Lymphadenopathy = abnormal enlargement of lymph nodes (>1 cm). It can be localised (single region, often reactive to local infection) or generalised (≥2 non-contiguous regions, often systemic). Pathophysiology involves reactive hyperplasia, infiltration (infection, malignancy), or storage disorders. ⚠️ In adults, persistent unexplained lymphadenopathy is more likely malignant; in children, infection is most common.

📍 Localised vs Generalised Causes

Type	Common Causes	Notes
Localised 🟢	Infections: tonsillitis, dental abscess, otitis media, TB Malignancy: head & neck cancer, lymphoma, breast cancer metastasis Autoimmune: localised sarcoid, thyroiditis Trauma or skin infections near drainage basin	Usually reactive; nodes are tender, mobile. Look for infection at the draining site (ENT, dental, skin).
Generalised 🌍	Infections 🦠: EBV, CMV, HIV, TB, syphilis, rubella, malaria, toxoplasmosis Autoimmune 🔥: SLE, rheumatoid arthritis, sarcoidosis Malignancy 🎗️: Hodgkin & Non-Hodgkin lymphoma, leukaemias, metastatic cancer Miscellaneous: Storage diseases, Castleman’s Iatrogenic 💊: Phenytoin, allopurinol, antibiotics	Think systemic: fevers, night sweats, weight loss (B symptoms). Nodes may be firm, rubbery, non-tender in malignancy.

🧩 Mnemonic – MIAMI

M = Malignancy 🎗️
I = Infection 🦠
A = Autoimmune 🔥
M = Miscellaneous (e.g., sarcoid, storage disorders)
I = Iatrogenic 💊 (drugs)

🔎 Clinical Assessment

History: duration, rate of growth, fever, night sweats, weight loss, rash, joint pain, travel, pets (cats → Bartonella), medications.
Examination:
- Size & site: supraclavicular = ⚠️ malignancy until proven otherwise
- Consistency: soft (infection), firm rubbery (lymphoma), hard (metastasis)
- Tenderness: tender = infection; painless = malignancy more likely
- Mobility: fixed = suspicious

📊 Investigations

Bloods: CBC, ESR/CRP, LFTs, HIV, EBV/CMV, hepatitis serology, ANA/RF if autoimmune suspected
Imaging: CXR (TB, mediastinal nodes), ultrasound for neck/axilla, CT chest/abdomen/pelvis for systemic disease, PET in suspected malignancy
Biopsy: Excisional biopsy is gold standard for lymphoma; FNA may be used initially for cytology

🩺 Management Principles

Infections: Antibiotics, antivirals, antifungals, anti-TB drugs as appropriate
Autoimmune: Steroids, immunosuppressants
Malignancy: Chemotherapy, radiotherapy, surgery depending on type
Supportive: Analgesia, nutrition, hydration, reassurance in benign/reactive cases

⚠️ Red Flags for Urgent Referral

Persistent > 6 weeks without explanation
Supraclavicular node enlargement
B symptoms: fever 🌡️, night sweats 😓, weight loss ⚖️
Hard, fixed, non-tender nodes
Generalised unexplained lymphadenopathy

📝 Prognosis

✅ Infections → usually resolve with treatment 🔥 Autoimmune → chronic but manageable with therapy 🎗️ Malignancy → prognosis depends on type & stage 👶 In children → most are benign/reactive 👴 In older adults → persistence is more concerning

📌 Flowchart: Approach to Lymphadenopathy

👂 History → infection exposures, systemic symptoms, drug history
👐 Examination → localised vs generalised, node characteristics
🧪 First-line labs → CBC, ESR/CRP, serologies, autoimmune screen
🖼️ Imaging → CXR/US/CT as appropriate
🧾 Biopsy → excisional if suspicious or unexplained

✨ Teaching Pearl

Always ask: Localised vs Generalised? 👉 Localised = often infection/reactive 👉 Generalised = think systemic (infection, autoimmune, malignancy) If in doubt → biopsy.

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Lymphadenopathy