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Enlargement of the lymph nodes of the roots of the lungs and mediastinum

 

Among the general symptoms of a fairly wide range of diseases, there is an increase in lymph nodes in the lungs - pulmonary, basal bronchopulmonary, peribronchial or paratracheal. Since lymph nodes are an integral part of the body's immune system, their increase, revealed by radiography, CT or MRI of the lung, is one of the clinical signs of pathologies of infectious or oncological origin.

Lymph node enlargement may be called lymphadenopathy, hyperplasia and even enlarged lymph node syndrome (in AIDS patients), but in any case the pathology has the same R59 code in accordance with ICD-10, and the subclass R includes symptoms and abnormalities, which are detected in patients during a medical examination.

Epidemiology

To date, there is no precise statistics of the increase in lymph nodes in the lungs, as well as of lymphadenopathy of other localization. But the infection-related increase in palpable knots (BTE, submaxillary, cervical, etc.) in childhood, according to experts from the British Paediatric Association, range from 38-45%, and this is one of the most common clinical problems of pediatrics.

According to the American Society of Clinical Oncology, the degree of malignant lymph node enlargement correlates with age, increasing from 17.5-20% in 18-35 year olds to 60% among older patients. And in children this is most often the result of leukemia, and in adolescents - Hodgkin's lymphoma.

The proportion of benign reactive lymphadenopathy accounts for an average of 30% of cases, and an increase in lymph nodes with non-tumor diseases is 26%.

Causes of the enlargement of lymph nodes in the lungs

The increase of localized in the lungs (intrapulmonary) nodes occurs in response to the main pathological process of the disease - due to their T and B lymphocytes, macrophages, dendrites, lymphatic follicles and other protective factors of lymphoid tissue.

Among the main diseases associated with the causes of enlarged lymph nodes in the lungs include:

  • pneumonia caused by staphylococci and beta-hemolytic streptococcus, as well as pneumococcal pneumonia;
  • pulmonary tuberculosis (caused by Mycobacterium tuberculosis);
  • tuberculosis of lymph nodes (with pulmonary and extrapulmonary forms of tuberculosis);
  • sarcoidosis of the lungs;
  • fibrosis of the lungs with systemic lupus erythematosus or amyloidosis;
  • acute or chronic forms of bronchopulmonary mycoses caused by aerogenic infection of the respiratory organs with Histoplasma capsulatum fungi (histoplasmosis), mold fungus Aspergillus fumigatus (aspergillosis), yeast-like fungus Blastomyces dermatitidis (pulmonary blastomycosis);
  • exogenous allergic alveolitis (allergic pneumonitis);
  • chronic pulmonary occupational diseases - silicosis and pneumoconiosis;
  • lymph node cancer - lymphogranulomatosis (Hodgkin's lymphoma), non-Hodgkin's lymphoma (lymphosarcoma);
  • lung cancer (adenocarcinoma, karziosarcoma, paraganglioma, etc.);
  • acute lymphoblastic leukemia (a form of leukemia associated with malignant damage to the hematopoietic cells of the bone marrow);
  • metastasis in the pulmonary lymph nodes in malignant tumors of the esophagus, mediastinum, thyroid or mammary gland. See also - Metastases in lymph nodes

Pulmonologists note that the increase in lymph nodes in the root of the lung is characteristic for many pathologies, since here - in the zone of separation of the median and posterior mediastinal centers of the chest - there are not only bronchopulmonary and paratracheal lymph nodes but also the longest lymphatic duct (thoracic). The basal nodes may be enlarged in case of pneumonia, tubercular bronchoadenitis, sarcoidosis, allergic alveolitis, bronchioloalveolar lung tumor, metastases of breast cancer, etc. Also read the publication - Causes of enlarged lymph nodes

As you understand, the presence of these diseases is the main risk factors for enlarged lymph nodes, which is on the list of their symptoms.

Pathogenesis

The mechanisms of origin and development - the pathogenesis of enlarging the lymph node - are partly due to the functions of the lymph nodes that, with the help of macrophages of their sinuses and stroma, purify the lymph fluid from associated antigens, toxins and products of cellular metabolism. For more details, see Lymph node hyperplasia.

Depending on the cause of the disease and the mechanism of action on lymphoid tissue, the types of this pathology are distinguished: infectious, reactive and malignant. So, with an infection with a current of lymph, phagocytes with entrapped antigens and those killed by inflammatory necrosis of cells get into the nodes and accumulate. For example, in tubercular patients, mycobacterium M. Tuberculosis, which enter the lymph nodes, is absorbed by macrophages with the formation of phagolysomes, formation of granulomas and the development of caseous necrosis of lymphoid tissue.

Granulomatous changes in the lymph nodes (with the displacement of fibrotic lymphoid tissue) are also noted in sarcoidosis, the etiology of which is still unknown to medicine (although autoimmune and genetic causes of its occurrence are not excluded).

In cases of reactive enlargement of the lymph nodes in the lungs, the dominant pathological process is the increased proliferation of their follicles, which is provoked by autoimmune diseases - when the body's immune system produces antigens against healthy cells, as happens, in particular, in systemic lupus erythematosus.

With the increase of lymph nodes in lungs of malignant nature, lymphomas with abnormal cell proliferation are formed. And with metastases, lymphoproliferative disorders are caused by the infiltration of healthy tissues with atypical (cancerous) cells and their proliferation, which leads to pathological morphological changes.

Symptoms of the enlargement of lymph nodes in the lungs

As clinicians emphasize, the increase in lymph nodes in the lungs is a consequence of the development of diseases, and information on the dimensions of the intrapulmonary lymph nodes (diameter> 2 cm) can be obtained only when they are visualized.

So the symptoms of enlarged lymph nodes in the lungs do not distinguish from the clinical picture of the disease. Although the examination of the lymph nodes in the lungs not only fixes their size, location and quantity, but also the presence of an inflammatory process, granuloma, necrosis (caseous or abscess), pulmonary infiltrates, etc.

The tumor of the intrapulmonary lymph node can cause swelling of the surrounding tissues or the obstruction of the lymphatic vessels, which leads to the appearance of respiratory symptoms: persistent dry cough, stridor (wheezing), dyspnea.

Symptoms of calcified lymph nodes, for example, in histoplasmosis or tuberculosis, can also manifest as a cough when the enlarged node protrudes into the trachea.

And granulomatous hypertrophied lymph nodes of large size can be accompanied not only by problems with breathing, but also by painful sensations.

Complications and consequences

In most cases, the consequences and complications associated with the course of the underlying disease. A complication of enlarged lymph nodes in the lungs includes the formation of an abscess or phlegmon, fistula formation, development of septicemia.

The enlargement of the lymph nodes in the mediastinal region can lead to bronchial or tracheal obstruction, esophageal stricture, impaired blood flow in the superior vena cava.

Pulmonary infiltrate in the lymph nodes in sarcoidosis can lead to scar formation and irreversible pulmonary fibrosis, severe pulmonary dysfunction and heart failure.

In case of tuberculous lesion of intrathoracic lymph nodes with caseous contents, their rupture and infection into other structures of the mediastinum are possible.

With malignant increase of intrapulmonary lymph nodes there are metabolic complications: increased uric acid level in the blood, violation of electrolyte balance, functional kidney failure.

Diagnostics of the enlargement of lymph nodes in the lungs

Diagnosis of enlarged lymph nodes in the lungs is, first of all, instrumental diagnostics using X-ray, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET).

As a result, a hyperplastic node biopsy (endoscopic, bronchoscopic or excisional) and an immunohistochemical examination of the tissue sample obtained may be required. The results of a biopsy are especially important if there is a suspicion of a malignant tumor of the lymph node, and there are serious doubts about the diagnosis of the disease in which a pathological change in the lymph node was detected. Blood tests are also needed: general and biochemical, for antibodies, for immune status and oncomarkers. Skin tests for tuberculosis and sarcoidosis are done.

What do need to examine?

Differential diagnosis

Differential diagnosis based on biopsy histology results is necessary to determine the goodness (or malignancy) of lymph node hyperplasia - in order to establish the correct diagnosis.

Treatment of the enlargement of lymph nodes in the lungs

Given that hyperplastic intrapulmonary lymph nodes appear with various pathologies, the main therapeutic efforts are directed at these diseases, and isolated treatment of enlarged lymph nodes in the lungs is simply impossible.

When the main cause lies in bacterial infection, antibiotics are used; with bronchopulmonary mycoses, doctors prescribe systemic antifungal drugs. To reduce inflammation, drugs of the steroid hormone group (corticosteroids) or NSAIDs (non-steroidal anti-inflammatory drugs) can be used. In all cases it is recommended to take vitamins A and E.

And when enlarged lymph nodes cause degeneration of the tissues and the formation of an abscess, surgical treatment may be required.

In cases of malignant enlargement of the lymph nodes in the lungs, treatment may include irradiation, drug treatment with chemotherapy drugs, and surgical intervention - anatomical segmentectomy or resection of the entire site (lymphadenectomy).

Prevention

The increase in lymph nodes in the lung is a common clinical manifestation and diagnostic sign, and its prevention, that is, a set of specific measures, has not been developed. Doctors advise to seek medical help in case of long-term deterioration of well-being, which can prevent the development of serious diseases.

Forecast

Experts associate a more favorable prognosis with an increase in lymph nodes in the lungs with its benign character. With oncology, the development of the disease is unpredictable, both in terms of treatment outcomes and life expectancy.

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