The role of blood vessels and lymphatic capillaries is to absorb and divert the protein fluid from the blood capillaries and return it to the venous circulation. In the course of the lymphatic system near the blood vessels and large veins, the lymph nodes (in the human body there are more than 600) are grouped - pinkish-gray rounded or oval formations of about 0.5-50 mm, including in the mediastinum region - the middle part of the thorax, where the most important human organs are located: the heart, bronchi, lungs, pulmonary arteries and veins, etc. They are a kind of filtration chamber for lymph and serve as a barrier for various infections. Enlargement of mediastinal lymph nodes or lymphadenopathy is a response to the pathological process occurring in the lungs, or the consequence of malignant lesions in the anatomically adjacent organs: the mammary gland, larynx, thyroid, gastrointestinal tract.
According to statistics, mediastinal lymphadenopathy is reported in 45% of patients. Since this disease is associated with such diagnoses as cancer, pneumonia, sarcoidosis, the data related to these pathologies give an idea of the epidemiology of enlarged lymph nodes in the mediastinum. In the world, more than 14 million people have contracted lung cancer, and about 17 million a year - pneumonia. Sarcoidosis in different countries is distributed unevenly, so in 40 cases per 100tys. People identify him in Europe and 1-2 in Japan.
Causes of the enlargement of the lymph nodes of the mediastinum
The reason for enlarging the lymph nodes of the mediastinum lies in the ingress of pathogenic microbes into them, which activate white blood cells that fight infection. Primary in this case are bronchopneumonia, tuberculosis, sarcoidosis, malignant tumors. Malignant pathologies include lymphomas that affect not only the lymph nodes of the mediastinum, but also other areas, carcinoma metastases - tumors of epithelial tissues.
Enlargement of lymph nodes in lung cancer
Lung cancer is a malignant tumor, in 95% of cases developing in the epithelial layers of the bronchi and bronchioles. Less often, neoplasms affect pleural cells or ancillary lung tissue. Of all types of cancer, this is the most common cause of death for people around the world. Define the 4 stages of cancer depending on the size of the tumor, its spread to neighboring tissues and the presence of metastases in the lymph nodes and other organs. At stage 1 cancer, lymph nodes are not involved in the pathological process. The increase in lymph nodes in lung cancer is observed from stage 2. First the bronchial ones are affected, at the 3rd stage the mediastinal sides are connected, on the 3b - the bronchopulmonary of the opposite side, the supraclavicular lymph nodes.
Enlargement of mediastinal lymph nodes after bronchopneumonia
Bronchopneumonia is an acute infectious disease affecting the walls of the bronchioles. Often, it occurs after an acute respiratory viral infection, but it also happens to be a primary disease. The increase in lymph nodes after bronchopneumonia occurs due to the involvement of the lymphatic and vascular system, including the lymph nodes of the mediastinum, in the inflammatory process. As a rule, with this disease they are moderately increased.
The risk factors for enlarging the lymph nodes of the mediastinum include smoking, prolonged exposure to chemicals, harmful fumes, dusty and polluted air, and gases. Overcooling leads to a decrease in immunity and various viral infections that can be complicated by pneumonia. The hereditary factor of the onset of the disease, as well as the long-term effects of various medications, are not excluded.
Lymph nodes exist for the filtration of various infectious agents from the tissues of our body, therefore located in strategically important places of the body. Once in such "traps", white blood cells are activated, which fight against the infiltrated infection. The pathogenesis of the disease lies in the increased proliferation of lymphocytes - protective cells to intensify the fight against foreign elements, if the existing ones do not cope. As a result, the lymph nodes increase and become denser.
Symptoms of the enlargement of the lymph nodes of the mediastinum
Symptoms of enlarged lymph nodes of the mediastinum have a clearly expressed clinical picture.
The first signs are manifested by intense and severe pain in the chest, sometimes they can be given to the shoulder and neck. Appears voice hoarseness, cough, eye pupils are dilated, the eyeball can fall, there is a noise in the ears and headaches. Perhaps the swelling of veins on the neck, the passage of food is difficult. The chronic course of the disease is characterized by an increase in temperature, tachycardia, swelling of the extremities, weakness, sweating.
Based on the time of the course of the disease, three stages of the development of the disease are distinguished:
The latter is associated with a repeated outbreak of the disease.
Enlargement of lymph nodes in the root of the lung
Enlargement of lymph nodes in the root of the lung is one of the most frequent pathologies of this part of the body. Unilateral lesion is most often caused by tubercular bronchoadenitis, metastasis of cancer and malignant lymphomas, bilateral - sarcoidosis of the 1st stage, which is characterized by the formation of granulomas in the lymph nodes.
Increased hilar lymph nodes
One of the reasons for the increase in the intrathoracic lymph nodes of the lungs, as in their roots, is pulmonary tuberculosis. The lymphoid tissue grows, and the lymph node also increases accordingly. Then there are signs of a specific inflammation.
A slight increase in nodes (up to 1.5 cm) is called bronchoadenitis. Inflammation in the circumference of the lesion creates an infiltrative bronchoadenitis, which is localized primarily on one side. Even with a two-sided arrangement, it is asymmetric. Dying of tissues in the form of curds is typical for tumoral or tumorous bronchoadenitis.
Another cause of lung lymphadenopathy is a benign disease - sarcoidosis, for which the formation of epithelioid granulomas in the lymph nodes is characteristic. This pathology affects more women aged 20-40 years. The nature of this disease is not clear enough today, some scientists associate it with infectious agents, others with a genetic factor.
An increase in the intrathoracic lymph nodes of the lung can also be caused by an organ trauma.
Complications and consequences
Since the increase in lymph nodes of the mediastinum is most often secondary and develops against a background of a number of the above diseases, the consequences and complications depend on the underlying pathology. The enlargement of the mediastinal lymph nodes can lead to pulmonary arterial thromboembolism, sepsis. In any case, early detection of the problem even in malignant formations makes them less threatening to human life, as in the late stages of the disease.
Diagnostics of the enlargement of the lymph nodes of the mediastinum
Diagnosis of enlarging the lymph nodes of the mediastinum is based on anamnesis of the disease, analyzes, instrumental and differential diagnosis, tk. Visual lymph nodes inside the thorax are not available.
For laboratory confirmation of the alleged diagnosis, a general and biochemical blood test, a micro-reaction of blood (a test for syphilis) is performed. Lymph node biopsy is also performed. With malignant neoplasms, leukocytosis, a decrease in the total number of lymphocytes, an increase in ESR, anemia are detected in the blood.
Assuming lymphogranulomatosis or leukemia make a bone marrow puncture. Suspecting tuberculosis, sputum analysis is performed. Sarcoidosis also makes changes in the general analysis of blood and urine, biochemical, including, the level of erythrocytes decreases, monocytes, lymphocytes, eosinophils, and ESR increase. For this disease, there are specific tests: a significant increase in the ACE enzyme in venous blood or calcium in the urine confirms the presence of pathology.
In addition to X-ray examination of the mediastinum, which is characterized by a two-dimensional flat image and is not able to give a complete picture of all its organs, including due to lack of contrast display, there are other methods of instrumental diagnosis.
X-ray is a modern and effective study that displays a more accurate three-dimensional image on the screen. It helps to clarify the structure and outlines of blackout, if it is a neoplasm - the degree of its growth into the mediastinum, the relation to other organs. Informative methods are also computer tomography, magnetic resonance imaging, ultrasound.
Bronchoscopy is a method with the help of an endoscope to obtain material for biological research in case of suspected tuberculosis, to examine trachea and bronchi. Endoscopy is used for examination of enlarged lymph nodes.
Enlargement of lymph nodes on the x-ray of the mediastinum
If there is no pathological process in the lungs, the lymph nodes are not visible in the picture. The enlargement of the lymph nodes on the mediastinal x-ray looks like a "pathological shadow" and gives an idea of the localization of the lesion, shape, outlines, mobility, relationship with neighboring organs. The enlargement of the lymph nodes may be indicated by compaction, expansion of the roots of the lungs in the picture. This pattern is typical for bronchitis, inflammation of the lungs and lungs of smokers. Tuberculosis of the intrathoracic lymph nodes is determined using an overview radiograph, and the clinical picture depends on the extent of their lesion, as evidenced by the shadow of the lung root, the outline of its outer contour and other characteristics. For a more accurate study of the anatomy of the mediastinum, various contrasted methods of fluoroscopy are used-pneumomediastinography (using gas by puncture), angiocardiography (iodine), bronchography (various contrast agents), and barium esophagus.
The task of differential diagnosis correctly recognize the pathology among all possible diagnoses: tuberculosis, tumors, sarcoidosis, lymphocytic leukemia, lymphogranulomatosis, viral infections, pneumonia and other diseases leading to an increase in lymph nodes in the mediastinum.
Treatment of the enlargement of the lymph nodes of the mediastinum
Treatment of an increase in the lymph nodes of the mediastinum directly depends on the diagnosis. Consider the therapy of the most possible pathologies. So, the treatment of sarcoidosis is effective with the help of steroid inhalations. Treatment of tuberculosis provides for a long period (up to six months) and is carried out in a hospital, after which, up to one and a half years is continued on an outpatient basis. Anti-tuberculosis therapy includes a combination of 3-4 anti-TB drugs in combination with immunomodulators, metabolic therapy, physiotherapy. Various neoplasms often require surgery in combination with chemotherapy and radiation. With mediastinal lymphoma and advanced stages of tumors, only conservative treatment is used.
For the treatment of sarcoidosis, prednisolone is initially used.
Prednisolone is a synthetic analogue of the hormones cortisone and hydrocortisone. It is an anti-inflammatory, antitoxic, anti-allergenic drug. It is produced in tablets and ampoules. The dose is determined individually, but usually starts 20-30 mg per day during an exacerbation. In chronic course - 5-10 mg. They can initially prescribe intravenously (30-45 mg), and with positive dynamics, switch to a reduced dose in tablets. Side effects are sometimes expressed by excessive hair, obesity, education and perforation of ulcers. Prednisolone is contraindicated in pregnancy, in old age, with hypertension, ulcerative lesions of the gastrointestinal tract.
To carry out inhalations, large doses of fluticasone, budesonide, are used. If pathology does not respond to treatment, azathioprine, crisanol, cyclosporine are prescribed.
Azathioprine - refers to drugs that correct immune processes. The form of release - tablets. A day is recommended to take 1-1.5 mg per kilogram of weight. Perhaps the emergence of nausea, vomiting, toxic hepatitis. Has a contraindication in leukopenia.
Combined treatment of tuberculosis may include the following drug combinations: isoniazid, pyrazinamide, rifampicin or isoniazid, rifampicin, etama butol. During treatment outside the hospital, a combination of two drugs is prescribed: isoniazid with ethambutol, or with ethionamide, or with pyrazinomide.
Isoniazid - is prescribed for the treatment of all forms and localizations of tuberculosis, both in adults and in children. Produced in tablets, powders, solutions. The methods of administration are different: oral, intramuscular, intravenous, intracavernous, with inhalation. The dose for each case is individual, an average of 15mg once-only after meals 1-3 times a day. There may be side effects in the form of nausea, vomiting, dizziness, drug hepatitis, an increase in mammary glands in men and bleeding in women. Contraindicated in patients with epilepsy, with increased blood pressure, liver disease, IHD, etc.
Rifampicin is a broad-spectrum antibiotic in the pharmacy chain is presented in capsules and ampoules with a porous mass. Capsules are drunk on an empty stomach half an hour before meals, intravenously drip only adults, using sterile water and glucose to prepare the solution. For adults, the daily dose is 0.45 g, for children 10 mg / kg. The course of treatment is a month and is under close supervision of doctors, tk. May be allergic reactions, lower blood pressure, indigestion, liver and kidney problems. It is not prescribed for pregnant women, children under 3 years old, with increased sensitivity to the drug.
An increase in the lymph nodes of the mediastinum, whatever cause it was caused, requires a balanced diet rich in vitamins and trace elements. The list of useful products is very large, including low-fat varieties of meat, vegetables (zucchini, carrots, asparagus, celery, cabbage, cucumbers, eggplants, onions, garlic, sweet peppers), various fresh and dried fruits, nuts, cereal cereals, cottage cheese, yogurts, fresh juices and other products. Increase the immunity will help infusions of dogrose, beef liver, butter, citrus. For sarcoidosis there is a restriction in the reception of calcium, but vitamins E, D, C, omega-3 are necessary for a sick body.
Physiotherapy treatment in the tumor nature of enlarging the lymph nodes of the mediastinum is not applied. For patients with sarcoidosis, EHF-therapy is effective on the thymus gland region. Tuberculosis of the lungs is treated with a laser, ultrasound, inductothermia. These methods increase blood circulation in the lungs, thereby increasing the effect of anti-tuberculosis drugs. Contraindicated in acute disease, hemoptysis, tumor processes.
In the recipes of alternative treatment of various lung diseases, we use herbs, bee products, animal and vegetable fats, nuts, etc. Here are some of them:
mix the interior lard (200 g), butter (50 g), honey (tablespoon), cocoa (50 g), egg yolks (4 pcs.), cream (300 g). The resulting mass is whipped in a blender and boiled to the state of thick sour cream. Drink in a cooled form 1 tablespoon 3 times a day;
2 tbsp. Spoons of lycopodium and a pack of softened oil are added to a half liter of honey, mix thoroughly. Take several times a day on a tablespoon;
beet juice, aloe, honey, "Cahors" wine (100 g each), a spoon of pork fat mix and insist 2 weeks, daily portion 40-50 g per day;
at a temperature, compresses of grated horseradish and grindings with vinegar are effective;
inhalation, using pine needles and eucalyptus oil.
In nature, there are many herbs that can help in a complex with medicamental treatment. If the enlargement of the lymph nodes of the mediastinum is associated with infectious diseases, pneumonia, tuberculosis, sarcoidosis, it is safe to use teas and decoctions with linden, berries or elderberry flowers, mother-and-stepmother, licorice, plantain, sage, celandine, nettle, calendula. In the pharmacy chain, special collections of herbs are sold, in which all the necessary components for combating pathological foci are balanced.
Homeopathy is often treated when various other methods have already been tested, but the result is not achieved. Homeopathic treatment for cancer uses open at different times by different scientists of biologically active substances aimed at stimulating the body's resistance and activating antitumor mechanisms. If all known methods of treatment have been exhausted, but the effect has not been reached, they resort to autonosod - homeopathic autovaccine, manufactured using ultra-small doses of toxins and poisons. Such preparations are individual and are made from blood, urine or saliva of the patient on the basis of an alcohol solution.
In the treatment of tuberculosis also resort to homeopathic remedies. Depending on the symptoms, this or that drug is prescribed. So, with prolonged sputum, phosphorus is prescribed in different dilutions (at 6, 12, 30); shortness of breath - adonis vernalis, apocinum, digitalis; hemoptysis - millefolium, ferrum acetylum, witch hazel; fever - aconite, belladonna, gelmeumium, ferrum phosphoricum; cough - sodium phosphorus, sodium sulfuricum.
Apocinum - made from the root of kutra red, applied in 3, 6, 12, 30 dilutions. Side effects and contraindications are not described.
Millefolium is an anti-inflammatory and venotonizing drug in droplets. It is recommended before meals to take 10-15 drops three times a day. No adverse events were detected.
Aconite - has a combined effect, reduces the secretion of sputum in the bronchi, reduces temperature, has antiseptic, anti-inflammatory, anesthetic properties. Eat half an hour before meals or an hour after. In the period of an exacerbation put under the tongue 8 granules 5 times a day, gradually reducing to three techniques. After 2 weeks, reduce the frequency of reception to 2 times, continue for another two weeks. There may be allergic manifestations, but stop treatment is not worth it. Contraindicated in pregnant, hypotensive, hypersensitive.
Witch hazel - for the treatment of the lungs is used in granules, the dose is determined by the homeopath individually. For use by pregnant women, a consultation with a gynecologist is necessary.
Surgical treatment is used for tumors and cysts of the mediastinum, and it is necessary to do this as soon as possible. In the case of malignant tumors, the approach is individual, because At the last stage, the radical method does not make sense. Indications for surgical intervention with tuberculosis is the lack of positive dynamics for 1.5-2 years. Sarcoidosis rarely requires surgical intervention, such a need may arise to save a person's life under various complications.
The best prevention is a healthy lifestyle, exercise, nutrition - all this strengthens the immune system, makes the body less susceptible to various infections. Also, it is necessary to avoid factors that cause diseases of the mediastinal organs: work or living in places of air pollution, contacts with patients, hypothermia, stress.
The prognosis of the development of pathologies is different for different diseases. Sarcoidosis does not directly carry the threat of life, but its complications can be very dangerous. Timely and full treatment of tuberculosis has a favorable dynamics, and neglect leads to death. Malignant tumors detected in the early stages are successfully eliminated by surgery, and at later stages they have an unfavorable prognosis.
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