Lymphadenopathy (Redirected from Hilar lymphadenopathy)

Lymphadenopathy
Other namesAdenopathy, swollen lymph nodes, swollen glands
A CT scan of axillary lymphadenopathy in a 57-year-old man with multiple myeloma.
SpecialtyInfectious disease, Oncology
Symptomsfever; Hard, fixed, rapidly growing nodes, indicating a possible cancer or lymphoma; night sweats; Runny nose; sore throat
Causesinfections; autoimmune diseases; malignancies; histiocytoses; storage diseases; benign hyperplasia; drug reactions
Risk factorsback pain; constipation; urinary frequency
Diagnostic methodCT scan; MRI scan; ultrasound

Lymphadenopathy or adenopathy is a disease of the lymph nodes, in which they are abnormal in size or consistency. Lymphadenopathy of an inflammatory type (the most common type) is lymphadenitis, producing swollen or enlarged lymph nodes. In clinical practice, the distinction between lymphadenopathy and lymphadenitis is rarely made and the words are usually treated as synonymous. Inflammation of the lymphatic vessels is known as lymphangitis. Infectious lymphadenitis affecting lymph nodes in the neck is often called scrofula.

Lymphadenopathy is a common and nonspecific sign. Common causes include infections (from minor causes such as the common cold and post-vaccination swelling to serious ones such as HIV/AIDS), autoimmune diseases, and cancer. Lymphadenopathy is frequently idiopathic and self-limiting.

Causes

Retroperitoneal lymphadenopathies of testicular seminoma embrace the aorta. Computed tomography image.

Lymph node enlargement is recognized as a common sign of infectious, autoimmune, or malignant disease. Examples may include:

Infectious causes of lymphadenopathy may include bacterial infections such as cat scratch disease, tularemia, brucellosis, or prevotella, as well as fungal infections such as paracoccidioidomycosis.

Benign (reactive) lymphadenopathy

Benign lymphadenopathy is a common biopsy finding, and may often be confused with malignant lymphoma. It may be separated into major morphologic patterns, each with its own differential diagnosis with certain types of lymphoma. Most cases of reactive follicular hyperplasia are easy to diagnose, but some cases may be confused with follicular lymphoma. There are seven distinct patterns of benign lymphadenopathy:

  • Follicular hyperplasia: This is the most common type of reactive lymphadenopathy.
  • Paracortical hyperplasia/Interfollicular hyperplasia: It is seen in viral infections, skin diseases, and nonspecific reactions.
  • Sinus histiocytosis: It is seen in lymph nodes draining limbs, inflammatory lesions, and malignancies.
  • Nodal extensive necrosis
  • Nodal granulomatous inflammation
  • Nodal extensive fibrosis (Connective tissue framework)
  • Nodal deposition of interstitial substance

These morphological patterns are never pure. Thus, reactive follicular hyperplasia can have a component of paracortical hyperplasia. However, this distinction is important for the differential diagnosis of the cause.

Diagnosis

Medical ultrasonography of a typical normal lymph node: smooth, gently lobulated oval with a hypoechoic cortex measuring less than 3 mm in thickness with a central echogenic hilum.
Ultrasonography of a suspected malignant lymph node:
- Absence of the fatty hilum
- Increased focal cortical thickness greater than 3 cm
- Doppler ultrasonography that shows hyperaemic blood flow in the hilum and central cortex and/or abnormal (non-hilar cortical) blood flow.

In cervical lymphadenopathy (of the neck), it is routine to perform a throat examination including the use of a mirror and an endoscope.

On ultrasound, B-mode imaging depicts lymph node morphology, whilst power Doppler can assess the vascular pattern. B-mode imaging features that can distinguish metastasis and lymphoma include size, shape, calcification, loss of hilar architecture, as well as intranodal necrosis. Soft tissue edema and nodal matting on B-mode imaging suggests tuberculous cervical lymphadenitis or previous radiation therapy. Serial monitoring of nodal size and vascularity are useful in assessing treatment response.

Fine-needle aspiration cytology (FNAC) has sensitivity and specificity percentages of 81% and 100%, respectively, in the histopathology of malignant cervical lymphadenopathy. PET-CT has proven to be helpful in identifying occult primary carcinomas of the head and neck, especially when applied as a guiding tool prior to panendoscopy, and may induce treatment related clinical decisions in up to 60% of cases.

Classification

Lymphadenopathy may be classified by:

  • Size, where lymphadenopathy in adults is often defined as a short axis of one or more lymph nodes is greater than 10mm.
  • By extent:
    • Localized lymphadenopathy: due to localized spot of infection; e.g., an infected spot on the scalp will cause lymph nodes in the neck on that same side to swell up
Inflammatory localized lymphadenopathy at right mandibular angle

Size

Micrograph of dermatopathic lymphadenopathy, a type of lymphadenopathy. H&E stain.
  • By size, where lymphadenopathy in adults is often defined as a short axis of one or more lymph nodes is greater than 10mm. However, there is regional variation as detailed in this table:
Upper limit of lymph node sizes in adults
Generally 10 mm
Inguinal 10 – 20 mm
Pelvis 10 mm for ovoid lymph nodes, 8 mm for rounded
Neck
Generally (non-retropharyngeal) 10 mm
Jugulodigastric lymph nodes 11mm or 15 mm
Retropharyngeal 8 mm
  • Lateral retropharyngeal: 5 mm
Mediastinum
Mediastinum, generally 10 mm
Superior mediastinum and high paratracheal 7mm
Low paratracheal and subcarinal 11 mm
Upper abdominal
Retrocrural space 6 mm
Paracardiac 8 mm
Gastrohepatic ligament 8 mm
Upper paraaortic region 9 mm
Portacaval space 10 mm
Porta hepatis 7 mm
Lower paraaortic region 11 mm

Lymphadenopathy of the axillary lymph nodes can be defined as solid nodes measuring more than 15 mm without fatty hilum. Axillary lymph nodes may be normal up to 30 mm if consisting largely of fat.

In children, a short axis of 8 mm can be used. However, inguinal lymph nodes of up to 15 mm and cervical lymph nodes of up to 20 mm are generally normal in children up to age 8–12.

Lymphadenopathy of more than 1.5–2 cm increases the risk of cancer or granulomatous disease as the cause rather than only inflammation or infection. Still, an increasing size and persistence over time are more indicative of cancer.

See also


This page was last updated at 2024-01-26 09:25 UTC. Update now. View original page.

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