Enlarged Lymph Nodes : Causes, Symptoms, Diagnosis & Treatment

• General Characteristics
• Development Mechanism
• Classification

An increase in lymph nodes (lymphadenopathy) is a change in the size, consistency and mobility of the peripheral organs of the lymphatic system. A combination of a symptom with an increase in temperature, a change in the condition of the skin, an increase in the liver and spleen is possible. Lymphadenopathy is detected in infectious diseases, immunoproliferative, dysmetabolic and tumor processes, taking certain drugs. To clarify the causes of enlarged lymph nodes, ultrasound, radiological, radionuclide, tomographic, cytological, laboratory methods are used. Until a diagnosis is made, no treatment is usually given.

general characteristics

Enlarged lymph nodes are soft, rigid or dense rounded formations that are palpable under the lower jaw, in the neck, axillary zone, groin and other places. The surface of the lymph nodes is smooth or bumpy. Often, an increase is preceded by acute infectious and inflammatory processes (ARVI, tonsillitis, pulpitis), injuries with skin lesions, and vaccination. Sometimes changes in the lymph nodes are detected by chance by a patient or a doctor during a preventive or advisory examination.

An increase in lymph nodes is said to occur when their density, surface and mobility change, and their dimensions exceed 1 cm (for elbow formations - 0.5 cm, for inguinal - 1.5 cm). When palpated, the nodes are both painful and painless. In addition to lymphadenopathy, skin manifestations are possible (elements of a rash, skin redness), fever up to 38 ° C and above, prolonged low-grade fever, complaints of fatigue, sweating, heaviness in the left or right hypochondrium caused by an enlarged spleen, liver.

The reason for going to the doctor is the self-detection of large painless lymph nodes, a sharp soreness of the lymphoid tissue when trying to probe, a combination of lymphadenopathy with other pathological signs - rash, hyperthermia, weight loss, fatigue. Of particular concern should be lymph nodes measuring 2-3 cm, which have increased for no apparent reason, are located in several zones and persist for more than 2 months.

Development mechanism

The increase in lymph nodes occurs in several ways, each of which involves the accumulation of a certain type of cell in the lymphoid tissue. The reaction of peripheral lymphatic organs is often associated with increased blood flow, proliferation of lymphocytes and macrophages in response to the appearance of foreign genes. With antigenic stimulation, the node can increase 5-15 times in 5-1 days. Systemic neoprocesses are characterized by active proliferation of degenerate lymphoid cells with an increase in the size of the affected lymph node.

The stroma of lymphatic formations can be infiltrated by inflammatory elements (in infectious diseases), tumor cells located in the zone of lymphatic drainage of this node. Metastatic lesions are often accompanied by proliferation of connective tissue. In some disorders of lipid metabolism (Niemann-Pick disease, Gaucher syndrome), macrophages overflowing with unsplit glycosphingolipids linger in the lymph node.

Axillary lymphadenitis in a child

Classification

When determining the forms of lymphadenopathy, first of all, the location of the enlarged lymph nodes is taken into account. Lymphoid tissue is the main protective barrier against the spread of infectious pathogens and tumor cells. Therefore, the location of the altered lymphatic formations facilitates the diagnosis of the disease that caused the lymphadenopathic reaction. Depending on the localization of the process, there are:

• Enlarged submandibular lymph nodes . It is typical for pathological processes in the head and neck area - diseases of the eyes, ENT organs and paranasal sinuses, skin lesions. Submandibular lymphadenopathy often signals dental problems, chronic tonsillitis.
• Enlarged cervical lymph nodes . It is usually observed in respiratory infections, pathology of the oral cavity, infectious mononucleosis, and advanced stages of tuberculosis. Cervical nodes can be affected by lymphomas, lymphogranulomatosis, metastasis of thyroid cancer, lungs.
• Enlarged supraclavicular lymph nodes . Most often due to neoplastic causes. Detection of an enlarged node on the right is pathognomonic for cancer of the esophagus and lungs. The left lymph node is affected in malignant processes in the abdominal cavity, pelvis, retroperitoneal space.
• Enlarged axillary lymph nodes . Inflammatory damage is possible in the presence of wound infections, cat scratch disease, brucellosis. The defeat of the nodes of the axillary group is typical for breast cancer, melanoma of the upper extremities, the installation of silicone breast implants.
• Enlarged inguinal lymph nodes . As a rule, nodes in the groin react to the development of syphilis, gonorrhea, chancroid, and other genital infections. Inguinal lymphadenopathy is also a sign of malignant lesions of the pelvic organs, lymphoma, bubonic plague.

Somewhat less often, lymph nodes of other groups are involved in the process - submental, cubital (in the elbow), parotid, occipital, jugular. With a planned instrumental examination, an increase in internal lymph nodes can be determined - intrathoracic (mediastinal), bronchopulmonary, para-aortic, splenic, mesenteric, retroperitoneal.

In the diagnostic plan, it is important to take into account other criteria for the classification of lymphadenopathy - the characteristics of altered lymphoid formations, the prevalence of the lesion. This approach suggests the type of pathological process that occurs in the involved nodes and the body as a whole. Important criteria for the classification of enlarged lymph nodes are:

• Dimensions . At the I degree of lymphadenopathy, the diameter of the affected formations is 0.5-1.4 cm, at the II degree - 1.5-2.4 cm, and at the III degree - from 2.5 cm or more. A significant and prolonged increase in the size of the lymph nodes is more characteristic of malignant processes.
• Soreness . Intense pain sensations often manifest inflammation of the lymph nodes, especially acute purulent lymphadenitis. Formations that have undergone malignant transformation are often painless, except in cases of hemorrhage in the necrotic center.
• Density . Enlarged inflamed lymph nodes are usually soft, with their suppuration during palpation, fluctuation (fluid fluctuation) is felt. For the metastatic process, a stony consistency of formations is typical, for lymphomas - tight elasticity.
• Communication among themselves . A pathological formation of lymph nodes, palpable as a whole and moving together, is called a conglomerate. Lymph nodes soldered together are detected in tuberculosis, sarcoidosis, venereal lymphogranuloma, lymphomas and metastasis.
• Quantity . Both one or two, and several nodes in one zone can be affected. In the first case, they talk about single enlarged nodes, in the second - about local lymphadenopathy. The more active the process, the more formations are affected, however, during metastasis, one large node is often found.
• Prevalence . With local lymphadenopathy, single nodes are determined in one area, with regional lymphadenopathy - several formations in 1-2 adjacent zones. A generalized (common) process is characterized by damage to the lymphatic structures in three or more areas.

Taking into account the pathogenesis, an increase in lymph nodes can be primary (systemic), secondary (reactive) and inflammatory. Primary polyadenopathies develop with systemic malignancy of lymphoid tissue (leukemia, lymphogranulomatosis, non-Hodgkin's lymphomas) and benign processes (sinus histiocytosis). Reactive lesions are a response to another pathology (infection, immune disease, spread of tumor cells, metabolic disorders). Inflammation (lymphadenitis) occurs when infectious agents multiply in the tissue of the node.