The Intern At Work: Internal Medicine 47. Lumps and Bumps: An Approach to Lymphadenopathy
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Feb 23, 2020 A clinical walkthrough of lymphadenopathy, from lymphocyte basics and causes to a handy CHICAGO differential. Risk factors like EBV and HIV are explored alongside typical Hodgkin presentations. Practical guidance covers exams, lab and imaging choices, biopsy techniques, and current treatment strategies including ABVD and salvage options.
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Bimodal Age Pattern And Major Subtypes
- Hodgkin lymphoma shows a bimodal age distribution with a peak at 15–30 years and another after 50, and classical Hodgkin comprises 95% of cases.
- Subtypes include nodular sclerosis, mixed cellularity, lymphocyte rich, and lymphocyte depleted with similar management.
Use CHICAGO To Frame Lymphadenopathy Causes
- Use the mnemonic CHICAGO to structure differential diagnosis: Cancers, Hypersensitivity, Infections, Connective tissue, Atypical lymphoproliferative, Granulomatous, Other.
- Include specific causes like EBV, CMV, Bartonella, TB, sarcoidosis, and Castleman disease when evaluating nodes.
Targeted History Flags Malignancy Risk
- In history, focus on location, duration, onset, and B symptoms; nontraumatic, painless progressive nodes or >4 weeks duration raise concern for malignancy.
- Ask about alcohol-induced node pain, EBV/HIV risk, immunosuppression, medications, travel, and TB exposures.