Regional Lymphadenopathy

Aka: Regional Lymphadenopathy, Inguinal Lymphadenopathy, Axillary Lymphadenopathy, Epitrochlear Lymphadenopathy, Regional Lymphadenitis, Tender Regional Lymphadenopathy

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II. Causes: Tender Regional Unilateral Lymphadenopathy or Lymphadenitis

  1. Cat-Scratch Disease
  2. Cytomegalovirus (CMV)
  3. Epstein-Barr Virus (EBV, Mononucleosis)
  4. Humn ImmunodeficiencyVirus (HIV)
  5. Mycobacterium Marinum (and other non-tuberculous Mycobacterium)
  6. Staphylococcus Aureus
  7. Toxoplasmosis
  8. Lymphoma
  9. Leukemia (children)

III. Causes: Right Supraclavicular Nodes

  1. Drainage Patterns
    1. Mediastinum
    2. Lungs
    3. Esophagus
  2. Lymphadenopathy Causes
    1. Lung Cancer
    2. Gastrointestinal cancer
    3. Cancer of the Retroperitoneum

IV. Causes: Left Supraclavicular Nodes

  1. Drainage Patterns
    1. Thorax
    2. Abdomen (Thoracic Duct drainage)
  2. Lymphadenopathy Causes (See Virchow's Node)
    1. Lymphoma
    2. Cancer of the thorax
    3. Cancer of the Retroperitoneum
    4. Bacterial Infection
    5. Fungal Infection

V. Causes: Infraclavicular Nodes

  1. Highly associated with Non-Hodgkin Lymphoma

VI. Causes: Axillary Nodes

  1. Drainage Patterns
    1. Arm
    2. Thoracic wall
    3. Breast
  2. Lymphadenopathy due to Infection
    1. Miscellaneous infectious causes
    2. Cat Scratch Disease
    3. Silicone Breast Implants
    4. Brucellosis
    5. Melanoma
    6. Tularemia
    7. Sporotrichosis
    8. Sarcoidosis
    9. Syphilis
    10. Leprosy
    11. Leishmaniasis
  3. Lymphadenopathy due to Malignancy (esp. left axilla, "Irish Node")
    1. Lymphoma
    2. Leukemia
    3. Kaposi Sarcoma
    4. Breast Cancer (may precede palpable Breast Mass)
    5. Skin Cancer (including Melanoma)

VII. Causes: Epitrochlear Nodes (proximal to elbow medial epicondyle)

  1. Drainage Patterns
    1. Ulnar Forearm
    2. Ulnar hand
    3. Pinky and ring finger
  2. Lymphadenopathy Causes
    1. Infection
      1. Miscellaneous infectious causes
      2. Tularemia
    2. Malignancy (high risk for cancer when infection is absent)
      1. Lymphoma
      2. Melanoma
    3. Connective Tissue Disorders
      1. Sarcoidosis
      2. Secondary Syphilis

VIII. Causes: Inguinal Nodes

  1. Drainage Patterns
    1. Horizontal Group (along inguinal ligament, at midline thigh)
      1. Skin of lower anterior abdominal wall
      2. Retroperitoneal drainage
      3. Penis and Scrotum
      4. Vulva and vagina
      5. Gluteal region
      6. Lower anal canal
      7. Perineum
    2. Vertical Group (along upper great saphenous vein, at medial thigh)
      1. Penis and Scrotum
      2. Gluteal region
      3. Lower limb drainage
  2. Lymphadenopathy Causes (Lymph Nodes >2 cm)
    1. Infections
      1. Infections of the leg and foot (e.g. Cellulitis)
      2. Granulomatous Disease
        1. Bubonic Plague
        2. Tuberculosis
      3. Sexually Transmitted Infection
        1. Herpes Simplex Virus
        2. Gonorrhea
        3. Syphilis
        4. Chancroid
        5. Granuloma Inguinale
        6. Lymphogranuloma venereum
    2. Malignancy
      1. Lymphoma
      2. Kaposi Sarcoma
      3. Pelvic malignancy
      4. Melanoma
      5. Squamous Cell Carcinoma (penis, vulva, anus)
  3. Non-Causes
    1. Testicular Cancer metastasizes to para-aortic nodes

IX. References

  1. Degowin (1987) Diagnostic Exam, Macmillan, p. 467
  2. Dornbland (1992) Adult Ambulatory Care, p. 662-7
  3. Lee (1999) Wintrobe's Hematology, p. 1826-30
  4. Wilson (1991) Harrison's Internal Medicine, p. 354-6
  5. Falk (2025) Am Fam Physician 112(3): 286-93 [PubMed]
  6. Ferrer (1998) Am Fam Physician 58(6): 1313-2 [PubMed]
  7. Gaddey (2016) Am Fam Physician 94(11): 896-903 [PubMed]
  8. Habermann (2000) Mayo Clin Proc 75:728 [PubMed]

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