Enlargement of the cervical lymph nodes (cervical lymphadenopathy) is the presence on the lateral and posterior surface of the neck of formations of lymphoid tissue larger than 5 mm, having an elastic or dense texture. The symptom is observed with viral and bacterial infections of the upper respiratory tract, inflammatory processes in the oropharynx, tumor formations of the neck and head. To determine the cause of lymphadenopathy, ultrasound, puncture biopsy, lymphography, and laboratory tests are prescribed. Symptoms are relieved with non-steroidal anti-inflammatory drugs, analgesics, antiseptics.
This group of lymph nodes drains the head, neck, upper chest, proximal upper limbs. Accordingly, enlarged cervical nodes most often indicate the presence of thyroid diseases, inflammatory processes in the oropharynx, bacterial and viral infections. The symptom is pathognomonic for rubella, develops with measles, and can be detected with rarer infectious pathologies - ornithosis, Ebola and Marburg fever, mycoplasma infections.
Thyroid neoplasias account for about 1.5% of all malignant neoplasms and in most cases are asymptomatic. The most typical variant is papillary cancer. Follicular tumors are quite common. With these volumetric formations, there is always an increase in the cervical lymph nodes, which indicates an increased proliferation of malignant thyrocytes, metastasis of tumor cells. Usually the lymph node remains soft and mobile for a long time, since the process does not affect the capsule and surrounding tissues.
Patients usually go to the doctor about an incidentally discovered thyroid nodule when it reaches 1 cm or more. As the tumor grows, other manifestations join: cough, hoarseness associated with compression of neighboring anatomical structures. Large neoplasms can compress the airways, causing shortness of breath and suffocation. When cancer spreads beyond the capsule of the organ, an expansion of the subcutaneous venous network occurs, deformation of the contours of the neck. In elderly patients, cachexia increases.
Cervical lymphadenopathy is one of the signs of thyroid lymphoma, an aggressive neoplasia characterized by intensive growth and involvement of neighboring organs in the pathological process. The disease often develops against the background of autoimmune thyroiditis. The tumor grows rapidly, occupying a whole share of the organ. Patients themselves often find a woody density node, which is combined with an increase and compaction of the cervical lymph nodes on the side of the lesion. Compression of the surrounding tissues provokes dysphagia, paresis of the vocal cords, displaces the esophagus and trachea.
In other lesions of the endocrine gland, an increase in lymph nodes is due to an increase in blood flow by 10-15 times, increased production and differentiation of normal lymphocytes in response to stimulation with foreign antigens. The size of the lymph nodes is more than 1 cm, they are elastic, not soldered to the surrounding tissues, sometimes they are sensitive to palpation. The symptom is typical for acute inflammatory processes, but it also occurs with benign neoplasms, chronic autoimmune thyroiditis. Lead to cervical lymphadenopathy:
Cervical lymphadenopathy involving the posterior cervical and occipital nodes is an important symptom of rubella. Lymph nodes are moderately enlarged, painless, not soldered to the surrounding skin. For children, the appearance of "buckshot" lymph nodes is typical - multiple small formations on the neck. Simultaneously with lymphadenopathy, a rash occurs - punctate or papular rashes are localized on the extensor surfaces of the limbs, in the region of the trunk and head. The rash disappears in a few days, leaving no peeling and pigmentation.
Lymphadenitis with an increase in the cervical lymph nodes develops in the catarrhal stage of measles. Lymphadenopathy is combined with rhinitis, conjunctivitis, hyperemia of the pharynx and puffiness of the face. In adults, the manifestations of the catarrhal period are less pronounced. The pathognomonic sign of measles is Belsky-Filatov-Koplik spots on the buccal mucosa. After 4-5 days, a second wave of fever begins, which coincides with the appearance of a maculopapular rash. On the 1st day, the rashes are located on the face and neck, by the end of the first day they spread to the trunk, on the third day the rash goes to the limbs.
Cervical lymphadenopathy is detected in various infections occurring in the oral cavity, ENT organs. Possible manifestation of a symptom in systemic bacterial and protozoal lesions - anginal-bubonic form of tularemia, sleeping sickness, diphtheria. Enlargement of lymph nodes is associated with the primary penetration and reproduction of pathogenic microorganisms, intensive proliferation and accumulation of specific clones of lymphocytes in the follicular and paracortical zones. With the defeat of the cervical lymphoid formations proceed:
Severe cases of tonsillitis can be complicated by a retropharyngeal abscess - purulent inflammation of the pharyngeal tissue. In addition to lymphadenopathy of the upper cervical and occipital lymph nodes, the patient is concerned about sharp pains in the throat, difficulty swallowing, with a large abscess, respiratory disorders are possible. The general condition is disturbed, the body temperature rises to 39-40 ° C. An increase in lymph nodes, combined with damage to the jugular vein and septicemia, is pathognomonic for Lemierre's syndrome. In children, cervical lymphadenopathy often indicates adenoiditis.
Lymph from the face and neck enters directly into the cervical lymph nodes, therefore, with various malignant tumors of this zone, they are a typical site of metastasis. Lymph nodes are usually woody in density, tightly connected to the skin and surrounding tissue, and are not painful. Lymphadenopathy in certain types of tumors is the initial sign of the disease, when the primary neoplasm does not yet cause clinical symptoms. An increase in lymph nodes is observed with such malignant neoplasia as:
Enlarged lymph nodes in the neck can be the first sign of lymphogranulomatosis - malignant hyperplasia of the lymphoid tissue with the formation of specific granulomas. The disease is characterized by the appearance of dense painless nodes, which are arranged in the form of a chain. In the local form of the lesion, an increase in one group of lymph nodes occurs, in the generalized form, total lymphadenopathy develops with damage to the internal organs. Cervical lymph nodes are affected in chronic lymphocytic leukemia, autoimmune lymphoproliferative syndrome.
An increase in the cervical lymph nodes, which is not accompanied by other symptoms, is an indication for consulting a hematologist. With a combination of lymphadenopathy with signs of damage to the organs of the respiratory, digestive systems, consultations of other specialists may be required. Diagnosis involves assessing the state of pathologically altered lymph nodes and identifying the cause of the condition. The most valuable are:
A further list of studies is formed taking into account the patient's complaints. Often, an examination of the upper respiratory tract is required - pharyngoscopy, rhinoscopy, laryngoscopy. To confirm the infectious etiology of the process, specific serological reactions are performed (RIF, ELISA, PCR). If there is a suspicion of a connection between the defeat of the cervical lymphatic structures and the pathology of the thyroid gland, a blood test for triiodothyronine and thyroxine, scintigraphy with radioactive iodine is performed.
In infectious diseases with lesions of the pharynx, gargling with an antiseptic solution is recommended to relieve local symptoms, inhalations and plenty of warm drinking are useful. To relieve pain in the neck and ENT organs, non-steroidal anti-inflammatory drugs, analgesics are prescribed. Etiotropic treatment is selected only after consulting a specialist. With a combination of cervical lymphadenopathy with febrile fever, palpable formations of the head and neck, a rapid deterioration in the general condition, it is necessary to consult a doctor as soon as possible.