16. Differential diagnosis of enlarged lymph nodes and splenomegaly

Enlarged lymph nodes

When is it seen?
May be incidental finding in patients being examined for various reasons
Doctor must decide whether the lymphadenopathy is a normal finding or one that requires further study
Soft, flat, submandibular nodes (<1cm) are often palpable in healthy children and young adults
Healthy adults may have palpable inguinal nodes of up to 2cm
Locations
Virchow’s node- enlarged left supraclavicular node!
Can occur from lung, breasts, testis or ovarian cancers
TB, sarcoidosis, toxoplasmosis
Axillary lymphadenopathy- injuries or localised infections
Secondary to breast cancer
Inguinal lymphadenopathy- secondary to infections or trauma
May accompany STIs
Occipital
Preauricular
Supraclavicular
Symptoms
Sore throat
Cough
Fever
Night sweats
Fatigue
Weight loss
Pain in nodes
Physical examination
Localised or generalised nodes
Size of nodes, texture, presence of nodal tenderness
Splenomegaly

Localised lympadenopathy
Local infection- pyogenic (pharyngitis), viral infections, cat scratch fever, TB, lymphogranuloma venereum
Lymphoma- HL and NHL
Secondary carcinomas
Generalised lymphadenopathy
Infection- viral (measles, rubella, HIV), bacterial (syphylis, brucellosis, TB, salmonella), fungal (histoplasmosis), protozoal (toxoplasmosis)
Non-infectious inflammatory disease- sarcoidosis, RA, SLE, serum sickness
Malignancy- CLL, ALL, lymphoma, Waldenstrom’s macroglobulinemia
Sinus histiocytosis
Reaction to drugs and chemicals (hydantoins)
Hyperthyroidism