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What are matted nodes?
Matted (periadenitis) means that the lymph nodes are adhered to form a mass, and are common in tuberculosis, and rarely seen in chronic lymphadenitis and NHL. What is generalised lymphadenopathy?
The definitions of different terminology related to lymhadenopathy are: Lymphadenopathy is the inflammatory or non-inflammatory enlargement of lymph nodes. ‘Localised’ (regional) lymphadenopathy is limited to one area (i.e., single anatomical area of lymph node involvement). Generalised lymphadenopathy is the involvement of 3 or more non-contiguous lymph node areas, and the common causes in clinical practice are: – Tuberculosis (disseminated or miliary) – Lymphoma [Hodgkin’s disease (HD) or non-Hodgkin’s lymphoma (NHL)] – Leukaemias [acute lymphoblastic (ALL) and chronic lymphocytic leukaemia (CLL)] – Secondary metastases to lymph nodes – Collagen vascular diseases e.g., SLE – HIV and other viral infections [e.g., cytomegalovirus (CMV)] – Infectious mononucleosis – Chronic lymphadenitis – Sarcoidosis – Others: Filariasis, secondary syphilis, toxoplasmosis, blast crisis of chronic myeloid leukaemia (CML), brucellosis, amyloidosis, drug-induced (phenytoin, hydralazine, cyclosporine A, carbamazepine). Some hard facts about lymph node enlargement one should know.
1. Small, soft, discrete, non-tender nodes are usually ‘benign’ in nature, whereas hard, fixed, non-tender (sometimes tender) nodes, which are fixed to deeper tissues are ‘malignant’ in nature. 2. Red flag signs for underlying malignancy include a node >2 cm which is progressively enlarging, associated with weight loss >10%, age >40 years, and especially involving supraclavicular nodes; associated constitutional symptoms like pyrexia, night sweats and weight loss make the clinician more suspicious. 3. ‘Tender lymph nodes’ are usually infectious or inflammatory in nature. When the enlarged nodes are of pathological in nature?
Lymph nodes are said to be significant in nature (though always needs clinical correlation), when: – >1 cm in diameter – Firm in consistency – Matted (nodes are adherent) – Tender on palpation. However, in this setting, the clinical context is to be considered as a whole. Inguinal nodes 2 cm size may be considered significant, and even lower size (1 cm) of epitrochlear lymphadenopathy may be considered pathological. Hard and fixed nodes are commonly ‘malignant’ in nature. How to describe a lymph node enlargement?
The enlarged lymph node should be described in the following ways: 1. Site (anatomical region)—situation and extent 2. Size 3. Number 4. Margin—discrete or matted 5. Tenderness 6. Consistency: Soft (inflammation, cold abscess) Rubbery and elastic (lymphoma) Firm and shotty (syphilis) Rock-hard (malignancy) 7. Surface 8. Mobility—fixity to surrounding structures (e.g., muscles, vessels, viscus) i.e., fixed or mobile 9. Skin changes over the node (sinus, peau d’orange, or signs of inflammation) 10. Rise of local temperature (i.e., indicating inflammation) 11. Lymphangitis: Red, linear, tender lymph vessels radiating proximally, or not 12. Draining area (e.g., in inguinal adenopathy, examine the sole of foot).
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