Optional medical device diagnostics – depending on the results of the history, physical examination, and obligatory laboratory parameters – for differential diagnostic clarification.
- Abdominal ultrasonography (ultrasound examination of the abdominal organs) – as a standard diagnostic tool in cases of unclear lymph node swelling.
- X-ray of the thorax (X-ray thorax / chest), in two planes, if necessary, computed tomography of the thorax / chest (thoracic CT) – in unclear thoracic lymph node enlargement, as well as suspected: Carcinoma, tuberculosis, lymphoma, sarcoidosis, sepsis.
- Computed tomography (CT) or magnetic resonance imaging (MRI) of the abdomen (abdominal CT/abdominal MRI) – if pelvic, paraaortic and mesenteric lymph node enlargement is suspected.
- Computed tomography (CT) or magnetic resonance imaging (MRI) of the thorax/chest (thoracic CT/thoracic MRI) – when hilar and paratracheal lymph node enlargements are suspected.
- Electrocardiogram (ECG; recording of the electrical activity of the heart muscle) – if heart failure (cardiac insufficiency) is suspected.
- X-ray images, computed tomography / magnetic resonance imaging of different localization – depending on the suspected diagnosis.
Sonography of the lymph nodes (LK)
| Benign (inflammatory-reactive) LK | Malignant (malignant) LK |
| Enlargement > 1 cm (inguinal region/groin region > 2 cm). | Magnification > 1 cm (inguinal region > 2 cm) |
| oval shape | round, ballooned shape (“puffing up”) |
| preserved echo rich hilus | No more echo rich hilus; LK is completely echo deficient. |
| Shiftable/not packing with the environment | relocatable/pack with the environment |
Anamnestic information:
- Patient <30 years old → lymph node enlargement mostly benign (benign) in origin.
- Patient > 50 years → lymph node enlargement mostly malignant (malignant) origin.
Notes on palpation findings (palpation findings):
- Soft, well-displaced and pressure-dolent (pressure-painful) lymph node enlargement → often in inflammation.
- Small, hard, painless, displaceable lymph nodes – sign of an old healed lymphadenitis (lymphadenitis).
- Hard, painless, with the surrounding tissue “caked” lymph nodes → malignant (malignant) changes (eg, metastases).
