Lymphadenopathy refers to lymph nodes that are abnormal in size, consistency, or number. Lymph nodes are generally considered abnormal when they are larger than 1.5 cm in diameter. Generally speaking, the larger the lymph node, the more the physician should be alerted to the possibility of malignancy. Lymphadenopathy may be considered “generalized” if lymph nodes are enlarged in two or more non-contiguous areas, and “localized” if only one area is involved. In most cases, a careful history and physical exam will reveal the cause of the lymphadenopathy.
When a patient presents with persistent unexplained fatigue or generalized lymphadenopathy, the physician’s investigation should include a full blood count, differential, an erythrocyte sedimentation rate, and C-reactive protein. Many physicians will attempt an empiric course of antibiotics on the presumptive diagnosis of a subclinical infection.
Most patients who present with cervical lymphadenopathy can be diagnosed on the basis of a physical examination and clinical history. Many of the causes of lymphadenopathy can be traced to environmental factors that have caused a bacterial or viral infection. In those cases, the underlying infection should be treated, and biopsy of the enlarged node itself is not indicated. If generalized lymphadenopathy is present, the physician should consider systemic diseases such as mononucleosis, HIV, cat-scratch disease, and a number of other systemic infections or disorders, and perform testing accordingly. If, after a period of observation, the lymph nodes have grown, increased in number, or substantially changed in character, then a biopsy is indicated.
Lymphadenopathy medical expert witness specialties include head and neck surgery, interventional radiology, surgical oncology, general surgery, breast surgery, otolaryngology, oncology, pathology, and radiology.
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