Neobook — clinical reference

Introduction
Differential Diagnosis in Pathological Cervical Adenopathy Seen in a Surgical Clinic
Lymphadenopathy Algorithm

Context: Outpatients

Introduction

By far the most common cause of neck mass is lymphadenopathy, across all age groups. Most cases represent reactive enlargement to recent upper aerodigestive tract infections, and some do not have an overt precipitating cause. Occasionally the neck lymph nodes are markers of more systemic illness (such as HIV, infectious mononucleosis, sarcoidosis, etc).

Decide clinically if the mass you feel is an enlarged lymph node or not. It is seldom necessary to order US imaging to confirm this. Always examine the patient thoroughly, look for generalized lymphadenopathy, splenic-, and hepatomegaly. Examine the breasts in women. Look for subtle skin lesions, and examine the floor of the mouth and teeth.

The key clinical decision is to consider if the patient's lymphadenopathy is reactive (benign and self-limiting) or pathological. The former is of little relevance, whereas pathological lymph nodes need urgent investigation.

	Pathological	Reactive
Duration	Persistent	Short history
Pain	Nil	Tender
Predisposing Factors	Systemic symptoms, LOW, hoarseness	Reactive to URTI, dental sepsis, pharyngitis
Size	Large >2cm	Usually <2cm, often more than one LN enlarged
Consistency	Firm, matted, fixed rubbery	Tender, mobile

Differential Diagnosis in Pathological Cervical Adenopathy Seen in a Surgical Clinic

Incidence	Clues
TB (65%)	Matted, fixed, may discharge greyish pus or have chronic sinus Systemic symptoms, chronic cough, HIV+
Lymphoma (15%)	Large, rounded rubbery nodes May have Type B symptoms
Metastases (15%)	Primary sites are ENT cancers, thyroid, melanoma, GIT, lung, breast
Systemic disease (<5%) (Infective / Non infective)	HIV / EBV / Brucella / Toxoplasmosis / CMV / histoplasmosis / coccidiomycosis / sarcoidosis / Castelman disease

Lymphadenopathy Algorithm

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