Enlargement of lymph nodes

Enlargement of lymph nodes (lymphadenopathy) is a change in the size, consistency and mobility of peripheral organs of the lymphatic system. It is possible to combine the symptom with an increase in temperature, a change in the condition of the skin, an increase in the liver and spleen. Lymphadenopathy is detected in infectious diseases, immunoproliferative, dysmetabolic and tumor processes, taking certain medications. Ultrasound, radiological, radionuclide, tomographic, cytological, laboratory methods are used to clarify the causes of lymph node enlargement. Before diagnosis, treatment is usually not prescribed.

Enlarged lymph nodes are soft, tight-elastic or dense rounded formations, palpable under the lower jaw, in the neck, axillary area, groin and other places. The surface of the lymph nodes can be smooth or bumpy. Often, the increase is preceded by acute infectious and inflammatory processes (ARVI, sore throat, pulpitis), injuries with skin damage, vaccination. Sometimes changes in lymph nodes are detected accidentally by a patient or a doctor during a preventive or consultative examination.

An increase in lymph nodes is indicated when their density, surface and mobility change, and the dimensions exceed 1 cm (for elbow formations — 0.5 cm, for inguinal — 1.5 cm). When feeling the nodes are both painful and painless. In addition to lymphadenopathy, skin manifestations are possible (elements of rash, redness of the skin), an increase in temperature to 38 ° C and above, prolonged subfebrility, complaints of fatigue, sweating, heaviness in the left or right hypochondrium caused by an increase in the spleen, liver.

The reason for contacting a doctor is the independent detection of large painless lymph nodes, sharp soreness of lymphoid tissue when probing, a combination of lymphadenopathy with other pathological signs — rash, hyperthermia, weight loss, fatigue. Particular alertness should be caused by lymph nodes of 2-3 cm in size, which have increased for no apparent reason, are located in several zones and persist for more than 2 months.

Mechanism of development
The enlargement of lymph nodes occurs in several ways, each of which involves the accumulation of a certain type of cells in the lymphoid tissue. The reaction of peripheral lymphatic organs is often associated with increased blood flow, proliferation of lymphocytes and macrophages in response to the appearance of foreign genes. With antigenic stimulation, the node can increase by 5-15 times in 5-10 days. Systemic neoprocess is characterized by active proliferation of degenerated lymphoid cells with an increase in the size of the affected lymph node.

The stroma of lymphatic formations can be infiltrated by inflammatory elements (in infectious diseases), tumor cells located in the lymphatic drainage zone of this node. Metastatic lesion is often accompanied by an overgrowth of connective tissue. In some disorders of lipid metabolism (Niemann-Pick disease, Gaucher syndrome), macrophages overflowing with non-cleaved glycosphingolipids linger in the lymph node.

Axillary lymphadenitis in a child

Classification
When determining the forms of lymphadenopathy, the location of enlarged lymph nodes is primarily taken into account. Lymphoid tissue is the main protective barrier against the spread of infectious pathogens and tumor cells. Therefore, the location of the altered lymphatic formations facilitates the diagnosis of the disease that caused the lymphadenopathic reaction. Depending on the localization of the process , there are:

Enlargement of submandibular lymph nodes. It is characteristic of pathological processes in the head and neck — eye diseases, ENT organs and paranasal sinuses, skin damage. Submandibular lymphadenopathy often signals dental problems, chronic tonsillitis.
Enlargement of the cervical lymph nodes. It is usually observed in respiratory infections, oral pathology, infectious mononucleosis, late stages of tuberculosis. Cervical nodes can be affected by lymphomas, lymphogranulomatosis, metastasis of thyroid cancer, lung.
Enlargement of the supraclavicular lymph nodes. Most often caused by tumor causes. Detection of an enlarged node on the right is pathognomonic for esophageal and lung cancer. The left lymph node is affected by malignant processes in the abdominal cavity, pelvis, retroperitoneal space.
Enlargement of axillary lymph nodes. Inflammatory lesion is possible in the presence of wound infections, cat scratch disease, brucellosis. The lesion of the axillary group nodes is typical for breast cancer, melanoma of the upper extremities, the installation of silicone breast implants.
Enlargement of the inguinal lymph nodes. As a rule, nodes in the groin react to the development of syphilis, gonorrhea, chancroid, and other genital infections. Inguinal lymphadenopathy is also a sign of malignant pelvic organ damage, lymphoma, bubonic plague.
Somewhat less often, lymph nodes of other groups are involved in the process — subcutaneous, cubital (in the area of the elbow bend), parotid, occipital, jugular. With a planned instrumental examination, an increase in internal lymph nodes can be determined — intra-thoracic (mediastinal), bronchopulmonary, paraaortic, splenic, mesenteric, retroperitoneal.

In diagnostic terms, it is important to take into account other criteria for the classification of lymphadenopathy — the characteristics of altered lymphoid formations, the prevalence of the lesion. This approach suggests the type of pathological process occurring in the involved nodes and the body as a whole. Important criteria for the classification of enlarged lymph nodes are:

Sizes. With grade I lymphadenopathy, the diameter of the affected formations is 0.5-1.4 cm, with grade II — 1.5-2.4 cm, and with grade III — 2.5 cm or more. A significant and prolonged increase in the size of lymph nodes is more characteristic of malignant processes.
Soreness. Intense pain often manifests inflammation of the lymph nodes, especially acute purulent lymphadenitis. Formations that have undergone malignant degeneration are often painless, except in cases of hemorrhage in a necrotic center.
Density. Enlarged inflamed lymph nodes are usually soft, with their suppuration during probing, fluctuation (fluctuation of fluid) is felt. For the metastatic process, the rocky consistency of formations is typical, for lymphomas — tight elasticity.
The connection between each other. The pathological formation of lymph nodes, probed as a whole and shifting together, is called a conglomerate. Soldered lymph nodes are detected in tuberculosis, sarcoidosis, venereal lymphogranuloma, lymphomas and metastasis.
Quantity. One or two or several nodes in one zone can be affected. In the first case, they talk about single enlarged nodes, in the second — about local lymphadenopathy. The more active the process, the more formations are affected, however, when metastasizing, one large node is often found.
Prevalence. With local lymphadenopathy, single nodes are determined in one area, with regional — several formations in 1-2 adjacent zones. The generalized (widespread) process is characterized by damage to lymphatic structures in three or more areas.
Taking into account the pathogenesis, the enlargement of lymph nodes can be primary (systemic), secondary (reactive) and inflammatory. Primary polyadenopathies develop with systemic malignancy of lymphoid tissue (leukemia, lymphogranulomatosis, non-Hodgkin’s lymphomas) and benign processes (sinus histiocytosis). Reactive lesions are a response to another pathology (infection, immune disease, spread of tumor cells, metabolic disorders). Inflammation (lymphadenitis) occurs when infectious agents multiply in the node tissue.

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