Enlargement of lymph nodes

An important diagnostic feature, often a symptom of the pathological process, is an increase in lymph nodes. In a number of cases, this is the first and only sign of diseases, which is why a doctor should examine all groups of lymph nodes and record information about them in medical records.

Normally, the lymph nodes are painless, mobile, of elastic consistency, their size varies from several millimeters to 1-1.5 cm. The maximum value is the lymph nodes located along the lymphatic vessels collecting lymph from the areas that are most antigenically irritated (inguinal, cervical , axillary), which is caused by abrasions, traumas, inflammatory processes in the mouth and nasopharynx.

To assess the state of the lymph nodes in a clinical study take into account the patient's complaints about their soreness and swelling, pay attention to the localization of lymphadenopathy, the sharpness of the contours and the size of the lymph nodes, the discoloration of the skin above them, the consistency, mobility or adhesion between themselves and surrounding tissues. Inspection and palpation of the lymph nodes are carried out in the following order: occipital, pre- and tail, anterior and posterior, submandibular, supra- and subclavian, axillary, ulnar, inguinal, popliteal.

The lymph nodes together with the spleen, tonsils and lymphoid tissue are referred to the secondary (peripheral) organs of the immune system. Lymph nodes contain lymphocytes and macrophages; the sinus of the cortical node of the lymph nodes is filled with phagocytes providing the first stage of the immune response in infections. Antigenic stimulation is accompanied by the proliferation of T and B lymphocytes in the lymph nodes. Transformation of B-lymphocytes into plasma cells secreting immunoglobulins (antibodies). In addition, the lymph nodes - a biological filter that prevents the entry into the lymph and blood of various foreign agents, including microorganisms, their metabolic products and toxins. That is why, in many infectious diseases, there is a regular appearance in some extent of expressed lymphadenopathy. Which is usually combined with other symptoms characteristic of infections: fever, intoxication, hepatosplenomegaly, rash, etc.

The increase in regional lymph nodes, for example cervical, as well as other areas, sometimes serves as the main complaint of patients leading them to the doctor. In this case, the enlarged lymph nodes can be noticeable, since they deform the corresponding part of the body. However, the main method of studying lymph nodes is palpation. Palpation of the lymph nodes is performed by soft movements of the fingertips, comparing the symmetrical parts of the head, neck, chela.

When palpation is evaluated the following characteristics of the lymph nodes:

• Amount.
• The form.
• The size.
• Consistency.
• Soreness.
• Mobility.
• Spaynost with surrounding tissues (in the presence of several lymph nodes - also among themselves).

Lymph nodes should be probed in a certain order: occipital, parotid, submandibular (anterior and posterior), nodobhopoonochnye, superficial cervical, supraclavicular, subclavian, pectoral, axillary, ulnar, inguinal.

• The occipital lymph nodes should be palpated at the attachment point of the trapezius muscle in the region of the transition of the posterior surface of the neck to the occiput.
• Parotid lymph nodes palpate anteriorly from the tragus of the auricle.
• Anterior submandibular lymph nodes (in clinical practice it is not accepted their correct designation as submandibular nodes) should be palpated anteriorly from submandibular salivary gland.
• Posterior submandibular lymph nodes (in clinical practice they are not quite rightly called tonsillar) lie behind the submandibular gland near the angle of the lower jaw.
• Sub-chin lymph nodes palpate in the chin triangle of the neck (behind the body of the lower jaw). The increase in submandibular and sub-chimney lymph nodes often occurs as a local reaction to inflammatory processes in the palatine tonsils and teeth.
• Surface cervical lymph nodes lie anterior to the sternocleidomastoid muscle.
• Supraclavicular lymph nodes are located in the supraclavicular fossae between the legs of the sternocleidomastoid muscle.
• Subclavian lymph nodes should be palpated under the clavicle of the subclavian vein.
• The thoracic lymph nodes are located under the large pectoral muscles.
• Axillary lymph nodes palpate in the armpits.
• Surface ulnar lymph nodes are located on the front surface of the forearm at the level of the medial supramargle of the shoulder along the medial subcutaneous vein of the arm. Palpable elbow lymph node - usually a sign of systemic lymphadenopathy.
• Inguinal lymph nodes should be palpated in the inguinal areas along the inguinal fold. The sizes of the revealed enlarged lymph node are expressed in millimeters. Sometimes, in the area of the dense lymph node, scar tissue can be found - traces of fistulous past passages or fresh fistulas with the separation of pus, another fluid, which naturally need to be specifically examined (for example, to detect tuberculosis). In some cases, the lymph nodes are revealed even after a general examination.

The characteristic, for example, of the submaxillary group of lymph nodes will sound like this: a single submandibular lymph node of round shape, 7 mm in size, of soft consistency, movable, painless, not soldered to surrounding tissues, is palpated.

[1], [2], [3]

Causes of enlarged lymph nodes

The most significant increase in lymph nodes in the following conditions.

• Various acute inflammatory diseases, for example acute pharyngitis, acute purulent, mastitis.
• Early stage of HIV infection: in many cases, generalized lymphadenopathy is the only clinical sign of the disease.
• Diseases of the blood are primarily hemoblastoses.
• Lymphoproliferative diseases - lymphogranulomatosis.
• Systemic diseases of connective tissue.
• Tumors with metastases to the lymph nodes. A classic example is the so-called Virchow metastasis (one or more enlarged but painless lymph nodes that are palpable between the upper edge of the clavicle and the outer edge of the sternocleidomastoid muscle) is a common sign of metastasis of stomach cancer. Unfortunately, the detection of Virchow metastasis in stomach cancer is indicative of the advanced stage of the tumor process.
• Some infectious diseases, for example brucellosis.

To clarify the cause of enlarged lymph nodes, in addition to general clinical and laboratory tests, a node biopsy is performed for its morphological study.

[4], [5], [6], [7]

Diagnosis of enlarged lymph nodes

To diagnose a patient with lymphadenopathy, the following factors must be taken into account.

• The patient's age (infectious mononucleosis, adenovirus infection, rubella often occurs in children and young people).
• Information about the transferred diseases (frequent tonsillitis and acute respiratory infections, inflammatory processes in the oropharynx explain the increase in the lymph nodes of the cervical group), pay special attention to tuberculosis. Lymphadenopathy in the anamnesis.
• Other symptoms (fever, splenomegaly, rashes on the skin, lung damage, etc.).
• Epidemiological anamnesis (contact with animals, stay in endemic regions for various infections, promiscuity, etc.).

The examination of patients with lymphadenopathy is carried out in stages. Sometimes the results of determining peripheral blood parameters are sufficient: for the diagnosis of infectious mononucleosis (lymphomonocytosis, atypical mononuclears), chronic lymphocytic leukemia (absolute lymphocytosis), acute lymphoblastic leukemia, lymphogranulomatosis (absolute lymphopenia, eosinophilia). The routine methods include ultrasound of the abdominal cavity and pelvic organs, radiographic examination of the chest, the study of blood serum for antibodies to the causative agents of some of the infectious diseases mentioned. If necessary, puncture and / or biopsy of the lymph node with bacteriological and histological examination of the biopsy specimen is performed. Definition of specific oncomarkers.

Differential diagnostics

Differential diagnosis in the detection of lymphadenopathy includes a wide range of both infectious and somatic diseases.

[8], [9], [10], [11], [12]

Principles of treatment of patients with lymphadenopathy

• It is necessary to establish as soon as possible the cause of lymphadenopathy and only then to prescribe appropriate therapy.
• Antibacterial drugs should be used only for bacterial infections, including rickettsiosis.
• With lymphadenopathy of unknown etiology, it is recommended to avoid the appointment of glucocorticoids.
• With suppuration of the lymph nodes (tularemia, benign lymphoreticulosis, staphylococcal, streptococcal lymphadenitis), surgical intervention is indicated.