Lymphadenopathy

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Lymphadenopathy
Other namesAdenopathy
Lymphadanopathy.JPG
Neck lymphadenopathy associated with infectious mononucleosis
Specialty Infectious disease

Lymphadenopathy or adenopathy is disease of the lymph nodes, in which they are abnormal in size or consistency. Lymphadenopathy of an inflammatory type (the most common type) is lymphadenitis, [1] producing swollen or enlarged lymph nodes. In clinical practice, the distinction between lymphadenopathy and lymphadenitis is rarely made and the words are usually treated as synonymous. Inflammation of the lymphatic vessels is known as lymphangitis. [2] Infectious lymphadenitis affecting lymph nodes in the neck is often called scrofula.

Disease abnormal condition negatively affecting organisms

A disease is a particular abnormal condition that negatively affects the structure or function of part or all of an organism, and that is not due to any external injury. Diseases are often construed as medical conditions that are associated with specific symptoms and signs. A disease may be caused by external factors such as pathogens or by internal dysfunctions. For example, internal dysfunctions of the immune system can produce a variety of different diseases, including various forms of immunodeficiency, hypersensitivity, allergies and autoimmune disorders.

Lymph node organ of the lymphatic system

A lymph node or lymph gland is an ovoid or kidney-shaped organ of the lymphatic system, and of the adaptive immune system, that is widely present throughout the body. They are linked by the lymphatic vessels as a part of the circulatory system. Lymph nodes are major sites of B and T lymphocytes, and other white blood cells. Lymph nodes are important for the proper functioning of the immune system, acting as filters for foreign particles and cancer cells. Lymph nodes do not have a detoxification function, which is primarily dealt with by the liver and kidneys.

Inflammation signs of activation of the immune system

Inflammation is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molecular mediators. The function of inflammation is to eliminate the initial cause of cell injury, clear out necrotic cells and tissues damaged from the original insult and the inflammatory process, and initiate tissue repair.

Contents

The term comes from the word lymph and a combination of the Greek words αδένας, adenas ("gland") and παθεία, patheia ("act of suffering" or "disease").

Lymphadenopathy is a common and nonspecific sign. Common causes include infections (from minor ones such as the common cold to serious ones such as HIV/AIDS), autoimmune diseases, and cancers. Lymphadenopathy is also frequently idiopathic and self-limiting.

A medical sign is an objective indication of some medical fact or characteristic that may be detected by a patient or anyone, especially a physician, before or during a physical examination of a patient. For example, whereas a tingling paresthesia is a symptom, erythema is a sign. Symptoms and signs are often nonspecific, but often combinations of them are at least suggestive of certain diagnoses, helping to narrow down what may be wrong. In other cases they are specific even to the point of being pathognomonic.

Infection invasion of a host by disease-causing organisms

Infection is the invasion of an organism's body tissues by disease-causing agents, their multiplication, and the reaction of host tissues to the infectious agents and the toxins they produce. Infectious disease, also known as transmissible disease or communicable disease, is illness resulting from an infection.

Common cold common viral infection of upper respiratory tract

The common cold, also known simply as a cold, is a viral infectious disease of the upper respiratory tract that primarily affects the nose. The throat, sinuses, and larynx may also be affected. Signs and symptoms may appear less than two days after exposure to the virus. These may include coughing, sore throat, runny nose, sneezing, headache, and fever. People usually recover in seven to ten days, but some symptoms may last up to three weeks. Occasionally those with other health problems may develop pneumonia.

Causes

Retroperitoneal lymphadenopathies of testicular seminoma, embrace the aorta. Computed tomography image. Retroperitoneal lymphadenopathy of testicular seminoma, 1 50, CT image.svg
Retroperitoneal lymphadenopathies of testicular seminoma, embrace the aorta. Computed tomography image.

Lymph node enlargement is recognized as a common sign of infectious, autoimmune, or malignant disease. Examples may include:

Virus Type of non-cellular infectious agent

A virus is a small infectious agent that replicates only inside the living cells of an organism. Viruses can infect all types of life forms, from animals and plants to microorganisms, including bacteria and archaea.

Tuberculous lymphadenitis

Tuberculous lymphadenitis is the most common form of tuberculosis infections that appears outside the lungs. Tuberculous lymphadenitis is a chronic, specific granulomatous inflammation of the lymph node with caseation necrosis, caused by infection with Mycobacterium tuberculosis or related bacteria.

Cat-scratch disease Human disease

Cat-scratch disease (CSD) is an infectious disease that results from a scratch or bite of a cat. Symptoms typically include a non-painful bump or blister at the site of injury and painful and swollen lymph nodes. People may feel tired, have a headache, or a fever. Symptoms typically begin within 3-14 days following infection.

Less common infectious causes of lymphadenopathy may include bacterial infections such as cat scratch disease, tularemia, brucellosis, or prevotella.[ citation needed ]

Tularemia primary bacterial infectious disease that has material basis in Francisella tularensis, which is transmitted by dog tick bite (Dermacentor variabilis), transmitted by deer flies (Chrysops sp) or transmitted by contact with infected animal tissues.

Tularemia, also known as rabbit fever, is an infectious disease caused by the bacterium Francisella tularensis. Symptoms may include fever, skin ulcers, and enlarged lymph nodes. Occasionally, a form that results in pneumonia or a throat infection may occur.

Brucellosis Human disease

Brucellosis is a highly contagious zoonosis caused by ingestion of unpasteurized milk or undercooked meat from infected animals, or close contact with their secretions. It is also known as undulant fever, Malta fever, and Mediterranean fever.

Prevotella is a genus of Gram-negative bacteria.

Benign (reactive) lymphadenopathy

Benign lymphadenopathy is a common biopsy finding, and may often be confused with malignant lymphoma. It may be separated into major morphologic patterns, each with its own differential diagnosis with certain types of lymphoma. Most cases of reactive follicular hyperplasia are easy to diagnose, but some cases may be confused with follicular lymphoma. There are seven distinct patterns of benign lymphadenopathy: [6]

These morphological patterns are never pure. Thus, reactive follicular hyperplasia can have a component of paracortical hyperplasia. However, this distinction is important for the differential diagnosis of the cause.

Diagnosis

Medical ultrasonography of a typical normal lymph node: smooth, gently lobulated oval with a hypoechoic cortex measuring less than 3 mm in thickness with a central echogenic hilum. Ultrasonography of a normal lymph node.jpg
Medical ultrasonography of a typical normal lymph node: smooth, gently lobulated oval with a hypoechoic cortex measuring less than 3 mm in thickness with a central echogenic hilum.
Ultrasonography of a suspected malignant lymph node:
- Absence of the fatty hilum
- Increased focal cortical thickness greater than 3 mm
- Doppler ultrasonography that shows hyperaemic blood flow in the hilum and central cortex and/or abnormal (non-hilar cortical) blood flow. Ultrasonography of a suspected malignant lymph node.jpg
Ultrasonography of a suspected malignant lymph node:
- Absence of the fatty hilum
- Increased focal cortical thickness greater than 3 mm
- Doppler ultrasonography that shows hyperaemic blood flow in the hilum and central cortex and/or abnormal (non-hilar cortical) blood flow.

In cervical lymphadenopathy (of the neck), it is routine to perform a throat examination including the use of a mirror and an endoscope. [25]

On ultrasound, B-mode imaging depicts lymph node morphology, whilst power Doppler can assess the vascular pattern. [26] B-mode imaging features that can distinguish metastasis and lymphoma include size, shape, calcification, loss of hilar architecture, as well as intranodal necrosis. [26] Soft tissue edema and nodal matting on B-mode imaging suggests tuberculous cervical lymphadenitis or previous radiation therapy. [26] Serial monitoring of nodal size and vascularity are useful in assessing treatment response. [26]

Fine needle aspiration cytology (FNAC) has sensitivity and specificity percentages of 81% and 100%, respectively, in the histopathology of malignant cervical lymphadenopathy. [25] PET-CT has proven to be helpful in identifying occult primary carcinomas of the head and neck, especially when applied as a guiding tool prior to panendoscopy, and may induce treatment related clinical decisions in up to 60% of cases. [25]

Classification

Lymphadenopathy may be classified by:

Size

Long and short axis.png
Micrograph of dermatopathic lymphadenopathy, a type of lymphadenopathy. H&E stain. Dermatopathic lymphadenopathy - low mag.jpg
Micrograph of dermatopathic lymphadenopathy, a type of lymphadenopathy. H&E stain.
CT scan of axillary lymphadenopathy in a 57-year-old man with multiple myeloma. CT of axillary lymphadenopathy - annotated.jpg
CT scan of axillary lymphadenopathy in a 57-year-old man with multiple myeloma.
  • By size, where lymphadenopathy in adults is often defined as a short axis of one or more lymph nodes is greater than 10mm. [27] [28] However, there is regional variation as detailed in this table:
Upper limit of lymph node sizes in adults
Generally10 mm [27] [28]
Inguinal10 [29] – 20 mm [30]
Pelvis 10 mm for ovoid lymph nodes, 8 mm for rounded [29]
Neck
Generally (non-retropharyngeal)10 mm [29] [31]
Jugulodigastric lymph nodes 11mm [29] or 15 mm [31]
Retropharyngeal8 mm [31]
  • Lateral retropharyngeal: 5 mm [29]
Mediastinum
Mediastinum, generally10 mm [29]
Superior mediastinum and high paratracheal7mm [32]
Low paratracheal and subcarinal11 mm [32]
Upper abdominal
Retrocrural space6 mm [33]
Paracardiac8 mm [33]
Gastrohepatic ligament8 mm [33]
Upper paraaortic region9 mm [33]
Portacaval space10 mm [33]
Porta hepatis7 mm [33]
Lower paraaortic region11 mm [33]

Lymphadenopathy of the axillary lymph nodes can be defined as solid nodes measuring more than 15 mm without fatty hilum. [34] Axillary lymph nodes may be normal up to 30 mm if consisting largely of fat. [34]

In children, a short axis of 8 mm can be used. [35] However, inguinal lymph nodes of up to 15 mm and cervical lymph nodes of up to 20 mm are generally normal in children up to age 8–12. [36]

Lymphadenopathy of more than 1.5 cm - 2 cm increases the risk of cancer or granulomatous disease as the cause rather than only inflammation or infection. Still, an increasing size and persistence over time are more indicative of cancer. [37]

See also

Related Research Articles

Lymphoma hematologic cancer that affects lymphocytes that reside in the lymphatic system and in blood-forming organs

Lymphoma is a group of blood cancers that develop from lymphocytes. The name often refers to just the cancerous versions rather than all such tumors. Signs and symptoms may include enlarged lymph nodes, fever, drenching sweats, unintended weight loss, itching, and constantly feeling tired. The enlarged lymph nodes are usually painless. The sweats are most common at night.

Kikuchi disease rare disease

Kikuchi disease was described in 1972 in Japan. It is also known as histiocytic necrotizing lymphadenitis, Kikuchi necrotizing lymphadenitis, phagocytic necrotizing lymphadenitis, subacute necrotizing lymphadenitis, and necrotizing lymphadenitis.Kikuchi disease occur sporadically in people with no family history of the condition.

Castlemans disease lymphoproliferative syndrome characterized by one or more enlarged lymph nodes containing cells with hyaline-vascular, plasmacytic, or mixed appearance microscopically

Castlemandisease is a group of uncommon lymphoproliferative disorders characterized by lymph node enlargement, characteristic features on microscopic analysis of enlarged lymph node tissue, and a range of symptoms and clinical findings.

Tumors of the hematopoietic and lymphoid tissues tumor that affect the blood, bone marrow, lymph, and lymphatic system

Tumors of the hematopoietic and lymphoid tissues or tumours of the haematopoietic and lymphoid malignancies are tumors that affect the blood, bone marrow, lymph, and lymphatic system. As those elements are all intimately connected through both the circulatory system and the immune system, a disease affecting one will often affect the others as well, making myeloproliferation and lymphoproliferation closely related and often overlapping problems.

The CDC Classification System for HIV Infection is the medical classification system used by the United States Centers for Disease Control and Prevention (CDC) to classify HIV disease and infection. The system is used to allow the government to handle epidemic statistics and define who receives US government assistance.

Splenic marginal zone lymphoma (SMZL) is a type of cancer made up of B-cells that replace the normal architecture of the white pulp of the spleen. The neoplastic cells are both small lymphocytes and larger, transformed lymphoblasts, and they invade the mantle zone of splenic follicles and erode the marginal zone, ultimately invading the red pulp of the spleen. Frequently, the bone marrow and splenic hilar lymph nodes are involved along with the peripheral blood. The neoplastic cells circulating in the peripheral blood are termed villous lymphocytes due to their characteristic appearance.

Angioimmunoblastic T-cell lymphoma is a mature T-cell lymphoma of blood or lymph vessel immunoblasts characterized by a polymorphous lymph node infiltrate showing a marked increase in follicular dendritic cells (FDCs) and high endothelial venules (HEVs) and systemic involvement.

Thyroid nodule human disease

Thyroid nodules are nodules which commonly arise within an otherwise normal thyroid gland. They may be hyperplasia or a thyroid neoplasm, but only a small percentage of the latter are thyroid cancers. Small, asymptomatic nodules are common, and many people who have them are unaware of them. But nodules that grow larger or produce symptoms may eventually need medical care. Goitres may have one nodule – uninodular, multiple nodules – multinodular, or be diffuse.

Solitary pulmonary nodule small lesion in the lung

A solitary pulmonary nodule (SPN) or coin lesion is a mass in the lung smaller than 3 centimeters in diameter. It can be an incidental finding found in up to 0.2% of chest X-rays and around 1% of CT scans.

Cervical lymphadenopathy

Cervical lymphadenopathy refers to lymphadenopathy of the cervical lymph nodes. The term lymphadenopathy strictly speaking refers to disease of the lymph nodes, though it is often used to describe the enlargement of the lymph nodes. Similarly, the term lymphadenitis refers to inflammation of a lymph node, but often it is used as a synonym of lymphadenopathy.

Progressive transformation of germinal centres

Progressive transformation of germinal centres (PTGCs) is a reactive lymph node process of undetermined cause.

The stages of HIV infection are acute infection, latency and AIDS. Acute infection lasts for several weeks and may include symptoms such as fever, swollen lymph nodes, inflammation of the throat, rash, muscle pain, malaise, and mouth and esophageal sores. The latency stage involves few or no symptoms and can last anywhere from two weeks to twenty years or more, depending on the individual. AIDS, the final stage of HIV infection, is defined by low CD4+ T cell counts, various opportunistic infections, cancers and other conditions.

Follicular hyperplasia is a type of lymphoid hyperplasia. It is caused by a stimulation of the B cell compartment. It is caused by an abnormal proliferation of secondary follicles and occurs principally in the cortex without broaching the lymph node capsule. The follicles are cytologically polymorphous, are often polarized, and vary in size and shape. Follicular hyperplasia is distinguished from follicular lymphoma in its polyclonality and lack of bcl-2 protein expression, whereas follicular lymphoma is monoclonal, and does express bcl-2).

Bilateral hilar lymphadenopathy

Bilateral hilar lymphadenopathy is a bilateral enlargement of the lymph nodes of pulmonary hila. It is a radiographic term for the enlargement of mediastinal lymph nodes and is most commonly identified by a chest x-ray.

Human herpesvirus 8 associated multicentric Castleman disease is a subtype of Castleman disease, a group of rare lymphoproliferative disorders characterized by lymph node enlargement, characteristic features on microscopic analysis of enlarged lymph node tissue, and a range of symptoms and clinical findings.

Unicentric Castleman disease Localized Castleman disease (LCD) is the most common form of Castleman disease (CD; see this term) and it is usually asymptomatic or it may present with enlarged lymph nodes. LCD may be cured by surgical resection.

Unicentric Castleman disease is a subtype of Castleman disease, a group of lymphoproliferative disorders characterized by lymph node enlargement, characteristic features on microscopic analysis of enlarged lymph node tissue, and a range of symptoms and clinical findings

Idiopathic multicentric Castleman disease Castleman disease characterized by systemic inflammatory symptoms, polyclonal lymphoproliferation, cytopenias, and multiple organ system dysfunction caused by a cytokine storm often including interleukin-6

Idiopathic multicentric Castleman disease (iMCD) is a subtype of Castleman disease, a group of lymphoproliferative disorders characterized by lymph node enlargement, characteristic features on microscopic analysis of enlarged lymph node tissue, and a range of symptoms and clinical findings.

In CT scan of the thyroid, focal and diffuse thyroid abnormalities are commonly encountered. These findings can often lead to a diagnostic dilemma, as the CT reflects the nonspecific appearances. Ultrasound (US) examination has a superior spatial resolution and is considered the modality of choice for thyroid evaluation. Nevertheless, CT detects incidental thyroid nodules (ITNs) and plays an important role in the evaluation of thyroid cancer.

Epstein–Barr virus-associated lymphoproliferative diseases are a group of disorders in which one or more types of lymphoid cells, i.e. B cells, T cells, NK cells, and histiocytic-dendritic cells, are infected with the Epstein–Barr virus (EBV), proliferate excessively, and are associated with the development of various non-malignant, pre-malignant, and malignant lymphoproliferative disorders (LPD). These LPD include the well-known disorder occurring during the initial infection with the EBV, infectious mononucleosis, and the large number of subsequent disorders that may occur thereafter. The virus is usually involved in the development and/or progression of these LPD although in some cases it may be an "innocent" bystander, i.e. present in, but not contributing to, the disease.

References

  1. " lymphadenitis " at Dorland's Medical Dictionary
  2. " lymphangitis " at Dorland's Medical Dictionary
  3. Fontanilla, JM; Barnes, A; Von Reyn, CF (September 2011). "Current diagnosis and management of peripheral tuberculous lymphadenitis". Clinical Infectious Diseases. 53 (6): 555–562. doi:10.1093/cid/cir454. PMID   21865192.
  4. Klotz, SA; Ianas, V; Elliott, SP (2011). "Cat-scratch Disease". American Family Physician. 83 (2): 152–155. PMID   21243990.
  5. Butler, T (2009). "Plague into the 21st century". Clinical Infectious Diseases. 49 (5): 736–742. doi:10.1086/604718. PMID   19606935.
  6. 1 2 3 Weiss, LM; O'Malley, D (2013). "Benign lymphadenopathies". Modern Pathology. 26 (Supplement 1): S88–S96. doi:10.1038/modpathol.2012.176. PMID   23281438.
  7. Sweeney, DA; Hicks, CW; Cui, X; Li, Y; Eichacker, PQ (December 2011). "Anthrax infection". American Journal of Respiratory and Critical Care Medicine. 184 (12): 1333–1341. doi:10.1164/rccm.201102-0209CI. PMC   3361358 . PMID   21852539.
  8. Kennedy, PG (February 2013). "Clinical features, diagnosis, and treatment of human African trypanosomiasis (sleeping sickness)". Lancet Neurology. 12 (2): 186–194. doi:10.1016/S1474-4422(12)70296-X. PMID   23260189.
  9. 1 2 3 Status and anamnesis, Anders Albinsson. Page 12
  10. Kim, TU; Kim, S; Lee, JW; Lee, NK; Jeon, UB; Ha, HG; Shin, DH (September–October 2012). "Plasma cell type of Castleman's disease involving renal parenchyma and sinus with cardiac tamponade: case report and literature review". Korean Journal of Radiology. 13 (5): 658–663. doi:10.3348/kjr.2012.13.5.658. PMC   3435867 . PMID   22977337.
  11. Zhang, H; Wang, R; Wang, H; Xu, Y; Chen, J (June 2012). "Membranoproliferative glomerulonephritis in Castleman's disease: a systematic review of the literature and 2 case reports". Internal Medicine (Tokyo, Japan). 51 (12): 1537–1542. doi:10.2169/internalmedicine.51.6298. PMID   22728487.
  12. Bratucu, E; Lazar, A; Marincaş, M; Daha, C; Zurac, S (March–April 2013). "Aseptic mesenteric lymph node abscesses. In search of an answer. A new entity?" (PDF). Chirurgia (Bucarest, Romania: 1990). 108 (2): 152–160. PMID   23618562.
  13. Leung, A; Sigalet, DL (June 2003). "Acute Abdominal Pain in Children". American Family Physician. 67 (11): 2321–2327.
  14. Glass, C (September 2008). "Role of the Primary Care Physician in Hodgkin Lymphoma". American Family Physician. 78 (5): 615–622. PMID   18788239.
  15. Colon, NC; Chung, DH (2011). "Neuroblastoma". Advances in Pediatrics. 58 (1): 297–311. doi:10.1016/j.yapd.2011.03.011. PMC   3668791 . PMID   21736987.
  16. Sagatys, EM; Zhang, L (January 2011). "Clinical and laboratory prognostic indicators in chronic lymphocytic leukemia". Cancer Control. 19 (1): 18–25. PMID   22143059.
  17. Melikoglu, MA; Melikoglu, M (October–December 2008). "The clinical importance of lymphadenopathy in systemic lupus erythematosus" (PDF). Acta Reumatologia Portuguesa. 33 (4): 402–406. PMID   19107085.
  18. Lederman, MM; Margolis, L (June 2008). "The lymph node in HIV pathogenesis". Seminars in Immunology. 20 (3): 187–195. doi:10.1016/j.smim.2008.06.001. PMC   2577760 . PMID   18620868.
  19. Quan, D (October 2012). "North American poisonous bites and stings". Critical Care Clinics . 28 (4): 633–659. doi:10.1016/j.ccc.2012.07.010. PMID   22998994.
  20. Komagamine, T; Nagashima, T; Kojima, M; Kokubun, N; Nakamura, T; Hashimoto, K; Kimoto, K; Hirata, K (September 2012). "Recurrent aseptic meningitis in association with Kikuchi-Fujimoto disease: case report and literature review". BMC Neurology. 12: 187–195. doi:10.1186/1471-2377-12-112. PMC   3570427 . PMID   23020225.
  21. Noguchi, S; Yatera, K; Shimajiri, S; Inoue, N; Nagata, S; Nishida, C; Kawanami, T; Ishimoto, H; Sasaguri, Y; Mukae, H (2012). "Intrathoracic Rosai-Dorfman disease with spontaneous remission: a clinical report and a review of the literature". The Tohoku Journal of Experimental Medicine. 227 (3): 231–235. doi:10.1620/tjem.227.231. PMID   22789970.
  22. Weiss, PF (April 2012). "Pediatric vasculitis". Pediatric Clinics of North America. 59 (2): 407–423. doi:10.1016/j.pcl.2012.03.013. PMC   3348547 . PMID   22560577.
  23. Koh, H; Kamiishi, N; Chiyotani, A; Takahashi, H; Sudo, A; Masuda, Y; Shinden, S; Tajima, A; Kimura, Y; Kimura, T (April 2012). "Eosinophilic lung disease complicated by Kimura's disease: a case report and literature review". Internal Medicine (Tokyo, Japan). 51 (22): 3163–3167. PMID   23154725.
  24. 1 2 Dialani, V.; James, D. F.; Slanetz, P. J. (2014). "A practical approach to imaging the axilla". Insights into Imaging. 6 (2): 217–229. doi:10.1007/s13244-014-0367-8. ISSN   1869-4101. PMC   4376818 . Creative Commons attribution license
  25. 1 2 3 Balm, A. J. M.; van Velthuysen, M. L. F.; Hoebers, F. J. P.; Vogel, W. V.; van den Brekel, M. W. M. (2010). "Diagnosis and Treatment of a Neck Node Swelling Suspicious for a Malignancy: An Algorithmic Approach". International Journal of Surgical Oncology. 2010: 1–8. doi:10.1155/2010/581540. ISSN   2090-1402.
  26. 1 2 3 4 Ahuja, A.T. (2008). "Ultrasound of malignant cervical lymph nodes". Cancer Imaging. 8 (1): 48–56. doi:10.1102/1470-7330.2008.0006. ISSN   1470-7330. PMC   2324368 .
  27. 1 2 3 Ganeshalingam, Skandadas; Koh, Dow-Mu (2009). "Nodal staging". Cancer Imaging. 9 (1). doi:10.1102/1470-7330.2009.0017. ISSN   1470-7330.
  28. 1 2 Schmidt Júnior, Aurelino Fernandes; Rodrigues, Olavo Ribeiro; Matheus, Roberto Storte; Kim, Jorge Du Ub; Jatene, Fábio Biscegli (2007). "Distribuição, tamanho e número dos linfonodos mediastinais: definições por meio de estudo anatômico". Jornal Brasileiro de Pneumologia. 33 (2): 134–140. doi:10.1590/S1806-37132007000200006. ISSN   1806-3713.
  29. 1 2 3 4 5 6 Torabi M, Aquino SL, Harisinghani MG (September 2004). "Current concepts in lymph node imaging". Journal of Nuclear Medicine. 45 (9): 1509–18. PMID   15347718.
  30. "Assessment of lymphadenopathy". BMJ Best Practice . Retrieved 2017-03-04. Last updated: Last updated: Feb 16, 2017
  31. 1 2 3 Page 432 in: Luca Saba (2016). Image Principles, Neck, and the Brain. CRC Press. ISBN   9781482216202.
  32. 1 2 Sharma, Amita; Fidias, Panos; Hayman, L. Anne; Loomis, Susanne L.; Taber, Katherine H.; Aquino, Suzanne L. (2004). "Patterns of Lymphadenopathy in Thoracic Malignancies". RadioGraphics. 24 (2): 419–434. doi:10.1148/rg.242035075. ISSN   0271-5333.
  33. 1 2 3 4 5 6 7 Dorfman, R E; Alpern, M B; Gross, B H; Sandler, M A (1991). "Upper abdominal lymph nodes: criteria for normal size determined with CT". Radiology. 180 (2): 319–322. doi:10.1148/radiology.180.2.2068292. ISSN   0033-8419.
  34. 1 2 Page 559 in: Wolfgang Dähnert (2011). Radiology Review Manual. Lippincott Williams & Wilkins. ISBN   9781609139438.
  35. Page 942 in: Richard M. Gore, Marc S. Levine (2010). High Yield Imaging Gastrointestinal HIGH YIELD in Radiology. Elsevier Health Sciences. ISBN   9781455711444.
  36. Laurence Knott. "Generalised Lymphadenopathy". Patient UK . Retrieved 2017-03-04. Last checked: 24 March 2014
  37. Bazemore AW, Smucker DR (December 2002). "Lymphadenopathy and malignancy". American Family Physician. 66 (11): 2103–10. PMID   12484692.
Classification
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