Further Outpatient Care
Further outpatient treatment depends on establishing a diagnosis and determining management of that diagnosis.
Further Inpatient Care
Additional inpatient treatment depends on establishing the diagnosis and determining management based on that diagnosis.
Inpatient & Outpatient Medications
Inpatient and ambulatory medications depend on the specific underlying etiology of the lymphadenopathy.
Transfer
Transfer of the patient usually depends on the specific diagnosis. Patients who develop superior vena cava syndrome with either respiratory symptoms or obstruction to blood flow require emergency medical care and may require transfer to a tertiary care center.
Complications
Complications are usually related to the specific underlying disorder causing the lymphadenopathy; however, the lymphadenopathy itself can cause potentially serious complications.
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Mediastinal adenopathy can result in several potentially life-threatening complications. Recognition of these complications is important because mediastinal adenopathy cannot be directly assessed clinically and therefore may be easily missed.
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Mediastinal adenopathy can cause superior vena cava syndrome with obstruction of blood flow; bronchial or tracheal obstruction with cough, wheezing, and ultimately respiratory tract obstruction (which can be life threatening); and dysphagia from esophageal compression. Occasionally, erosion of a node into a bronchus or trachea can result in hemoptysis.
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When the diagnosis of an underlying malignancy is missed, serious metabolic complications can occur. These include uric acid nephropathy, hyperkalemia, hypercalcemia, hypocalcemia, hyperphosphatemia, and acid renal failure.
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Abdominal adenopathy can cause abdominal or back pain, constipation, and urinary frequency. Intestinal obstruction caused by intussusception can be life threatening.
Prognosis
The prognosis of lymphadenopathy almost entirely depends on the underlying etiology. Patients with specific complications, such as superior vena cava syndrome, are at risk unless this specific complication is managed. Their prognosis is dependent on the management of the neoplastic process resulting in superior vena cava syndrome.
Patient Education
Patient and family education depends on the specific etiology of the lymphadenopathy.
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A lymph node biopsy is performed. Note that a marking pen has been used to outline the node before removal and that a silk suture has been used to provide traction to assist the removal.
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A lymph node after removal by means of biopsy, which was performed completely under a local anesthetic technique.
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A gross image of a node following excision. The cut surface of the node shows the typical fish-flesh appearance seen with lymphoma.
