Lymphadenopathy (LAD) Workup, Evaluation and Differential ...
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Lymphadenopathy (LAD) Workup, Evaluation and Differential Diagnosis

Generalized LAD DDx: HIV, EBV, mycobacteria (TB), SLE, medications (e.g. phenytoin), sarcoid, lymphoma/malignancy

Localized LAD DDx: cervical (EBV, CMV, toxo, TB, lymphoma), supraclav (malignancy), axillary (infx, breast ca), inguinal (STDs)

Hx: exposures, travel, meds, B sx (fevers/drenching night sweats, >10% unintentional wt loss in 6 mo), other si/sxs of infx or malig

Exam: localization (think about area of nodal drainage), size (abnormal >1 cm), consistency, fixation, tenderness (inflammation)

Labs: CBC, HIV (RNA if acute), LDH, HBV/HCV, PPD/TSpot, RPR, ANA, heterophile Ab; consider HTLV and EBV serologies

Imaging: CT C/A/P, PET (can define node size and distribution, more helpful for monitoring of disease treatment/progression)

Biopsy: consider if large node (>2cm), persistence 4-6 wks, or increase in size, with immunophenotyping and cytogenetics

Excisional (open) biopsy: reveals abnormal cells and nodal architecture (THIS IS THE PREFERED METHOD)

 • Core needle biopsy: tissue for molecular studies, alternative to open if node inaccessible; ask IR to use large-bore needle

 • FNA: can be used as initial screening test for LAD, not diagnosis; no info on tissue architecture, high false neg rate



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