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Differenzialdiagnose und -abklärung von Lymphknotenvergrößerungen

Differential diagnosis and diagnostic strategies of lymphadenopathy

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Zusammenfassung

Neben der akuten entzündlichen Schwellung eines Lymphknotens, der akuten Lymphadenitis, kommen Lymphknotenvergrößerungen bei verschiedensten gut- und bösartigen Erkrankungen vor. Eine solche „Lymphadenopathie“ kann in lokalisierter oder generalisierter Form auftreten und bedarf einer weiterführenden Diagnostik. Als Ursache kommen v. a. infektiöse, immunologische, neoplastische und metabolische Erkrankungen in Frage. Anamnese und klinischer Untersuchungsbefund liefern erste diagnostische Hinweise. Lokalisierte Lymphknotenschwellungen sind oft infektiöser Genese, sodass zunächst der mögliche Infektionsherd zu identifizieren ist. Eine generalisierte Lymphadenopathie ist insbesondere im Erwachsenenalter oft Zeichen einer hämatologischen Systemerkrankung. Daher ist bei jeder über einen Monat persistierenden Lymphknotenschwellung eine invasive Diagnostik zum Ausschluss einer malignen Ursache indiziert. Hierbei ist eine histologische Untersuchung anzustreben, besonders in der Lymphomdiagnostik ist die Exzision ganzer Lymphknoten zwingend notwendig. Bei malignen Lymphomen schließen sich Staging-Untersuchungen zur Prognoseeinschätzung und Therapieplanung an.

Abstract

Besides acute inflammatory swelling of a lymph node, acute lymphadenitis, enlarged lymph nodes occur in conjunction with various benign and malignant diseases. Lymphadenopathy can appear in a localized or generalized form and requires further diagnostic measures. Possible causes are primarily infectious, immunological, neoplastic, and metabolic disorders. The medical history and physical examination provide the first clues to the diagnosis. Localized swollen glands often have an infectious etiology so that the first step is to identify the possible focus of infection. Generalized lymphadenopathy is frequently a sign of a hematological systemic disease, particularly in adults. Therefore, in every case of lymphadenopathy persisting for more than 1 month, invasive diagnostic procedures are indicated to rule out a malignant cause. The aim should be to perform a histological analysis; excision of entire lymph nodes is exigent, especially for the work-up of lymphoma. In cases of malignant lymphoma, staging examinations should subsequently be conducted to assess the prognosis and formulate a treatment plan.

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Jung, W., Trümper, L. Differenzialdiagnose und -abklärung von Lymphknotenvergrößerungen. Internist 49, 305–320 (2008). https://doi.org/10.1007/s00108-008-2016-0

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