Examination of the Lymphatic System

Physical signs of lymphatic system disease include the following:

Palpable lymph nodes

Lymphangitis

Lymphedema

Lymph nodes should be described as painless or tender and as single or matted. Generalized lymphadenopathy and localized lymphadenopathy are suggestive of different diagnoses. Generalized lymphadenopathy is the presence of palpable lymph nodes in three or more lymph node chains. Lymphoma, leukemia, collagen vascular disorders, and systemic bacterial, viral, and protozoal infections may be responsible. Localized lymphadenopathy is usually the result of localized infection or neoplasm.

Lymphangitis is lymphatic spread manifested by thin red streaks on the skin. Obstruction to lymphatic flow produces lymphedema, which is usually indistinguishable from other types of edema. In Figure 16-8, the patient has marked lymphedema of her left arm secondary to inflammatory breast carcinoma.

The examinations for lymphadenopathy of the head, neck, and supraclavicular areas are described in Chapter 9, The Head and Neck, and in Chapter 13, The Chest. Chapter 16, The Breast, describes the examination for palpating axillary adenopathy. Chapter 18, Male Genitalia and Hernias, describes the technique for palpating inguinal lymph nodes. The only other important lymph node chain is the epitrochlear nodes, discussed in the following section.

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