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Evaluation of peripheral lymphadenopathy in adults

Robert H Fletcher, MD, MSc
Section Editor
Laurence A Boxer, MD
Deputy Editor
Lee Park, MD, MPH


Peripheral lymphadenopathy without an obvious cause after the history and physical examination presents a diagnostic dilemma. On the one hand, there are countless potential causes, some of which are severe and treatable. On the other, severe causes are uncommon and the best way to reach a definitive diagnosis is by biopsy, which is invasive and not justified in most cases.

The general approach to the adult patient with lymphadenopathy is reviewed here. The evaluation and differential diagnosis of neck masses, which includes lymphadenopathy and other lesions, is presented separately. (See "Evaluation of a neck mass" and "Differential diagnosis of a neck mass".)

Evaluation and treatment of lymphadenopathy in children is also discussed separately. (See "Peripheral lymphadenopathy in children: Evaluation and diagnostic approach" and "Cervical lymphadenitis in children: Diagnostic approach and initial management" and "Peripheral lymphadenopathy in children: Etiology" and "Evaluation of inguinal swelling in children".)


The location of peripheral lymph node groups is shown schematically in the figures (figure 1 and figure 2). Normal lymph nodes are usually less than 1 cm in diameter and tend to be larger in adolescence than later in life. Lymph nodes are often palpable in the inguinal region in healthy people, perhaps because chronic trauma and infection is so common in the lower extremities, and may also be palpable in the neck (particularly submandibular) following head and neck infections.

Distinguishing between localized and generalized lymphadenopathy can help to formulate a differential diagnosis. A clinically useful approach is to classify lymphadenopathy as localized when it involves only one region, such as the neck or axilla, and generalized when it involves more than one region [1].


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Literature review current through: Nov 2016. | This topic last updated: Thu Jul 03 00:00:00 GMT 2014.
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