenous drug use.
Occupational risks: Hunters, trappers, fishermen, fishmongers, slaughterhouse workers have a higher risk for certain diseases that cause lymph node enlargement.
Travel related risks: Recent travel to any of the following geographical areas; Arizona, southern California, New Mexico, western Texas, Southwestern United States, Southeastern or central United States, Southeast Asia, India, northern Australia, Central or west Africa, Central or South America, East Africa, Mediterranean, China, Latin America, Mexico, Peru, Chile, India, Pakistan, Egypt, Indonesia.

TABLE 1
Epidemiologic Clues to the Diagnosis of Generalized  Lymphadenopathy (same as above text)
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Exposure
Diagnosis
General
Cat
Undercooked meat
Tick bite
Tuberculosis
Recent blood transfusion or transplant
High-risk sexual behavior

Intravenous drug use

Cat-scratch disease, toxoplasmosis
Toxoplasmosis
Lyme disease, tularemia
Tuberculous adenitis
Cytomegalovirus, HIV
HIV, syphilis, herpes simplex virus, cytomegalovirus, hepatitis B infection
HIV, endocarditis, hepatitis B infection
Occupational
Hunters, trappers
Fishermen, fishmongers,
slaughterhouse workers

Tularemia
Erysipeloid
Travel-related
Arizona, southern California, New Mexico, western Texas
Southwestern United States
Southeastern or central United States
Southeast Asia, India,
northern Australia
Central or west Africa
Central or South America
East Africa, Mediterranean, China,
Latin America
Mexico, Peru, Chile, India, Pakistan,
Egypt, Indonesia

Coccidioidomycosis

Bubonic plague
Histoplasmosis
Scrub typhus

African trypanosomiasis (sleeping sickness)
American trypanosomiasis (Chagas' disease)
Kala-azar (leishmaniasis)

Typhoid fever

HIV=human immunodeficiency virus.

3) Third, is the patient taking a medication that may cause lymphadenopathy?

Some medications are known to specifically cause lymphadenopathy (e.g., phenytoin [Dilantin]), while others, such as cephalosporins, penicillins or sulfonamides, are more likely to cause a serum sickness-like syndrome with fever, arthralgias and rash in addition to lymphadenopathy.
A more extensive list of medications causing lymph node enlargement includes: [1]

Allopurinol (Zyloprim)
Atenolol (Tenormin)
Captopril (Capozide)
Carbamazepine (Tegretol)
Cephalosporins
Gold
Hydralazine (Apresoline) Penicillin
Phenytoin (Dilantin)
Primidone (Mysoline)
Pyrimethamine (Daraprim)
Quinidine
Sulfonamides
Sulindac (Clinoril)

References:
=========
1. Pangalis GA, Vassilakopoulos TP, Boussiotis VA, Fessas P. Clinical approach to lymphadenopathy. Semin Oncol 1993; 20:570-82.

12. Is it cancer?

Incidence
Findings from a Dutch study revealed that only 10 percent of patients with unexplained adenopathy required referral to a subspecialist, 3 percent required a biopsy and only 1 percent had a malignancy.[1]

References:
==========
1. Fijten GH, Blijham GH. Unexplained lymphadenopathy in family practice. An evaluation of the probability of malignant causes and the effectiveness of physicians' workup. J Fam Pract 1988;27: 373-6.

Age
In primary care settings, patients 40 years of age and older with unexplained lymphadenopathy have about a 4 percent risk of cancer versus a 0.4 percent risk in patients younger than age 40.[1]

References:
==========
1. Fijten GH, Blijham GH. Unexplained lymphadenopathy in family practice. An evaluation of the probability of malignant causes and the effectiveness of physicians' workup. J Fam Pract 1988;27: 373-6.

13. The supraclavicular lymph node

Right supraclavicular lymph node enlargement

The right supraclavicular lymph node is located on the right side in the hollow above the clavicle, just lateral to where it joins the sternum. It drains the mediastinum, lungs, esophagus. Common causes of enlargement include lung, retroperitoneal or gastrointestinal cancer.

Left supraclavicular lymph node enlargement

The left supraclavicular lymph node is located on the left side in the hollow above the clavicle, just lateral to where it joins the sternum. It drains the thorax, abdomen via thoracic duct. Common causes of enlargement include lymphoma, thoracic or retroperitoneal cancer, bacterial or fungal infection.

Supraclavicular lymphadenopathy has the highest risk of malignancy, estimated as 90 percent in patients older than 40 years and 25 percent in those younger than age 40 [1]. This refers to a clinically significant lymph node enlargement. Little information exists to suggest that a specific diagnosis can be based on node size.
However, nodes are generally considered to be normal if they are up to 1 cm in diameter [2,3].

References:
==========
1. Fijten GH, Blijham GH. Unexplained lymphadenopathy in family practice. An evaluation of the probability of malignant causes and the effectiveness of physicians' workup. J Fam Pract 1988;27: 373-6.
2. Libman H. Generalized lymphadenopathy. J Gen Intern Med 1987;2:48-58.
3. Morland B. Lymphadenopathy. Arch Dis Child 1995; 73:476-9.

14. How to proceed

If after evaluation the lymph node enlargement is unexplained, then your doctor may choose to put you under observation for 3 to 4 weeks and then re-evaluate these nodes. The doctor may also recommend a course of antibiotics based on his evaluation.

If it persists after a period of observation then the patient should seek medical attention which may require further investigations using ultrasonography and FNAC or an excisional biopsy.

If the lymph node enlargement is unexplained, it may need to undergo a period of observation for 3-4weeks +/- empirical antibiotics.



 

 

Causes of pretracheal LN enlargement

-Sarcoidosis
-lymphoma
-lung, head and neck, esophageal, laryngeal Cancer.
-lung infection
-TB

Rarely interstitial lung disease