Lymph nodes, in conjunction with the spleen, tonsils, adenoids, and Peyer patches, are highly organized

centers of immune cells that filter antigen from the extracellular fluid. Directly interior to the fibrous
capsule is the subcapsular sinus. This allows lymph, an ultrafiltrate of blood, to traverse from the afferent
lymph vessels, through the sinuses, and out the efferent vessels. The sinuses are studded with
macrophages, which remove 99% of all delivered antigens.
The lymph node, with its high concentration of lymphocytes and antigen-presenting cells, is an ideal
organ for receiving antigens that gain access through the skin or gastrointestinal tract. Nodes have
considerable capacity for growth and change. Lymph node size depends on the person's age, the location
of the lymph node in the body, and antecedent immunological events. In neonates, lymph nodes are
barely perceptible, but a progressive increase in total lymph node mass is observed until later childhood.
Lymph node atrophy begins during adolescence and continues through later life.
Lymphadenopathy reflects disease involving the reticuloendothelial system, secondary to an increase in
normal lymphocytes and macrophages in response to an antigen. Most lymphadenopathy in children is
due to benign self-limited disease such as viral infections. Other less common etiologies responsible for
adenopathy include nodal accumulation of inflammatory cells in response to an infection in the node
(lymphadenitis), neoplastic lymphocytes or macrophages (lymphoma), or metabolite-laden macrophages
in storage diseases (Gaucher disease).
Lymph nodes are present throughout the body, but particular collections are present in the neck, axillae,
and inguinal region; a few small (< 1 cm) nodes often are palpable in those areas in healthy people.
Lymphadenopathy is palpable enlargement (> 1 cm) of one or more lymph nodes; it is categorized as
localized when present in only 1 body area and as generalized when present in 2 body areas.
Lymphadenopathy with pain and/or signs of inflammation (eg, redness, tenderness) is termed
lymphadenitis (see Lymphadenitis)

Lymphadenopathy or lymphadenitis refers to lymph nodes which are abnormal in size, number or
consistency [1] and is often used as a synonym for swollen or enlarged lymph nodes. Common
causes of lymphadenopathy are infection, autoimmune disease, ormalignancy.
Inflammation as a cause of lymph node enlargement is known as lymphadenitis. [2] In practice, the
distinction between lymphadenopathy and lymphadenitis is rarely made. Inflammation of
the lymphatic vessels is also known as lymphangitis.[3]Infectious lymphadenitides affecting lymph
nodes in the neck are often called scrofula.

TYPES

Localized lymphadenopathy: due to localized spot of infection e.g., an infected spot on the
scalp will cause lymph nodes in the neck on that same side to swell up

Generalized lymphadenopathy: due to a systemic infection of the body e.g., influenza or

secondary syphilis

Persistent generalized lymphadenopathy (PGL): persisting for a long time, possibly

without an apparent cause

Dermatopathic lymphadenopathy: lymphadenopathy associated with skin disease.

If lymph nodes are detected, the following five characteristics should be noted and

described:
Size. Nodes are generally considered to be normal if they are up to 1 cm in diameter;

however, some authors suggest that epitrochlear nodes larger than 0.5 cm or inguinal nodes
larger than 1.5 cm should be considered abnormal. 7,8 Little information exists to suggest that
a specific diagnosis can be based on node size. However, in one series 10 of 213 adults with
unexplained lymphadenopathy, no patient with a lymph node smaller than 1 cm2 (1 cm 1
cm) had cancer, while cancer was present in 8 percent of those with nodes from 1 cm 2 to
2.25 cm2 (1 cm 1 cm to 1.5 cm 1.5 cm) in size, and in 38 percent of those with nodes
larger than 2.25 cm2 (1.5 cm 1.5 cm). In children, lymph nodes larger than 2 cm in diameter
(along with an abnormal chest radiograph and the absence of ear, nose and throat
symptoms) were predictive of granulomatous diseases (i.e., tuberculosis, cat-scratch disease
or sarcoidosis) or cancer (predominantly lymphomas). 11 These studies were performed in
referral centers, and conclusions may not apply in primary care settings.
Pain/Tenderness. When a lymph node rapidly increases in size, its capsule stretches and

causes pain. Pain is usually the result of an inflammatory process or suppuration, but pain
may also result from hemorrhage into the necrotic center of a malignant node. The presence
or absence of tenderness does not reliably differentiate benign from malignant nodes. 4
Consistency. Stony-hard nodes are typically a sign of cancer, usually metastatic. Very firm,

rubbery nodes suggest lymphoma. Softer nodes are the result of infections or inflammatory
conditions. Suppurant nodes may be fluctuant. The term shotty refers to small nodes that
feel like buckshot under the skin, as found in the cervical nodes of children with viral
illnesses.
Matting. A group of nodes that feels connected and seems to move as a unit is said to be

matted. Nodes that are matted can be either benign (e.g., tuberculosis, sarcoidosis or
lymphogranuloma venereum) or malignant (e.g., metastatic carcinoma or lymphomas).
Location. The anatomic location of localized adenopathy will sometimes be helpful in
narrowing the differential diagnosis. For example, cat-scratch disease typically causes
cervical or axillary adenopathy, infectious mononucleosis causes cervical adenopathy and a
number of sexually transmitted diseases are associated with inguinal adenopathy

How is lymphadenopathy diagnosed?

Your caregiver will check your lymph node for its size and location. You may need the following tests
to help caregivers find the cause of your lymphadenopathy:

Blood tests may show if you have an infection or other medical condition.

A chest x-ray is a picture that helps caregivers check your lung and heart function.

An ultrasound uses sound waves to show pictures of the lymph nodes on a monitor.

A CT scan is also called a CAT scan. An x-ray machine uses a computer to take pictures of
your lymph nodes. You may be given a dye before the pictures are taken to help caregivers see
the pictures better. Tell the caregiver if you have ever had an allergic reaction to contrast dye.

An MRI uses powerful magnets and a computer to take pictures of your lymph nodes. You
may be given dye to help the pictures show up better. Tell the caregiver if you have ever had an
allergic reaction to contrast dye. Do not enter the MRI room with anything metal. Metal can
cause serious injury. Tell the caregiver if you have any metal in or on your body.

A lymph node biopsy is a procedure used to remove a sample of tissue to be tested.

Caregivers may remove lymph cells through a needle or remove one or more lymph nodes
during surgery.

Pathophysiology
Some plasma and cells (eg, cancer cells, infectious microorganisms) in the interstitial space, along with certain
cellular material, antigens, and foreign particles enter lymphatic vessels, becoming lymphatic fluid. Lymph
nodes filter the lymphatic fluid on its way to the central venous circulation, removing cells and other material.
The filtering process also presents antigens to the lymphocytes contained within the nodes. The immune
response from these lymphocytes involves cellular proliferation, which can cause the nodes to enlarge (reactive
lymphadenopathy). Pathogenic microorganisms carried in the lymphatic fluid can directly infect the nodes,
causing lymphadenitis (see Lymphadenitis), and cancer cells may lodge in and proliferate in the nodes.

What is lymphadenopathy?
Lymphadenopathy is the term for swelling of the lymph nodes. These are the bean-shaped organs found in the
underarm, groin, neck, chest, and abdomen. They act as filters for the lymph fluid as it circulates through the body.
Lymphadenopathy can occur in just one area of the body, such as the neck, or it may be generalized, with lymph
node enlargement in several areas. The cervical lymph nodes found in the neck are the most common site of
lymphadenopathy.

What causes lymphadenopathy?

The lymphatic system is part of the immune system and functions to fight disease and infections. As infection-fighting
cells and fluid build up, the lymph nodes enlarge to many times their normal size. Nearly all children will develop
lymphadenopathy at some time, as the condition commonly occurs in response to an infection from a virus, such as
an upper respiratory infection. Bacterial infections, such as strep throat caused by the streptococcus bacterium, can
also cause lymphadenopathy.
Since enlarged lymph nodes are often near the source of infection, their location can help determine the cause. For
example, an infant with a scalp infection may have enlarged lymph nodes at the back of the neck. Swollen lymph
nodes around the jaw may be due to an infection in the teeth or mouth. However, the lymphadenopathy may be
generalized, with lymph node enlargement in more than one area, which is typical of a viral illness.

Sometimes, one or more lymph nodes themselves can become inflamed and enlarged, a condition called
lymphadenitis. Lymph nodes can also enlarge due to cancer in the lymphatic system, such as Hodgkin disease.

What are the symptoms of lymphadenopathy?

In children, it is normal to be able to feel some lymph nodes as small, movable lumps under the skin. However, if the
nodes become more enlarged than usual, there may be an underlying problem. The following are the most common
symptoms of lymphadenopathy:

Swollen, enlarged lumps in the neck, back of the head, or other locations of lymph nodes

Tenderness of the nodes, although the nodes may not be painful if the child is no longer ill

Fever

History of illness
The symptoms of lymphadenopathy may look like other neck masses or medical problems. Always consult your
child's health care provider for a diagnosis.

How is lymphadenopathy diagnosed?

Diagnosis of lymphadenopathy is often based on the presence of other conditions, such as an infection. It is
important to determine if the child has been exposed to any diseases, such as varicella (chickenpox), or has been
bitten by an animal (cat) that may transmit an illness called cat-scratch fever. The size and location of the nodes, how
long ago the swelling began, and the presence of pain are helpful in determining the cause. In addition to a complete
medical history and physical exam, other tests may include a lymph node biopsy in which a sample of tissue is
removed from the lymph node and examined under a microscope. Further tests may be necessary for specific
diseases or infections that may be related to the lymphadenopathy.

Treatment of lymphadenopathy
Treatment may include:

Antibiotic medications (to treat an underlying bacterial infection)

Continued evaluation (to check the size and location of the enlarged nodes)

Medications or procedures (to treat other conditions that may have caused the lymph node enlargement)