Differential Diagnosis of

Lymphadenopaties
 Lymphadenopathy (LAP)
Nodular syndrome
• the enlargement of lymph nodes
• Cervical lymph nodes > 10 mm
• Inguinal lymph nodes > 15 mm
• Epitrochlear lymph nodes > 5 mm
• Regional LAP
- cervical, mediastinal, mesenterial, ...
• Generalized LAP
- enlargement of lymph nodes in 2 or more
non-corellating areas
 Generalized LAP

Infectious diseases
Malignities
(typ. systemic character)

Systemic & Rheumatic

Immunological diseases
diseases

Hereditary metabolic
Other
disorders
(Endocrine, Drugs, ...)
(Thesaurismosis)
 Infectious diseases – Viral
Most commonly exanthematic viral infections
• Infectious mononucleosis (EBV, CMV)
• CMV infection
• Chickenpox
• Rubeola
• Hepatitis A-E
• HIV (loss of weight)
• Adenoviruses
- flu-like symptoms (fatigue, joint & muscle pain, T°)
- commonly accompanied with HSM
 Infectious diseases – Bacterial & Other
• Pyogenic infections (eg. chron. streptococcal inf.)
• Scarlet fever
• Tuberculosis (frequently loss of weight)
• Mycoplasmatic infection (rarely)
• Sepsis
• Leptospirosis
• Brucelosis
• Cat scratch disease (40%)
• Toxoplasmosis
• Histoplasmosis
• Coccidiomycosis
 Systemic & Rheumatologic diseases
• Juvenile idiopathic arthrits
• Systemic lupus erythematodes
- in case of JIA or SLE in 2/3 of kids in acute phase
- fevers, rash, LAP, joint pain

• Kawasaki syndrome (more commonly reg. LAP)

• Serum sickness
- hypersensitivity of 3rd type
• Sarcoidosis - cca 40%
(more commonly mediastinal LAP)
 Immunological diseases
• Hyper-IgD syndrome
- periodic fevers
- shivers
- headache, abdominal pain
• Hyper-IgE syndrome
• Chronic granulomatosis
- phagocytic disorder
- purulent inflammation of lymph nodes with
fistulations
 Malignant diseases
• ALL - 70% of kids
• AML - 30% of kids
• Histiocytosis

• Fixation of lymph nodes to surrounding tissue

• Lymph nodes > 3 cm
• Tough consistency
• Packet
• Usually non-tender
• B symptomes
(fever, nocturnal sweating, loss of weight)
• Always consider is they grow rapidly
 Hereditary metabolic diseases
(Thesaurizmoses)
• products of disfunctional metabolism are being
cummulated in lymph nodes & parenchymal
organs including RES
• frequently also other organ manifestations
(cardiomegaly, HSM, CNS affections, ...)
Niemann-Pick´s disease
- sphingomyelin & non-esterified cholesterole are
being accumulated
Gaucher´s disease
- glucocerebrosides are being accumulated
 Other diseases & Conditions

• Hyperthyreosis
• Adrenal insufficiency
• Adverse drug reactions
- antiepileptic medication, commonly phenytoin
- LAP, exanthema, eosinophilia
- commonly also fevers and HSM
• Hemolytic anemias
- eg. if accompanied with ongoing viral infection
- autoimmune hemolytic anemias
 Cervical lymphadenopathy

• Nuchal
• Occipital
• Retroauricular
• Preauricular
• Submandibular
• Submental
• Precervical
• Retrocervical
• Supraclavicular
 Cervical lymphadenopathy
• sometimes even after overcoming an infection
(fibrotisation)
• eventually permanent Ag stimulation in recurrent
viral infections of upper respiratory tract
(subtle, soft, tender on palpation, many)
• Occipital
- rubeola
- seborhea
• Preauricular
- chlamydias (also conjunctivitis)
- adenoviruses
 Cervical LAP – Viral diseases
• flu-like symptoms (fatique, joint & muscle pain, T°)
• frequently accompanied with HSM
Rubeola
• retroauricular, suboccipital, retrocervical
• maculopapular exanthema starting on face,
gradually developing all over the body
Infectious mononucleosis
• fever, tonsilopharyngitis, fatique
• ↑Mono, ALT, AST
 Cervical LAP – Bacterial & Other infetions
• Pyogenic infections (respiratory, cutaneous)
- reddness, oedema, tenderness on palpation
- possible fluctuation (abscess)
• Brucelosis, tularemia, cat scratch disease
- posit. EA (being in contact with inf. animal)
- frequently without other clinical manifestations
• Atypical mycobacterial infection
• - positivity of tuberculin test
- edematic eryhtematous lymph nodes
• Toxoplasmosis
- frequently retrocervical lymph nodes
 Cervical LAP – Malignities
• Leukemias / Lymphomas / Tumors
• Hodgkin (older kids)
• Neuroblastoma (younger kids)
• MTS

• Supraclavicular lymph nodes

- high risk of malignanacy
• Posterior triangle of cervical lymph nodes
- high risk of malignanacy
 Axillar LAP
• Infections in upper lim region & Chest wall
• Cat scratch disease
• Vaccination
- into m. deltoideus
- BCG, tetanus, typhoid fever

Mesenterial LAP
• frequently only as a part of generalized LAP
• abdominal pains
• possible constipation
• risk of bowel obstrucktion in intususception
Mediastinal lymphadenopathy
 Mediastinal lymphadenopathy

• Sarcoidosis
- pneumonic affection
- uveitis var.
- also as generalized LAP
• Hodgkin lymphoma
• non-Hodgkin lymphoma
• TBC
 Inguinal LAP
- inflammation in genital area and surrounding
structures
- inflammation in lower limb areas
- inflammation in lower abdominal region

• Differential diagnosis of palpable inguinal mass

- inguinal hernia
- ectopic testicle
- aneurysm
- lipoma
 Clinical Approach
• History & Physical examination
• Lab test
- CBC ↓Leu & ↑Ly% - viral inf.
↑Leu & ↑Neu - bact. inf.
↓Ery and/or ↓Tro & ↑/↓Leu = tumor
- ↑LDH = malignity
- Serological tests if suspecting infectious ethiolgy
- Ig, autoAb, RF, K – systemic & rheumatic disease
• Chest X-ray, Abdominal ultrasound – 1st line
• CT of lungs / CT of abdomen – 2nd line
• Biopsy & histologic examination of lymph node