Enlarged lymph nodes, or lymphadenopathy, can be a sign of various medical conditions, ranging from benign infections to malignancies. The approach to diagnosing and managing enlarged lymph nodes is systematic and involves considering the location, duration, and associated symptoms.
Causes of Enlarged Lymph Nodes:
- Infections:
- Bacterial (e.g., Streptococcal or Staphylococcal infection)
- Viral (e.g., Infectious mononucleosis, HIV)
- Fungal or Parasitic infections
- Malignancies:
- Primary cancers of the lymphatic system (e.g., Lymphoma)
- Metastasis from other cancers (e.g., Breast, Lung)
- Immune Disorders:
- Autoimmune diseases (e.g., Rheumatoid Arthritis, Lupus)
- Hypersensitivity reactions
- Other Causes:
- Sarcoidosis
- Storage diseases
- Medication-induced
Diagnosis:
- History:
- Duration of lymph node enlargement.
- Associated symptoms (fever, night sweats, weight loss ie “B symptoms” in lymphoma).
- Recent infections or vaccinations.
- History of malignancy.
- Travel history and exposure to pets or vectors.
- Medication history.
- Physical Examination:
- Location, size, consistency, tenderness, and mobility of the lymph nodes.
- Presence of systemic signs (e.g., fever, rash).
- Examination of other lymph node areas.
- Assessment for hepatosplenomegaly and other organ involvement.
- Investigations:
- Blood Tests: Complete blood count, ESR, CRP, liver function tests, LDH, EBV and HIV test.
- Imaging: Ultrasound for local assessment; CT or MRI for more detailed evaluation.
- Biopsy: Essential for definitive diagnosis, particularly if malignancy is suspected or lymphadenopathy is persistent, unexplained, and/or associated with systemic symptoms.
- Specialized Tests: Depending on clinical suspicion (e.g., Tuberculin skin test, serologies for specific infections).
Differential Diagnosis (DDx):
- Reactive lymphadenopathy (due to infection or inflammation)
- Lymphoma
- Metastatic cancer
- Autoimmune lymphadenopathy
- Infectious mononucleosis
- Tuberculosis
- Sarcoidosis
Management:
- Treatment of Underlying Cause:
- Antibiotics for bacterial infections.
- Antiviral or antifungal medications for specific infections.
- Chemotherapy, radiation, or other oncologic treatments for malignancies.
- Corticosteroids or immunosuppressive agents for autoimmune diseases.
- Supportive Care:
- Analgesics for pain management.
- Management of associated symptoms.
- Monitoring and Follow-Up:
- Regular follow-up to assess response to treatment.
- Monitoring for the development of new symptoms or complications.
- Referral:
- Referral to specialists (e.g., oncologist, infectious disease specialist) for further evaluation and management in cases of uncertain diagnosis, suspected malignancy, or lack of response to initial treatment.
Conclusion:
Enlarged lymph nodes require a thorough evaluation to determine the underlying cause. The management strategy focuses on treating the specific underlying condition. Persistent, unexplained, or atypical lymphadenopathy warrants further investigation, often including biopsy, to rule out serious conditions like malignancy. Regular follow-up is important to ensure appropriate management and to monitor for potential complications.