Lymph nodes

1. Axillary Lymph
Nodes Examination
Section 1

2. Examination of the
Lymphatic System
 Utilizes inspection and palpation.
 Generally examined region by region during
the examination of the other body systems.
 Always ask patients if they are aware of any
“lumps”.

3. Examination of the Lymphatic System
 Inspect:
 any visible nodes for:
• edema
• erythema
 Palpate:
 the superficial nodes
 compare side to side for:
• size
• consistency
• mobility
• discrete borders or
matted
• tenderness
• warmth

4. Nodal Character and Size
 Hard and painless nodes have higher suspicion of
malignancy or granulomatous disease.
 Viral infection typically produces hyperplastic nodes
that are bilateral, mobile, nontender, and clearly
demarcated.
 Increasing size and persistence over time are of
greater concern for malignancy than a specific level
of nodal enlargement.

5. Differential Diagnosis of Nodes
CANCER
 Firm, hard
 Non-movable
 No fever
 Not painful
INFECTION
 Soft
 Movable
 Fever
 Painful

6. Examination of the
Lymphatic System
 If an enlarged lymph node is found,
examine:
P Primary site
A All associated nodes
L Liver
S Spleen

7. Palpable Lymph Node Groups
 Head/neck
 Axillary
 Epitroclear
 Inguinal/femoral

8. Examination of Lymph Nodes
 Small, mobile, discrete, nontender nodes are common
and termed shotty
 Nodes are abnormal if greater than 1 cm and/or present
greater than one month
 Hard nodes suggest malignancy
 Tender nodes suggest infection
 Rubbery nodes suggest lymphoma

9. Age Related Variations
Infants and Children
 Commonly find small, discreet, firm, movable nodes in
occipital, postauricular, cervical and inguinal chains . . .
 should not be warm or tender
 shape usually ovoid or globular
 often referred to as “shotty nodes”
 May find enlarged postauricular and occipital nodes in
children < 2 years old

10. Axillary Lymph Nodes

11. 1. CENTRAL
2. LATERAL
3. PECTORAL
4. INFRACLAVICULAR
5. SUBSCAPULAR
Axillary Lymph Nodes

12. Axillary lymphatics and the
structures that they drain

13. Axillary Lymph Nodes

14. Axillary Lymph Nodes

15. Palpation of Axillary Lymph Nodes
When examining the left axilla,
grasp the patient's left wrist or
elbow with your left hand and lift
their arm up and out laterally.
Then use your right hand to
examine the axillary region as
described above.
This technique permits the
patient's arm to remain
completely relaxed, minimizing
tension in surrounding tissues
that can mask otherwise enlarged
lymph nodes.

16. Palpation of Axillary Lymph Nodes
When examining the right axilla,
grasp the patient's right wrist or
elbow with your right hand and lift
their arm up and out laterally.
Then use your left hand to
examine the axillary region as
described above.

17. Left Axillary Adenopathy

18. Axillary Lymphadenopathy
 Most of cases are nonspecific or reactive to local
injury/infection in etiology.
 Persistent lymphadenopathy is less commonly found
in the axillary nodes than in the inguinal chain.
 Breast adenocarcinoma often metastasis initially
to the anterior and central axillary nodes, which may
be palpable before discovery of the primary tumor.

19. Generalized Lymphadenopathy
 Generalized lymphadenopathy : lymphadenopathy
found in two or more distinct anatomic regions
 More likely to result from serious infections,
autoimmune diseases, and disseminated
malignancies.
 Specific testing is usually required.
 Generalized adenopathy infrequently occurs in pt’s
with neoplasms, but it is occasionally seen in
patients with leukemias and lymphomas, or
advanced disseminated metastatic solid tumors.

20. Causes of Generalized Lymphadenopathy
 Malignancy: lymphoma, leukemia or metastases.
 Autoimmune: SLE, RA or Sjogren’s syndrome.
 Infectious: Brucellosis, Cat-scratch disease, CMV,
HIV, EBV, Rubella, Tuberculosis, Typhoid Fever,
Syphilis or viral hepatitis.
 Other: Kawasaki’s disease, sarcoidosis,
amyloidosis, lipid storage diseases or
hyperthyroidism

21. Drugs which induces Lymphadenopathy
 Allopurinol
 Atenolol
 Captopril
 Carbamazepine
 Gold
 Hydralazine
 Penicillins
 Phenytoin
 Primidone
 Pyrimethamine
 Quinidine
 Trimethoprim/Sulfame
thozole

22.  Cervical nodes most commonly involved
 Usual course of lymph node disease is as follows:
Firm, discrete nodes

fluctuant nodes matted together

skin breakdown, abscesses, chronic sinuses

healing and scarring
Tuberculosis lymphadenopathy

23. Sarcoidosis
Bilateral symmetric hilar and is the most common
pattern of lymphadenopathy in sarcoidosis.

24. Thank you!