8-1-2-Diagnosis of lymphadenopathy

1-Diagnosis of lymphadenopathy is done when we find soft tissue masses in the anatomic sites of lymph nodes mentioned in Post # 8-1-1.

2-Pathology of lymphadenopathy:

-Lymphoid disorders as Castleman disease.

-Lymphoid neoplasm as lymphoma and leukemia.

-Metastatic spread.

-Infection as in TB, fungus and sarcoidosis.

3-Lymphadenopathy is the most common mediastinal abnormality.

4-You can differentiate between previous causes of lymphadenopathy by the following rules:

-Nodes with necrotic center is inflammatory or metastatic.

-In case of inflammatory lymph nodes, there is regular necrotic center  surrounded by thin regular enhanced wall, while in case of metastatic cause there is an irregular central necrosis surrounded by irregular enhanced thickened wall. 

-Bulky nodes are lymphoma.

-Calcification seen in TB(most common cause), sarcoid and silicosis.

-If the patient has history of primary, and at the same time, there is necrotic lymph nodes in mediastinum or in any other place, your diagnosis should be directed toward metastatic deposits rather than inflammatory causes.

-Homogenous lymphadenopathy with pulmonary parenchymal changes, could be sarcoid or lymphamgitic carcinomatosa. 

-If you cannot reach diagnosis, just write lymphadenopathy for further evaluation.

-Reticular diffuse parenchymal diseases associated with mediastinal lymphadenopathy are sarcoidosis and lymphangitis carcinomata.

 -Alveolar diffuse parenchymal diseases associated with mediastinal lymphadenopathy are alveolar cell carcinoma.

-Nodular diffuse parenchymal diseases associated with mediastinal lymphadenopathy are pneumoconiosis.

 -Cystic diffuse parenchymal diseases associated with mediastinal lymphadenopathy are lymphocytic interstitial pneumonia and lymphangioleimyomatosis.

-Focal lung diseases associated with mediastinal lymphadenopathy are bronchogenic carcinoma and metastases. 

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