Background-Peripheral lymphadenopathy(LAP) is a common clinical condition and presents a diagnostic dilemma especially when there is no obvious cause. Fine needle aspiration cytology(FNAC) is usually the first step diagnostic procedure. The patterns and etiologies of peripheral lymphadenopathy can vary depending on geographical areas. The present study was undertaken to investigate the patterns of presentation and the various etiologies of peripheral lymphadenopathy in Ranchi, on the basis of cytological & radiological examination, and correlate the findings. Methods-This observational descriptive study included 119 subjects of peripheral lymphadenopathy visiting the Deptt. of TB & Chest , RIMS, Ranchi. All patients were subjected to Fine-needle aspiration cytology (FNAC) and chest x-ray (CXR) along with other relevant investigations. Diagnosis for etiology was established on the basis of FNAC findings. Cytological findings were correlated with findings of chest x-ray showing Mediastinal involvement, Lung parenchyma involvement and/or Pleural effusion. All data was compiled and presented in tabular and/or graphical form. Results were correlated and compared with other studies. Results-Males showed a higher incidence than females(66% vs 34%). Most cases fell in the 21-30 yr age group(39.4%). Tuberculous lymphadenitis was the most frequent cytopathological finding(52.1%) followed by reactive(21%), pyogenic(18.5%), metastatic(5%) and lymphoma(3.4%). Malignant findings were seen in older age groups. Cervical lymph nodes were most frequently effected(45.3%), followed by supraclavicular(22.6%), axillary(18.4%), submental(7.5%), post-auricular(5%) and inguinal (0.08%). Tuberculous lesions were more common in cervical whereas malignant changes were also frequent in cervical & Supraclavicular groups. Abnormal chest X-ray findings were more common in Tuberculous and malignant lesions. Conclusion-It was found that the majority of patients presenting with LAP were diagnosed having tuberculous lesions most likely due to a high prevalence of TB in Ranchi zone. FNAC is a simple, safe procedure and can be accepted as a reliable technique to establish a cytological diagnosis in lymphadenopathies. Similar pattern was observed in some other geographical areas in India. Further procedure for histopathological study may be required in some cases associated with multiple other risk factors.