Lymphadenopathy
Summary
Lymphadenopathy is enlargement of lymph nodes (greater than 1cm, greater than 1.5cm inguinal). It may be localised or generalised. Most cases in primary care are reactive (infection), but persistent, unexplained lymphadenopathy – particularly supraclavicular, hard, fixed, or associated with B symptoms – requires investigation to exclude malignancy. Investigations include bloods, imaging (USS, CT), and excision biopsy for histology. Management depends on the underlying cause.
Key Facts
- Definition: Lymph node greater than 1cm (greater than 1.5cm inguinal)
- Classification: Localised vs Generalised
- Common causes: Infection (most common), malignancy, autoimmune
- Red flags: Supraclavicular, hard, fixed, persistent, B symptoms
Clinical Pearls
Supraclavicular Pearl: Left supraclavicular (Virchow's node / Troisier's sign) = abdominal malignancy. Always biopsy.
Duration Pearl: Reactive nodes typically resolve within 4-6 weeks. Persistent unexplained = investigate.
| Localised | Generalised |
|---|---|
| Local infection | Viral (EBV, CMV, HIV) |
| Lymphoma | Lymphoma |
| Metastatic cancer | Leukaemia |
| TB | SLE, sarcoidosis |
| Cat scratch disease | Drugs (phenytoin) |
| Test | Purpose |
|---|---|
| FBC, film | Lymphocytosis, lymphoma cells |
| LDH | Lymphoma |
| EBV/CMV/HIV serology | Infection |
| CXR/CT | Staging, mediastinal nodes |
| Ultrasound | Guide biopsy |
| Excision biopsy | Histology (preferred over FNA for lymphoma) |
- Treat underlying cause
- Reactive: observation with safety-netting
- Malignancy: refer haematology/oncology
- Biopsy if: persistent greater than 4-6 weeks, concerning features, unexplained
- Ferrer R. Lymphadenopathy: differential diagnosis and evaluation. Am Fam Physician. 1998;58(6):1313-1320. PMID: 9803196
Last Reviewed: 2026-01-01 | MedVellum Editorial Team