Lymphadenitis Differential Diagnoses

Diagnostic Considerations

Regional lymphadenitis

In a patient with regional lymphadenitis, knowledge of lymphatic drainage patterns and pathologic processes most likely to affect these areas can facilitate diagnostic investigation. ^[4]

Cervical lymph nodes

Cervical lymph nodes receive lymphatic drainage from the head, neck, and oropharyngeal cavities.

Infections associated with cervical lymph nodes are as follows ^[5] :

• Skin and soft tissue infections of the face

• Dental abscesses

• Otitis externa

• Bacterial pharyngitis

• Cytomegalovirus

• Adenovirus infection

• Rubella

• Toxoplasmosis

Malignancies associated with cervical lymph nodes are as follows:

• Hodgkin lymphoma

• Non-Hodgkin lymphomas

• Squamous cell carcinomas of nasopharyngeal or laryngeal structures

Axillary lymph nodes

Axillary lymph nodes receive lymphatic drainage from upper extremities and breasts.

Infections associated with axillary lymph nodes are as follows:

• B henselae infection (catscratch disease)

• Sporotrichosis

• Tularemia

• Staphylococcal or streptococcal skin infections

Malignancies associated with axillary lymph nodes are as follows:

• Lymphoma

• Melanoma

• Carcinoma of the breast

Epitrochlear lymph nodes

Epitrochlear lymph nodes receive lymphatic drainage from the hands.

Infections associated with epitrochlear lymph nodes are as follows:

• Skin and soft tissue infections from local trauma

Malignancies associated with epitrochlear lymph nodes are as follows:

• Lymphoma

Supraclavicular lymph nodes

Supraclavicular lymph nodes receive lymphatic drainage from the chest and mediastinum.

Infections associated with supraclavicular lymph nodes are as follows:

• Intrathoracic mycobacterial, fungal infections (not bacterial pneumonias or bronchial infections)

Malignancies associated with supraclavicular lymph nodes are as follows (Note: supraclavicular lymphadenitis is an ominous sign of malignancy):

• Intrathoracic and intra-abdominal malignancies (Note: left-sided supraclavicular sentinel node or the Virchow node is highly suggestive of an occult abdominal neoplasm.)

• Breast cancer

Other diseases associated with supraclavicular lymph nodes are as follows:

• Sarcoidosis

Inguinal lymph nodes

Inguinal lymph nodes receive lymphatic drainage from the lower extremities and skin of the lower abdomen, genitals, and perineum. ^[6]

Infections associated with inguinal lymph nodes are as follows:

• Cellulitis of the lower extremities

• Venereal infections - Syphilis, chancroid, herpes simplex virus infection, lymphogranuloma venereum

Malignancies associated with inguinal lymph nodes are as follows:

• Lymphomas

• Metastatic melanomas from lower extremity primary site

• Squamous cell carcinomas from genital primary site

Note: lymphatic drainage from internal pelvic organs and testes drain via iliac nodes into the para-aortic chain. Therefore, deep pelvic infections or malignancies do not present as inguinal lymphadenitis.

Hilar or mediastinal lymph nodes

Hilar or mediastinal lymph nodes receive lymph drainage from local structures and are usually found on radiologic examination.

Infections associated with hilar or mediastinal lymph nodes are as follows:

• Tuberculosis

• Fungal infections

Malignancies associated with hilar or mediastinal lymph nodes are as follows:

• Bronchogenic carcinoma

• Lymphoma

• Hodgkin lymphoma

Other diseases associated with hilar or mediastinal lymph nodes are as follows:

• Sarcoidosis

Intra-abdominal or retroperitoneal lymph nodes

Intra-abdominal or retroperitoneal lymph nodes receive lymph drainage from local structures, these are typically detected by finding a palpable mass on physical examination or by obstructive/pressure effects on surrounding structures.

Infections associated with intra-abdominal or retroperitoneal lymph nodes are as follows:

• Tuberculosis ^[7]

• Y enterocolitica infection

• Deep abscess

Malignancies associated with intra-abdominal or retroperitoneal lymph nodes are as follows:

• Hodgkin lymphoma (pelvic and retroperitoneal nodes)

• Non-Hodgkin lymphoma (mesenteric nodes)

Generalized lymphadenitis

In a patient with generalized lymphadenitis, the differential includes systemic conditions.

Associated medication toxicities are as follows:

• Hydralazine

• Allopurinol

Associated infections are as follows:

• Epstein-Barr virus infection

• Cytomegalovirus infection

• Toxoplasmosis

• HIV disease

• Tuberculosis (advanced)

• Histoplasmosis

• Coccidioidomycosis

• Brucellosis

• Bacterial endocarditis

• Hepatitis

• Syphilis (secondary)

Associated immunologic diseases are as follows:

• Sarcoidosis

• Rheumatoid arthritis

• Lupus

Associated malignancies are as follows:

• Acute lymphoblastic leukemia

• Chronic lymphocytic leukemia

• Lymphomas

• Angiofollicular lymph node hyperplasia (Castleman disease)

Differential Diagnoses

• Acute Complications of Sarcoidosis

• Brucellosis

• Cat Scratch Disease (Cat Scratch Fever)

• Cystinosis

• Gaucher Disease

• Gianotti-Crosti Syndrome

• Group A Streptococcal (GAS) Infections

• Hemolytic Disease of the Newborn

• Histiocytosis

• Hodgkin Lymphoma

• Hyperimmunoglobulinemia E (Job) Syndrome

• Juvenile Idiopathic Arthritis

• Kawasaki Disease

• Lymphadenopathy

• Neuroblastoma

• Pediatric Chronic Granulomatous Disease

• Pediatric Cytomegalovirus Infection

• Pediatric Graft Versus Host Disease

• Pediatric Mononucleosis and Epstein-Barr Virus Infection

• Pediatric Non-Hodgkin Lymphoma

• Pediatric Plague

• Pediatric Rhabdomyosarcoma

• Pediatric Salmonella Infection

• Pediatric Serum Sickness

• Pediatric Thalassemia

• Pediatric Tuberculosis

• Sickle Cell Disease (SCD)

• Sphingomyelinase Deficiency

• Staphylococcus Aureus Infection

• Thyroiditis

• Tularemia

• Yersinia Enterocolitica Infection