Lymphadenopathy (lymph node enlargement) may be localized, regional, or generalized.Lymph nodes usually cannot be palpated in the tissues in a demarcated manner!In this case, the lymph node can be described as follows:
- Soft
- Sliding
- Druckdolente (pressure painful)
- Derb/hard
- Caked with the environment
- Environment reddened
Other clues
- In children, normal cervical lymph nodes are often palpable.
- Lymph nodes are considered abnormal:
- Adult patients: > 1 cm (inguinal: > 1.5 cm).
- Children: lymph node enlargements up to 2 cm often do not require further clarification, as they are mostly of reactive genesis.
Warning signs (red flags)
- Anamnestic information:
- Patient <30 years old → lymph node enlargement mostly benign (benign) in origin.
- Patient > 50 years → lymph node enlargement mostly malignant (malignant) origin.
- Persistent fever → think of leukemia (blood cancer) or lymphoma (lymphoma).
- Generalized, persistent lymph node enlargement and weight loss and sweating in young patients → think of Pfeiffer’s glandular fever (infectious mononucleosis), lymphoma, or AIDS
- Cervical (“belonging to the neck”) lymph node enlargement in middle-aged and older patients → exclusion of nasopharyngeal carcinoma (cancer of the nasopharynx) required
- Spatial masses in the supraclavicular fossa (supraclavicular pit: pit formed inferiorly by the clavicle (collarbone) and medially by the lateral border of the sternocleidomastoid muscle) → malignant (malignant) lymphadenopathies (eg. E.g., Hodgkin’s lymphoma)Note: Patients > 40 years of age with space-occupying lesions in the subclavicular fossa have a 90% risk of malignancy (cancer); patients < 40 years of age have only a 25% risk.
- Virchow lymph node involvement (supraclavicular (“above the clavicle) (left) in gastric carcinoma / stomach cancer (absolute rarity).
Note: “Any unexplained lymph node swelling persisting for more than four weeks or showing definite progression should be clarified by biopsy and histological examination” [S3 Guideline: Hodgkin Lymphoma]….