Lymph Node Groups: Location, Lymphatic Drainage and Selected Differential Diagnosis

LOCATION LYMPHATIC DRAINAGE CAUSES

Submandibular Tongue, submaxillary gland, Infections of head, neck, sinuses, ears, eyes, scalp,
lips and mouth, conjunctivae pharynx

Submental Lower lip, floor of mouth, tip of Mononucleosis syndromes, Epstein-Barr virus,
tongue, skin of cheek cytomegalovirus, toxoplasmosiss

Jugular Tongue, tonsil, pinna, parotid Pharyngitis organisms, rubella

Posterior Scalp and neck, skin of arms Tuberculosis, lymphoma, head and neck malignancy
cervical and pectorals, thorax, cervical
and axillary nodes

Suboccipital Scalp and head Local infection

Postauricular External auditory meatus, Local infection

pinna, scalp

Preauricular Eyelids and conjunctivae, External auditory canal

temporal region, pinna

Right Mediastinum, lungs, Lung, retroperitoneal or gastrointestinal cancer

supraclavicular esophagus
node

Left Thorax, abdomen via thoracic Lymphoma, thoracic or retroperitoneal cancer,

supraclavicular duct bacterial or fungal infection
node

Axillary Arm, thoracic wall, breast Infections, cat-scratch disease, lymphoma, breast
cancer, silicone implants, brucellosis, melanoma

Epitrochlear Ulnar aspect of forearm and Infections, lymphoma, sarcoidosis, tularemia,

hand secondary syphilis

Inguinal Penis, scrotum, vulva, vagina, Infections of the leg or foot, STDs (e.g., herpes
perineum, gluteal region, simplex virus, gonococcal infection, syphilis,
LOCATION LYMPHATIC DRAINAGE CAUSES

lower abdominal wall, lower chancroid, granuloma inguinale, lymphogranuloma

anal canal venereum), lymphoma, pelvic malignancy, bubonic
plague

Evaluation of Suspected Causes of Lymphadenopathy

DISORDER ASSOCIATED FINDINGS TEST

Mononucleosis-type syndromes Fatigue, malaise, fever, atypical

lymphocytosis
DISORDER ASSOCIATED FINDINGS TEST

Epstein-Barr virus* Splenomegaly in 50% of patients Monospot, IgM EA or VCA

Toxoplasmosis* 80 to 90% of patients are IgM toxoplasma antibody

asymptomatic

Cytomegalovirus* Often mild symptoms; patients may IgM CMV antibody, viral
have hepatitis culture of urine or blood

Initial stages of HIV infection* “Flu-like” illness, rash HIV antibody

Cat-scratch disease Fever in one third of patients; cervical Usually clinical criteria; biopsy
or axillary nodes if necessary

Pharyngitis due to group A Fever, pharyngeal exudates, cervical Throat culture on appropriate
streptococcus, gonococcus nodes medium

Tuberculosis lymphadenitis* Painless, matted cervical nodes PPD, biopsy

Secondary syphilis* Rash RPR

Hepatitis B* Fever, nausea, vomiting, icterus Liver function tests, HBsAg

Lymphogranuloma venereum Tender, matted inguinal nodes Serology

Chancroid Painful ulcer, painful inguinal nodes Clinical criteria, culture

Lupus erythematosus* Arthritis, rash, serositis, renal, Clinical criteria, antinuclear

neurologic, hematologic disorders antibodies, complement levels

Rheumatoid arthritis* Arthritis Clinical criteria, rheumatoid

factor

Lymphoma* Fever, night sweats, weight loss in 20 Biopsy

to 30% of patients

Leukemia* Blood dyscrasias, bruising Blood smear, bone marrow

DISORDER ASSOCIATED FINDINGS TEST

Serum sickness* Fever, malaise, arthralgia, urticaria; Clinical criteria, complement

exposure to antisera or medications assays

Sarcoidosis Hilar nodes, skin lesions, dyspnea Biopsy

Kawasaki disease* Fever, conjunctivitis, rash, mucous Clinical criteria

membrane lesions

Less common causes of lymphadenopathy

Lyme disease* Rash, arthritis IgM serology

Measles* Fever, conjunctivitis, rash, cough Clinical criteria, serology

Rubella* Rash Clinical criteria, serology

Tularemia Fever, ulcer at inoculation site Blood culture, serology

Brucellosis* Fever, sweats, malaise Blood culture, serology

Plague Febrile, acutely ill with cluster of Blood culture, serology

tender nodes

Typhoid fever* Fever, chills, headache, abdominal Blood culture, serology

complaints

Still's disease* Fever, rash, arthritis Clinical criteria, antinuclear

antibody, rheumatoid factor

Dermatomyositis* Proximal weakness, skin changes Muscle enzymes, EMG,

muscle biopsy

Amyloidosis* Fatigue, weight loss Biopsy

*—Causes of generalized lymphadenopathy.

EA = early antibody; VCA = viral capsid antigen; CMV = cytomegalovirus; HIV = human
immunodeficiency virus; PPD = purified protein derivative; RPR = rapid plasma reagin; HBsAg =
hepatitis B surface antigen; EMG = electromyelography.