Axillary lymphadenitis.

Purulent inflammation of the lymph nodes, localized directly in the armpit area and causes axillary lymphadenitis. A characteristic feature of the disease is that axillary lymphadenitis is a typical complication of all sorts of purulent-inflammatory diseases, and does not develop as a pathology on its own.

In rare cases, when a lymph node is infected, for example due to injury or trauma, the disease can be considered primary. Literally from ancient Greek, axillary lymphadenitis has the following meaning: lymph - liquid, aden - gland, itis - inflammatory process. Thus, axillary lymphadenitis is inflamed lymph nodes in the armpit. Localization of inflamed lymph nodes in the groin area is possible.

According to the structure of the disease, axillary lymphadenitis is divided into two subtypes: catarrhal or serous and purulent. The development of non-specific lymphadenitis is possible during the course of various inflammatory processes. The course of inflammatory processes is caused by characteristic changes in the lymph nodes, namely, an increase in size, painful sensations when touched, easy mobility, plastic consistency, and an isolated state of the lymph nodes.

As a rule, serous inflammation of the lymph nodes is accompanied by their enlargement, their sensitivity and soreness increase, despite the fact that the general condition of the patient does not change in appearance. The skin does not change and is not fused with the compacted nodes. In the case when the disease lasts for a long time, there is a possibility of detecting inflamed areas of the lymph nodes in the patient, in the form of "packets".

The purulent form of axillary lymphadenitis is characterized by pronounced pain in the armpit, the color of its skin changes, redness and swelling appear, hyperthermia is also possible. The lymph nodes have blurred outlines and adhesions with the surrounding tissue, as well as with each other. The general condition of the patient significantly worsens, against the background of general malaise, tachycardia, fever, severe headache, chills, and rapid fatigue occur. Untimely treatment, in most cases, entails the development of an advanced form of the disease, possible complications, such as thrombophlebitis, abscess, adenophlegmon, in more severe cases, generalized infection - sepsis.

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Causes of axillary lymphadenitis

Most often, the causes of axillary lymphadenitis involve infection of the lymph nodes with all sorts of infectious microorganisms. These include intestinal and pseudomonas aeruginosa, staphylococci, streptococci, all sorts of pneumococci and diplococci. The enlargement of the lymph nodes occurs depending on the size of the inflammatory process and the size of the location of the infectious microorganism.

There are three ways of infection of lymph nodes: lymphatic, hematogenous, contact. All three ways involve infection of lymph nodes by penetration of infectious microorganisms. Regardless of the method of infection, the symptoms of axillary lymphadenitis remain unchanged, the only difference is in the time required for infection.

The main pathogens that provoke axillary lymphadenitis are streptococci and staphylococci that penetrate into the lymph nodes with the flow of lymph directly from the site of acute or chronic purulent inflammation or by direct contact through damaged skin due to wounds and injuries. According to the state of the inflammatory foci, specialists distinguish non-purulent and purulent axillary lymphadenitis. Depending on the duration of the inflammatory process, axillary lymphadenitis can be acute or chronic in its course. In some cases, purulent-inflammatory processes may affect one or several adjacent lymph nodes. Such extensive purulent-inflammatory foci of suppuration of soft tissues are transformed into adenophlegmon.

The primary causes of axillary lymphadenitis, as described above in the text, are all sorts of infectious foci in the human body. These include infected open wounds, inflammations and abrasions of the skin, various phlegmons, such as trophic ulcers, erysipelas, all sorts of osteomyelitis, furunculosis. Very often, inflammation of the lymph node is a consequence of inflammation of the lymphatic vessels or, in the words of specialists, lymphangitis. In most cases, axillary lymphadenitis is provoked by: proteus, various types of E. coli, staphylococci, entero-, streptococci or, as a consequence of their vital activity, toxic products of tissue decay of primary inflammatory foci. The form and nature of purulent processes determine the features of the clinical picture of axillary lymphadenitis. Depending on the type of causative bacteria, axillary lymphadenitis is divided into specific and non-specific. Specific diseases caused by viruses, bacteria, fungi, as well as tumors, both benign and malignant, form specific axillary lymphadenitis. Diseases that provoke the occurrence of axillary lymphadenitis include: tuberculosis, infectious mononucleosis, brucellosis, sarcoidosis, actinomycosis, AIDS.

As a rule, infection of the lymph node occurs through the penetration of harmful microorganisms through the lymphatic vessels along with the flow of lymph from the infected part of the body or the primary infectious focus. This method of infection spread is called lymphogenic by specialists. The primary infectious focus may well be any damage to the skin in the armpit area, for example, cuts from careless shaving of the armpits, all kinds of wounds or abrasions from tight clothing. Also, the primary infectious focus may be purulent-necrotic inflammation of the hair follicle and even a furuncle. In addition to this method of infection of the lymph nodes, there is a hematogenous method of infection - which involves the spread of infection along with the blood flow from infectious foci of internal organs, with inflammatory diseases of the intestines, ovaries, liver.

The hematogenous way of infection of the lymph nodes is quite common, as is the lymphagenous way of infection. Less common is the contact way of infection of the lymph node, which involves direct contact or contact of the infected surface and tissues of the lymph nodes.

The contact method is possible, for example, when trying on clothes. There is a high probability of penetration of infectious microorganisms with all kinds of wounds of the lymph nodes, when infection occurs through direct contact of microbes and wounds. In this case, the causes of axillary lymphadenitis are quite obvious and the disease is classified as primary. Regardless of the method by which infectious microorganisms penetrated the lymph nodes, poisoning by the waste products of these microorganisms is a consequence of this penetration. This explains the occurrence of inflammation, purulent tissue melting. Then serous inflammation occurs with further development of purulent formations. So, let's summarize.

It should be noted that the causes of axillary lymphadenitis may be associated with a number of diseases. For example, tuberculosis, malignant lesions of the neck and head, brucellosis, melanoma, rubella, lymphoma, non-specific infectious lesions, cat scratch disease. The presence of silicone implants in women's mammary glands is also not excluded by specialists from the cause of axillary lymphadenitis. In any of the above cases, when the size of the lymph node exceeds 1 cm in diameter, pain in the axillary region signals the need to examine the possible cause of axillary lymphadenitis.

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Lymphadenitis in the armpit

Lymph node axillary fold lymphadenitis occurs as a result of the spread of infectious microorganisms through lymphatic or blood vessels, there is also a possibility of contact penetration of infection through cuts, wounds and other violations of the integrity of the skin of the axillary region. The defeat of the lymphatic system occurs, as a rule, at the secondary level of infection with a local purulent-infectious process, general disease and possible intoxication, which occurs against the background of regional tissue damage. It is absolutely certain that the lymphatic glands reflect the general condition of the structure of organs and tissues of the body, both external and internal. And if a pathological process begins in the body, then the first reaction will be changes in the lymphatic system. Lymph node axillary fold lymphadenitis in most cases indicates the onset of such processes and, accordingly, requires immediate treatment.

Lymphadenitis of the axillary region

Axillary lymphadenitis is characterized by inflammatory processes of the supraclavicular and subclavian lymph nodes. In this case, lymph from nearby organs of the neck, chest, and shoulder girdle is concentrated in the axillary region. The course of simple forms of axillary lymphadenitis is localized in the inflamed capsule itself and a limited focus of the inflammatory process. A more complex form of axillary lymphadenitis is accompanied by the development of destruction of the inflammatory process and spread to nearby tissues. There is also a high probability of developing dense infiltrates - adenophlegmon, with foci of softening. Untimely treatment or ineffective forms of treatment lead to the onset of extensive spread of inflammatory processes with damage to the mediastinal tissue, the development of thrombophlebitis and septicopyemia. The formation of lymphatic fistulas as a result of purulent breakthroughs is not excluded. Often, acute axillary lymphadenitis progresses and becomes purulent. In such cases, inflammation of the lymph nodes with reddening of the skin around is observed. The lymph nodes become immobile and gradually fuse with each other and the adjacent tissues.

Symptoms of axillary lymphadenitis

Patients diagnosed with lymphadenitis usually have similar symptoms of axillary lymphadenitis, namely, severe pain of a pulling nature in the axillary region. The sensations are so painful that it is necessary to keep the limbs in a forced comfortable position. Painful sensations are accompanied by an increase in body temperature, the appearance of edema. With lymphadenitis located on the surface of the skin, hyperemia and local increase in temperature are often observed. For a later stage of the disease, the appearance of chills, fluctuation, leukocytosis is characteristic. At this point, the state of the primary infectious focus is no longer of particular importance.

The acute non-specific form has the following symptoms of axillary lymphadenitis by external signs - characteristic sudden painful sensations in the area of enlarged lymph nodes, accompanied by general weakness, malaise, headaches, and elevated body temperature. Non-purulent lymphadenitis usually does not affect the general condition of the patient, and externally proceeds without pronounced symptoms.

Symptoms of axillary lymphadenitis without purulent formations or non-purulent lymphadenitis are characterized by such external signs - enlarged lymph nodes, dense to the touch, painful upon palpation, have a mobile state, the skin over the nodes does not change externally. The purulent form of axillary lymphadenitis is characterized by intense painful sensations, constant, pulsating in nature. The lymph nodes grow together with the surrounding tissues and with each other, become practically immobile and dense to the touch. In cases of adenophlegmon, very often the skin over the inflammation site has noticeable redness. As a result of this redness, a tumor appears, dense in consistency with blurred boundaries and inflammation sites.

Secondary symptoms of axillary lymphadenitis with purulent formations have a characteristic increase in body temperature to 39ºС, accompanied by severe chills, rapid heartbeat, and pronounced general weakness. Putrefactive phlegmon, when palpating the inflamed area, creates a sound similar to the "crunch of snow". In the absence of timely drug treatment, there is a very high probability of the spread of purulent axillary lymphadenitis to larger areas and can subsequently provoke sepsis.

Axillary lymphadenitis in children

The fragile skin of a child in the armpit area is subject to all sorts of friction and irritation, which may well be a source of infection along with purulent inflammatory foci of individual organs. Axillary lymphadenitis in children occurs mainly as a complication due to childhood infectious diseases, such as measles, scarlet fever, tonsillitis, diphtheria. Axillary lymphadenitis is usually observed in older children. As pediatric practice shows, infection of the lymph nodes is initiated by staphylococci, but infection by any pyogenic microorganisms is also possible.

The development of axillary lymphadenitis in children occurs quite quickly and actively, which is why the transformation into an acute or chronic form of the disease does not take much time.

Symptoms of axillary lymphadenitis in children have characteristic features, such as headaches, decreased or loss of appetite, poor sleep, severe pain in the armpit area. The initial phase of axillary lymphadenitis in children is manifested by swelling of the lymph nodes. When palpating the lymph nodes, the child feels pain. The lymph nodes become hard to the touch. After a few days, the inflammatory processes spread to the tissues located near the lymph nodes, while the node itself is almost impossible to palpate. The lymph node and the tissues around it become denser and increase in size. It is very important not to miss the moment and begin timely treatment of axillary lymphadenitis, which will avoid the spread of inflammatory processes and complications.

With the development of the acute form of the disease, a significant increase in temperature and general malaise are observed, which is caused by the effect of microbial toxins on the child's body. With the development of purulent lymphadenitis, the axillary area of inflammatory processes usually turns red. The lymph nodes become dense in consistency, and painful sensations occur when palpated.

Diagnosing axillary lymphadenitis in children is not particularly difficult for a specialist, but doubts may arise in determining the etiology of the disease.

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Right-sided axillary lymphadenitis

Right-sided axillary lymphadenitis has a number of characteristic features in the primary symptoms and diagnostics. Its main, characteristic feature is its immediate proximity to the heart. And as a rule, this moment requires the utmost attention from specialists in terms of the correct diagnosis and choice of treatment method for the disease. The possibility of the transition of right-sided axillary lymphadenitis to a purulent infectious form is accompanied by temporary remissions and exacerbations, the disease has a persistent course. This form of the disease manifests itself at the initial stages with a special pain of a pulling nature in the right-sided axillary region, accompanied by general weakness, rapid fatigue, and a sluggish state. The first few days of the disease, the lymph nodes are quite mobile, there is no pain, adhesions with tissues are not detected. And only after three to four days, rapid development of tissue infiltration begins, adhesion of the lymph nodes occurs. In appearance, the lymph nodes resemble a bunch of grapes and fill the entire right-sided armpit.

Depending on the degree of development of the inflammatory focus, conservative or surgical treatment is used. If the patient seeks help at the stage of a pronounced inflammatory process with general health disorders, it is advisable to prescribe a therapeutic complex that suppresses the inflammatory process. Such a complex, as a rule, consists of local treatment, physiotherapy, and antibiotic therapy.

Timely and high-quality treatment leads to positive dynamics, the lymph nodes return to their previous size, the patient's general well-being improves significantly. Quite often, after using the therapeutic complex, the recovery process does not begin or proceeds very slowly, then it makes sense to perform surgery to remove the source of infectious inflammation and adjacent tissues of the right-sided axillary cavity. There are practically no complications with such surgical interventions, but exceptions are possible. Postoperative recovery of a patient with right-sided axillary lymphadenitis proceeds without characteristic features and is quite fast.

Diagnosis of axillary lymphadenitis

Diagnosis of axillary lymphadenitis is not particularly difficult for a specialist. To establish the correct diagnosis, it is necessary to take into account all clinical indications and anamnesis. It is a little more difficult to establish a diagnosis in complicated forms of axillary lymphadenitis. For all variants, it is necessary to determine the localization of the primary purulent foci of inflammation. As a rule, diagnosis of axillary lymphadenitis is carried out using a puncture biopsy of the lymph nodes; if necessary, excision of the lymph node is performed for histological analysis. Such a procedure is necessary to determine chronic forms of axillary lymphadenitis and diagnosis of diseases such as leukemia, metastatic lesions of the lymph nodes, lymphogranulomatosis. Diagnosis of axillary lymphadenitis involves a whole range of clinical laboratory studies - computed tomography of the lymph nodes, lymphoscintigraphy, X-ray contrast lymphography.

If necessary, it is possible to involve specialists from other medical fields, such as venereologists and infectious disease specialists. Preliminary diagnostics of axillary lymphadenitis involves an external examination of the patient's body, with detailed palpation of the location of the lymph nodes. If primary signs of the disease are detected, an ultrasound examination is prescribed. In order to eliminate the primary symptoms of intoxication of the body, drinking plenty of fluids is recommended.

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Treatment of axillary lymphadenitis

Treatment of axillary lymphadenitis depends primarily on the phase of development of the inflammatory process and the condition of the lymph nodes. In the early stages of axillary lymphadenitis, treatment is conservative and aimed at eliminating the primary infectious inflammatory focus. For this purpose, if necessary, abscesses and phlegmons are opened, abscesses are drained, and purulent leaks are opened. Antibiotic therapy is also mandatory, but it is necessary to take into account the sensitivity of the microbial flora of the primary inflammatory focus.

If necessary, axillary lymphadenitis is treated surgically. Opening abscesses, removing purulent masses, and draining wounds is usually practiced in acute purulent forms of axillary lymphadenitis. In cases where axillary lymphadenitis is secondary, treatment should begin with localizing the main source of the infectious focus. Treatment of axillary lymphadenitis of a specific form is determined by the condition of the lymph nodes and the degree of their damage.

In active inflammatory processes, first-line drugs are used, such as tubazid, ethambutol, streptomycin, protionamide, ethionamide. Streptomycin dressings are applied directly to the inflamed lymph node, treated with tibon or tubazid ointments, and local injections of streptomycin are also practiced. If purulent-inflammatory processes are pronounced, it is advisable to prescribe broad-spectrum antibiotics. In some cases, treatment of axillary lymphadenitis can last up to six months. Treatment methods for axillary lymphadenitis in children are practically no different from treatment methods for adults. Purulent inflammation of the lymph nodes is much less common in children, and enlarged lymph nodes are a symptom of many infectious diseases. As a result, the course of treatment is carried out in case of painful sensations of the lymph nodes or characteristic signs of infectious diseases did not appear before the inflammatory processes of the lymph nodes. Less often, specialists diagnose chronic axillary lymphadenitis in children; as a rule, there is no need for a special course of treatment. But this gives reason to detect the main infectious focus. In such cases, it is advisable to take appropriate measures to strengthen the child's immune system.

Prevention of axillary lymphadenitis

Prevention of axillary lymphadenitis is quite simple and accessible to everyone. First of all, maximum protection from possible infection by any means is necessary. Any inflammatory processes in the body must be promptly and effectively localized. Particular attention should be paid to all kinds of wounds, injuries, scratches of the axillary area. It is necessary to minimize the possibility of such injuries and, when they appear, timely and high-quality treatment with antiseptics is necessary in order to prevent the spread of infection. Any infectious disease must be treated with medication, under the supervision of a specialist, if necessary, you need to undergo general antibacterial therapy. Do not forget that untimely treatment or lack of treatment of axillary lymphadenitis provokes the development of inflammatory processes and the formation of purulent foci, the treatment of which subsequently takes a long period of time. Prevention of axillary lymphadenitis involves strengthening the human immune system as a whole, a balanced diet rich in vitamins, and compliance with personal hygiene rules.

Prognosis of axillary lymphadenitis

The prognosis of axillary lymphadenitis in most cases with the initial form of the disease and timely initiation of effective treatment is favorable, although in some cases long-term therapy is possible. The destructive form of axillary lymphadenitis entails the death of tissues of the lymph nodes with their subsequent restoration by scar tissue. Localization of lymphadenitis on the extremities provokes lymph drainage and develops lymphostasis and subsequently leads to the development of elephantiasis. The prognosis of acute axillary lymphadenitis of specific and non-specific forms is favorable in many cases. The result of an effective course of treatment is scarring of the lymph nodes, restoration of their functions. The duration of the course of treatment directly depends on the degree of development of the infectious focus and timely diagnosis of the disease in each specific case and can last up to one year or more.

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