Left sided supraclavicular adenopathy is associated with intra-abdominal malignancy, renal malignancy, and testicular or ovarian malignancy.2 It is important to obtain a detailed history and physical examination. Supraclavicular lymph node enlargement on the right side is associated with pulmonary malignancy, mediastinal malignancy, and esophageal malignancy. Localized lymphadenopathy in any region can be associated with Hodgkin’s disease and non-Hodgkin’s lymphoma. 2 Normal individuals may have small palpable nodes in the neck, axilla, and groin.2 Nodes that are palpable in areas other than the neck, axilla, or groin or that are larger than 1 cm in size may be an a potential abnormal finding.2 Generalized lymphadenopathy can be associated with infectious processes, hypersensitive reactions, metabolic disorders, and neoplasia such as Hodgkin’s disease in the advanced stage and non-Hodgkin’s lymphoma. 1 However one should be aware that cervical adenopathy is a common finding in Hodgkin’s disease. Cervical adenopathy may be present in 56% of healthy adults without any appearance of infection. The differential diagnoses associated with lymphadenopathy are determined by the location of the enlarged node. Three common differential diagnoses associated with supraclavicular adenopathy are Hodgkin’s disease, non-Hodgkins lymphoma, and malignancy of the mediastinum. Small fat pad present posterior to right medial malleolus. Moves all extremities without difficulty. Abdomen soft and flat with hypoactive bowel sounds. Good capillary refill present at less than two seconds. Dorsalis pedis pulses and posterior tibial pulses are strong bilaterally. S1 and S2 with regular rhythm auscultated. Apical and radial pulses are equal bilaterally. Breath sounds are clear and equal bilaterally.Ĭardiac. Oral mucosa is pink with adequate saliva. Tympanic membranes are pink and pearly bilaterally. Bilateral supraclavicular lymphadenopathy present on exam, the largest measuring 2.0 cm in diameter. Supraclavicular biopsy site is healing well and the incision edges are pink with minimal swelling. Neck is swollen bilaterally and tender especially at the site of the biopsy. Right thigh rash is smaller and extends to the right outer posterior portion of the thigh beneath the buttocks. Rash is more extensive on the left posterior thigh and extends across the entire width of the thigh to the outer medial area beneath the buttocks. Erythematous rash present on the back of thighs with multiple scabbed areas. Good spirits although clearly anxious and mentions several times throughout the exam that she wants us to cure her. Hair is nicely groomed and she is wearing make-up. Well-developed, well-nourished, well dressed woman who appears anxious. Patient is here to obtain a plan for treatment that can be implemented in her hometown. A biopsy of the right supraclavicular lymph node in February 1999 revealed a diagnosis of lymphoma. In December 1998 a chest x-ray revealed a mediastinal mass. She reports intermittent hoarseness for the past 3 months. The left side of her neck also became enlarged and tender. Her neck continued to be swollen and sore on the right side. The fatigue and swollen lymph nodes continued to be a problem and several more courses of antibiotics were given. Recovery from the hysterectomy was complicated by progressive fatigue. She then underwent a hysterectomy in March of 1998 due to fibroids. Several courses of antibiotics were given for what was thought to be an upper respiratory infection, bronchitis, or sinus infection. Enlarged nodes were first noted in January 1998. Forty-four year old white female presents to a medical center hospital with a history of enlarged cervical and supraclavicular lymph nodes on the right side of her neck for approximately one year.
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