2012 개원의와함께하는임상강좌 경희대학교의과대학감염내과학교실 문수연 F/29 CC: fever, headache, multiple cervical lymph node onset) 5 days ago 1 cm sized Bilateral, mild tender, movable, soft Reactive LN with viral infection 2012 개원의와함께하는임상강좌
맞춤진료 : 증례위주의실전강의 M/25 CC: fever, multiple cervical LN enlargement onset) 2 months ago Weight loss 2-3 cm sized Unilateral, non-tender, movable, firm TB lymphadeitis M/38 CC: multiple palpable cervical LN onset) 1 month ago Malaise, weight loss Lymphoma 2012 개원의와함께하는임상강좌
문수연 : 성인임파선염의진단 F/27 CC: palpable cervical LN enlargement onset) 1 month ago Unilateral, mild tender, movable, soft Toxoplasma Ab (-) Kikuchi s disease Epidemiology Peripheral lymphadenopathy Special clinic 0.6% annual incidence in general population 10% referred to subspecialist 3.2% biopsy 1.1% malignancy 0.4% risk in patients younger than 40 yrs Biopsy Malignanacy 2012 개원의와함께하는임상강좌
맞춤진료 : 증례위주의실전강의 600-800 LN in human body Am Fam Physician 58(6):1313-1320, 1998 Characteristics of LN Size and shape 1.0 cm generally considered abnormal 2.0 cm malignancy, TB, etc Benign LN: short axis to long axis ratio <0.5 Site 2012 개원의와함께하는임상강좌
문수연 : 성인임파선염의진단 Auricular Preauricular: Scalp, skin Scalp infections, mycobacterium, skin neoplasm, lymphoma, H&N SCC, occular disease, cat scratch disease Posterior auricular rubella Submandibular: Oral or dental lesion Mononucleosis, URI, mycobacterium, toxoplasma, CMV, dental disease, rubella, H&N SCC, lymphoma (NHL>HD), leukemia Occipital Scalp infection, infectious mononucleosis, toxoplasmosis, pediculosis capitis, tick bites, low grade NHL Cervical Anterior: larynx, tongue, oropharynx, anterior neck Same as submandibular nodes Posterior: scalp, neck, upper thoracic skin Same as preauricular nodes Supraclavicular GI, GU and pulmonary Abdominal/thoracic neoplasm, thyroid/laryngeal disease, mycobacterial/fungal infections Rt: mediastinum, lungs, upper 2/3 esophagus Lt: stomach, lower esophagus, testes/ovaries, kidneys, pancreas, prostate 2012 개원의와함께하는임상강좌
맞춤진료 : 증례위주의실전강의 Pain Indication of rapid increase in size stretch of capsular shell Texture Stony hard, fixed: cancer, metastatic Firm rubber: lymphoma Soft: infection or inflammation Fluctuant: suppurated nodes (TB, bacterial) Matting (conglomeration) Benign: TB, Kikuchi s disease Malignant: metastatic ca., lymphoma Duration Recent appearance (<15 days): usually infectious etiology Toxoplasmosis: <15 days ~ 6 months AIDS-related: >3 months TB: >15 days frequently LNs noticed by patient for more than 1 yr at presentation: usually nonspecific etiology TB, CLL, low grade lymphomas 2012 개원의와함께하는임상강좌
문수연 : 성인임파선염의진단 Etiology Non-specific, reactive: 60-70% Cancer Hypersensitivity syndromes Infections Connective tissue disorder Atypical lymphoproliferative disorder Granulomatous disease other 2012 개원의와함께하는임상강좌
맞춤진료 : 증례위주의실전강의 Infectious or inflammatory Younger than 40 yrs of age Infectious mononucleosis, toxoplasmosis, Kikuchi s disease (histiolytic necrotizing lymphadenitis), TB Malignancy More frequent in older patients NHL, metastatic tumors, Hodgkin s disease Diagnostic work-up History taking Physical examination Laboratory investigation Imaging study and lymph node biopsy Indication of LN biopsy Largest diameter of LN 2cm Supraclavicular LN enlargement Suspected malignancy: solitary, painless LN in the elderly with history of chronic smoking Suspected lymphoma: firm, movable LN Suspected primary H&N cancer: mucosal lesion, hard and solitary LN No decrease LN size after 4-6 weeks Systemic symptoms and signs 2 weeks (fever, weigh loss, arthralgia, hepatosplenomegaly, etc) 2012 개원의와함께하는임상강좌
문수연 : 성인임파선염의진단 Bedside approach Antibiotics Restricted to patients having sufficient evidence of active infection of nonviral origin Corticosteroids NEVER be administered to a patient with LN enlargement unless a life-threatening conditions Unwise steroid use lympholysis obscuring diagnosis or activation of TB 2012 개원의와함께하는임상강좌
맞춤진료 : 증례위주의실전강의 Summary Most cases are self-limiting, benign illness Deciding if it is representative of a serious illness or not is challenging History taking and physical examination Diagnostic work-up 2cm, firm, fixed, supraclavicular LN, systemic Sx /sign 2wks LN biopsy Others observation for 3-4weeks Empirical antibiotics and steroid: NOT recommended 2012 개원의와함께하는임상강좌