Adenopathies - Enlarged lymph nodes
What is a normal lymph node?
A lymph node is considered normal when its long axis is less than 1 cm in the majority of lymph node territories. Certain localizations tolerate slightly larger lymph nodes in the basal state: inguinal lymph nodes can reach 1.5 cm in adults without being pathological, particularly in people who walk a lot or have a history of lower-limb infections. Adenopathy is defined as 1 cm long in the cervical, axillary and mediastinal regions, and 1.5 cm in the inguinal region.
What are the main localizations and their causes?
| Location | Drainage area | Common causes |
|---|---|---|
| Cervical (neck) | Pharynx, tonsils, oral cavity, sinuses, scalp, thyroid gland | Angina, infectious mononucleosis, pharyngitis, otitis, sinusitis, dental abscess, toxoplasmosis, lymphoma, ENT or thyroid cancer |
| Submaxillary and submental | Lips, tongue, floor of mouth, teeth | Dental infections, stomatitis, gingivitis, oral cavity carcinoma |
| Axilla (armpit) | Breast, upper limbs, chest wall | Upper limb infection, cat scratch (cat scratch disease), breast cancer, lymphoma |
| Inguinal (groin) | Lower limbs, external genitalia, perineum | Lower limb skin infections, STIs (syphilis, gonorrhea, genital herpes, chancroid), lymphoma |
| Mediastinal | Lungs, bronchi, esophagus, heart | Sarcoidosis, tuberculosis, Hodgkin's lymphoma, bronchial cancer, histoplasmosis |
| Abdominal and mesenteric | Intestines, liver, spleen, pelvic organs | Bacterial gastroenteritis, yersiniosis, Crohn's disease, abdominal lymphoma, digestive metastases |
What causes adenopathy?
There are four main categories of causes:
| Category | Examples |
|---|---|
| Bacterial infections | Streptococcus (angina), staphylococcus (skin abscess), tuberculosis, syphilis, cat scratch disease (Bartonella henselae), brucellosis, listeriosis, yersiniosis |
| Viral infections | Infectious mononucleosis (EBV), cytomegalovirus (CMV), HIV (primary infection), herpes, measles, rubella, adenovirus, viral hepatitis |
| Parasitic and fungal infections | Toxoplasmosis (frequent cause of isolated cervical adenopathy in young adults), leishmaniasis, histoplasmosis |
| Inflammatory and autoimmune | Sarcoidosis, systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome, Kikuchi-Fujimoto's disease, Castleman's disease |
| Hematological malignancies | Hodgkin's lymphoma, non-Hodgkin's lymphoma, chronic lymphocytic leukemia (CLL), acute lymphocytic leukemia (ALL), multiple myeloma |
| Metastatic (solid tumors) | Breast cancer, bronchial cancer, ENT cancer, thyroid cancer, melanoma, digestive cancer with regional lymph node metastases |
| Medication | Phenytoin, carbamazepine, allopurinol, certain antibiotics, recent vaccinations |
How does the doctor assess adenopathy?
Clinical evaluation of adenopathy is based on several semiological features that strongly guide the diagnosis:
| Features | Benign orientation | Direction to monitor or investigate |
|---|---|---|
| Size | Less than 1-1.5 cm depending on territory | More than 2-3 cm, progressive growth |
| Consistency | Flexible, elastic | Hard, stony, rubbery (lymphoma) |
| Mobility | Mobile, well-defined | Attached to deep planes, adherent |
| Pain | Tender or painful (sign of reactive inflammation) | Painless (often associated with malignant causes) |
| Inflammatory nature | Red, warm, fluctuating (risk of abscess) | No local inflammatory signs despite volume |
| Duration | Regresses in 2 to 4 weeks with treatment | Persistence beyond 4 to 6 weeks with no identified cause |
| Number and distribution | Localized to a single territory in connection with a local infection | Generalized, affecting several territories without obvious infection |
Consult us without delay if you present with adenopathy associated with: prolonged fever, profuse night sweats, unexplained weight loss of more than 10 % of body weight in 6 months (B signs of lymphoma), a hard, painless cervical lymph node persisting for more than 3 weeks, supra-clavicular adenopathy (right or left: this territory is almost always pathological), persistent dyspnoea or cough suggestive of mediastinal involvement, or a rapidly enlarging lymph node within a few days.
How is adenopathy assessed?
- Complete blood count (CBC) with smear: check for hyperleukocytosis, atypical lymphocytosis (mononucleosis), blasts (leukemia), associated anemia or thrombocytopenia.
- Sedimentation rate (ESR) and C-reactive protein (CRP): markers of systemic inflammation
- Targeted infectious serologies according to context: EBV, CMV, toxoplasmosis, HIV, syphilis, Bartonella henselae, tuberculosis (IDR, Quantiferon)
- LDH (lactate dehydrogenase) and beta-2-microglobulin: non-specific tumor markers, elevated in lymphoma or leukemia
- Serum protein electrophoresis: search for monoclonal immunoglobulin (myeloma)
- Hepatic workup: investigation of viral hepatitis or hepatic tumor infiltration
- Ultrasound examination of lymph nodes: first-line examination to characterize lymph node morphology (size, shape, vascularization, internal architecture) and guide any sampling that may be required.
- Cervical, thoracic and abdominal-pelvic CT scans with injection: extension assessment in cases of suspected lymphoma or malignant disease, exploration of deep non-palpable adenopathies
- PET-scan (positron emission tomography): indicated for the assessment and follow-up of lymphomas and certain solid tumors
- Surgical lymph node biopsy or cytopsy: examination of certainty in cases of suspected malignancy, essential for histological diagnosis and classification of lymphoma.
What is the approach depending on the duration of the adenopathy?
| Duration and context | Recommended attitude |
|---|---|
| Recent adenopathy (< 2 weeks) with obvious infectious focus (sore throat, otitis, skin infection) | Treatment of the cause. Clinical monitoring. Regression expected in 2 to 4 weeks after healing of infection. |
| Persistent adenopathy (2 to 6 weeks) with no obvious cause | Medical consultation, first-line biological workup, lymph node ultrasound |
| Adenopathy persisting beyond 6 weeks or increasing | Thorough workup including cross-sectional imaging and specialist opinion (hematology, ENT, oncology depending on context) |
| Supraclavicular adenopathy, painless, hard, regardless of time of onset | Investigation without delay: this territory is highly suspected of malignancy (Troisier node on the left for digestive and lung cancers). |
Consult at Clinique Omicron
If you discover a ganglion that persists, enlarges or is accompanied by other symptoms such as fever, night sweats or weight loss, Clinique Omicron's physicians, at its points of service in Quebec, can perform a complete clinical examination, prescribe the appropriate biological workup and imaging, and quickly refer you to the appropriate specialist based on the results obtained.
The content of this page is provided for informational purposes only and is not intended to replace the advice of a qualified healthcare professional. Consult a physician for any symptoms, questions or decisions you may have regarding your health.
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