SIGNS OF LYMPHADENOPATHY

SIGNS OF LYMPHADENOPATHY OR OTHER ASSOCIATED PATHOLOGICAL CONDITIONS

• Lymphadenopathy refers to the abnormal size, number, or consistency of lymph nodes.

• It may be localized or generalized and can be a sign of various systemic or localized diseases.

• In Shalyatantra, lymph node swellings can be considered under Granthi, Arbuda, or Apachi based on signs and progression.

• Modern medicine considers lymphadenopathy a sign indicating underlying infections, malignancies, or immune responses.

CLASSIFICATION OF LYMPHADENOPATHY

• Localized Lymphadenopathy: Involves a single group of lymph nodes.

• Generalized Lymphadenopathy: Involves multiple lymph node regions.

• Acute Lymphadenopathy: Usually tender, soft, and mobile; seen in infections.

• Chronic Lymphadenopathy: Hard, non-tender, fixed; may indicate malignancy or tuberculosis.

SANSKRIT REFERENCES TO NODULES AND SWELLINGS

• Apachi (Cervical Lymphadenopathy)
  “अपचित्यपच्यते यत्र पच्यमानं च दृश्यते।
  रुजास्त्रस्तं गुरु स्थाणु रुजायुक्तं च लक्षणम्॥”
  — Suśruta Saṃhitā, Nidānasthāna, 11/6

• Granthi
  “मांसशोणितमेदांसि कफपित्तानिलान्वितम्।
  स्थितं सन्धिषु सन्थानं स्नाय्वस्थिमांससन्निभम्॥
  मृदु तु स्निग्धसंस्पर्शं रुजायुक्तं च लक्षणम्॥”
  — Aṣṭāṅga Hṛdaya, Uttarasthāna, 29/2

• Arbuda (Tumor)
  “स्थाणुः स्थिरो महांश्चैव मांसाश्रयकृशः शिथिलः।
  चिरवृद्धिरवक्रश्च सन्धिस्थश्चार्बुदं स्मृतम्॥”
  — Suśruta Saṃhitā, Nidānasthāna, 11/3

CLINICAL SIGNS OF LYMPHADENOPATHY

• Tenderness: Suggests acute inflammation or infection.

• Consistency:

  • Soft nodes: Acute infections.

  • Firm to hard: Chronic conditions or malignancies.

  • Rubbery: Lymphoma.

• Mobility:

  • Mobile: Benign or inflammatory.

  • Fixed: Malignant or tuberculous.

• Size:

  • 1 cm is typically considered abnormal.

  • Rapid increase in size: Suspect malignancy or abscess.

• Location-specific Features:

  • Cervical nodes: Upper respiratory or oral infections, TB, lymphoma.

  • Axillary nodes: Breast infections, cat-scratch disease, lymphoma.

  • Inguinal nodes: STI, skin infections of lower limb, malignancy.

• Associated Skin Changes: Redness, ulceration, draining sinus in TB.

• Constitutional Symptoms:

  • Fever, night sweats, weight loss (B symptoms in lymphoma).

  • Malaise, fatigue, anorexia in chronic infections or malignancy.

DIFFERENTIAL DIAGNOSIS OF LYMPHADENOPATHY

• Infectious Causes:

  • Bacterial: Streptococcus, Staphylococcus, TB

  • Viral: EBV, CMV, HIV

  • Fungal and parasitic: Histoplasmosis, toxoplasmosis

• Malignant Causes:

  • Lymphoma (Hodgkin and Non-Hodgkin)

  • Leukemia

  • Metastatic carcinoma

• Autoimmune Conditions:

  • Systemic lupus erythematosus

  • Rheumatoid arthritis

  • Sarcoidosis

• Other Causes:

  • Drug reactions (e.g., phenytoin)

  • Storage diseases (Gaucher's, Niemann-Pick)

MODERN DIAGNOSTIC APPROACH

• History and Clinical Examination

  • Duration, progression, associated systemic features.

• Blood Investigations

  • CBC, ESR, CRP

  • Specific tests: Monospot test, HIV, Mantoux

• Imaging

  • Ultrasound of lymph node

  • CT/MRI for deep lymph nodes

  • PET-CT in suspected malignancy

• FNAC (Fine Needle Aspiration Cytology)

  • First-line for assessing node morphology.

• Excisional Biopsy

  • Confirmatory for lymphoma or metastatic disease.

AYURVEDIC DIAGNOSIS OF LYMPH NODE SWELLINGS

• Granthi: Small, encapsulated, rounded mass; not rapidly progressive.

• Arbuda: Large, hard, non-suppurative tumor with minimal pain.

• Apachi: Swelling in the neck region with inflammatory signs.

Chikitsa Sutra (Line of Management)

• Apachi/Granthi/Arbuda treated with:

  • Shodhana Chikitsa – Vamana, Virechana

  • Shamana Chikitsa – Herbal decoctions and lepas

  • Bhedana Karma – For suppurative swellings (Sushruta Sutrasthana 1/27)

  • Rakta Mokshana – Indicated in dushta rakta dushti

MODERN MEDICAL MANAGEMENT

• Infective Lymphadenopathy

  • Antibiotics (Amoxicillin-clavulanate, Clindamycin)

  • Anti-tubercular Therapy for TB lymphadenitis

• Malignancy

  • Chemotherapy, Radiotherapy, Surgical excision

• Supportive Care

  • Analgesics

  • Antipyretics

  • Nutritional support

COMPLICATIONS OF UNTREATED LYMPHADENOPATHY

• Abscess formation

• Sinus tract or fistula (as seen in TB lymphadenitis)

• Malignant transformation

• Compression of adjacent neurovascular structures

• Dissemination in systemic infections

PROGNOSIS

• Dependent on the underlying cause

• Infective lymphadenopathy resolves well with treatment

• TB lymphadenitis requires long-term therapy

• Prognosis in malignancy varies with stage and type