Lymph node enlargement in children

Enlarged lymph nodes in children are observed in various infections, blood diseases, tumor processes, etc.

Causes of enlarged lymph nodes in children

Acute enlargement of one group of lymph nodes in a child (regional) in the form of a local reaction of the skin above them (hyperemia, edema), pain occurs with staphylococcal and streptococcal infection (pyoderma, furuncle, tonsillitis, otitis, infected wound, eczema, gingivitis, stomatitis, etc.). Sometimes the lymph nodes become purulent, which is accompanied by an increase in body temperature.

Diffuse enlargement of the occipital, posterior cervical, tonsillar and other lymph nodes in a child is observed with rubella, scarlet fever, infectious mononucleosis, acute respiratory viral diseases. In older children, the reaction of the submandibular and tonsillar lymph nodes is clearly expressed with lacunar tonsillitis, diphtheria of the pharynx.

In acute inflammations, lymphadenitis almost always disappears quickly. It persists for a long time in chronic infections, such as tuberculosis. Tuberculosis of the peripheral lymph nodes is limited to a certain area, most often the cervical group. The lymph nodes are a large, dense, painless package that has a tendency to caseous decay and the formation of fistulas, after which uneven scars remain. The nodes are fused together, with the skin and subcutaneous tissue. Sometimes tuberculosis of the cervical lymph nodes is compared to a collar. Intradermal vaccination against tuberculosis can rarely be accompanied by a reaction of the axillary lymph nodes (the so-called bezezhit). Auxiliary diagnostic methods include tuberculin tests, diagnostic punctures or biopsy. Generalized enlargement of the lymph nodes can be observed in disseminated tuberculosis and chronic tuberculosis intoxication. Chronic course is typical: fibrous tissue develops in the affected lymph nodes ("stone glands", according to A. A. Kisel). Sometimes, with disseminated tuberculosis, caseous decay and fistula formation are possible.

Another chronic infection, brucellosis, is accompanied by diffuse enlargement of the lymph nodes to the size of a hazelnut. They are slightly painful. At the same time, an enlargement of the spleen is noted. Of the protozoan diseases, lymphadenopathy is observed in toxoplasmosis. Some of its forms are characterized by an enlargement of the cervical lymph nodes. To clarify the diagnosis of the lesion, an intradermal test with toxoplasmin and a complement fixation reaction are used. Generalized enlargement of the lymph nodes can be observed in mycoses: histoplasmosis, coccidioidomycosis, etc.

Lymph nodes in children also enlarge with some viral infections. Occipital and parotid lymph nodes enlarge in the prodrome of rubella, later diffuse enlargement of the lymph nodes is possible; they are painful when pressed, have an elastic consistency. Peripheral lymph nodes can be moderately enlarged with measles, flu, adenovirus infection. Swollen lymph nodes have a dense consistency and are painful when palpated. With Filatov's disease (infectious mononucleosis), the enlargement of the lymph nodes is more pronounced in the neck, usually on both sides, less often other groups are enlarged, up to the formation of packets. Enlargement of regional lymph nodes with phenomena of periadenitis (adhesion to the skin) is noted in cat scratch disease. Chills and moderate leukocytosis may appear at the same time. Suppuration is rare.

Lymph nodes may enlarge in infectious and allergic diseases. Allergic subsepsis of Wissler-Fanconi is characterized by diffuse micropolyadenia. Parenteral administration of foreign protein often causes serum sickness, which is accompanied by diffuse lymphadenopathy.

The most significant increase in regional lymph nodes is at the site of serum administration.

A significant increase in lymph nodes in a child is observed in blood diseases. In most cases, with acute leukemia, diffuse enlargement of the lymph nodes is noted. It appears early and is most pronounced in the neck; their size, as a rule, is small - up to a hazelnut. However, with tumor forms, the size can be significant. In this case, the lymph nodes of the neck, mediastinum and other areas increase, forming large packets. Chronic leukemia - myelosis - is rare in children, the lymph nodes in it increase and are not clearly expressed.

Lymph nodes often become the center of tumor processes - primary tumors or metastases to them. In lymphosarcoma, enlarged lymph nodes can be seen or palpated in the form of large or small tumor masses, which, due to their growth into the surrounding tissues, are immobile and can cause symptoms of compression (edema, thrombosis, paralysis). Enlargement of peripheral lymph nodes is the main symptom of lymphogranulomatosis: cervical and subclavian lymph nodes enlarge, which are a conglomerate, a package with poorly defined nodes. At first, they are mobile, not fused with each other and the surrounding tissues. Later, they can be fused with each other and the underlying tissues, become dense, painless or moderately painful. The detection of Berezovsky-Sternberg cells in a puncture or histological preparation is typical.

Enlarged lymph nodes can be found in chloroma, multiple myeloma, reticulosarcoma. Metastases to regional lymph nodes are often observed in malignant tumors. The affected nodes enlarge and become dense.

The syndrome of enlarged peripheral lymph nodes in children can be observed with reticulohistiocytosis "X" (Letterer-Siwe, Hand-Schüller-Christian diseases), when enlargement of the cervical, axillary or inguinal lymph nodes is observed.

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Enlarged lymph nodes in children and childhood "lymphatism"

Childhood "lymphatism" as a manifestation of constitutional peculiarities. The growth of lymphatic tissue in children is very unique. Children, by their age, unlike adults, are bright "lymphatics". The first tissue that reacts to growth stimulation in a child's body, the tissue that has the richest representation of receptors for growth hormones, is lymphoid tissue. When a child grows, his lymphoid formations (tonsils, adenoids, thymus gland, peripheral lymph nodes, accumulations of lymphoid tissue on the mucous membranes, etc.) outpace the growth of the skeleton and internal organs. Childhood "lymphatism" is a purely physiological, absolutely symmetrical increase in lymph nodes and formations that accompanies the child's growth. At the age of 6 to 10 years, the total lymphoid mass of a child's body can be twice as large as the lymphoid mass of an adult. Then its involution begins. Manifestations of borderline health conditions may also include such conditions as hyperplasia of the thymus gland or peripheral lymph nodes, which go beyond physiological "lymphatism". Doctors should pay special attention to significant hyperplasia of the thymus gland, reaching respiratory disorders. Such degrees of hyperplasia of the thymus gland cannot be physiological. In such children, tumor processes, immunodeficiency states, etc. should be excluded.

Significant degrees of "lymphatism", including hyperplasia of the thymus gland, can be found in children with markedly accelerated physical development and, as a rule, with overfeeding, especially overfeeding with protein. This "lymphatism" can be called "macrosomatic" or "accelerated". It is typical for children at the end of the first year or the second, rarely 3-5 years of life. Its peculiar antipode is a variant of the classic constitutional anomaly known as "lymphatic-hypoplastic diathesis". In this form, an enlargement of the thymus gland and, to a small extent, hyperplasia of the peripheral lymphatic formations are combined with small indicators of length and body weight at birth and a subsequent lag in the rate of growth and increase in body weight, i.e. a state of hypoplasia or hypostature. According to modern concepts, this type of "lymphatism" is a reflection of the consequences of intrauterine infection or hypotrophy and the neurohormonal dysfunction that arose as a result. When such dysfunction leads to a decrease in reserves or glucocorticoid function of the adrenal glands, the child may have symptoms of thymus hyperplasia. Both types of "lymphatism" - both macrosomatic and hypoplastic - have a common increased risk due to the relative (growth) in the first variant and absolute insufficiency of adrenal reserves (in the second). This is the risk of malignant intercurrent, most often respiratory infections. Against the background of thymus hyperplasia, infection creates a risk of sudden or, more correctly, sudden death. Previously, in pediatrics, this was called "thymic" death, or "Mors thymica".

The "lymphatism" syndrome, which is very similar in clinical picture to age-related childhood "lymphatism", can be seen when a child is sensitized to some factor in his/her everyday environment. It is characterized by a greater degree of hyperplasia of lymphatic formations, disturbances of the general condition (crying, anxiety, instability of body temperature), transient disturbances of nasal breathing or runny nose. This is typical of respiratory sensitization with rapid stimulation of the growth of tonsils and adenoids, then other lymph nodes. The same is observed with food sensitization. Then the first lymph nodes to respond will be the mesenteric ones with a clinical picture of regular "colic" and bloating, then the tonsils and adenoids.

Sometimes "lymphatism" takes on a recurrent nature. In this case, the submandibular, anterior cervical lymph nodes usually come first, then the Waldeyer-Pirogov lymphopharyngeal ring. Less often, this is multiple hyperplasia of peripheral nodes. Often, after an infection, the enlargement of the lymph nodes remains pronounced for a long time. Such symptoms are characteristic of some forms of immunodeficiency states, in particular, insufficiency of antibody formation. Such patients require in-depth immunological examination.

And finally, we must not forget about the most trivial cause of persistent hyperplasia of the lymph nodes. Sometimes it is a very symmetrical hyperplasia, and its difference from physiological "lymphatism" consists only in the presence of some general complaints. The doctor must suspect the presence of a current chronic infection in each such child and conduct the appropriate examination and treatment. If earlier our teachers and predecessors identified tuberculosis infection in such patients, then we have a much wider choice - from a "bouquet" of intrauterine infections, including venereal diseases, to many latent viral infections and HIV. Thus, diagnoses of constitutional "lymphatism" have the right to exist only when other causes of lymphoid hyperplasia seem unlikely.