Lymphadenopathy of peripheral lymph nodes. Treatment of lymphadenopathy of the cervical lymph nodes

Lymphadenopathy is a pathological condition characterized by enlarged lymph nodes and is one of the leading symptoms of many diseases.

Approximately 1% of patients with persistent lymphadenopathy are diagnosed with malignancy during medical examination.

Lymph nodes are peripheral organs of the lymphatic system. They play the role of a kind of biological filter that cleanses the lymph entering them from the limbs and internal organs. There are about 600 lymph nodes in the human body. However, only the inguinal, axillary and submandibular lymph nodes, i.e. those that are located superficially, can be palpated.

Causes

Infectious diseases lead to the development of lymphadenopathy:

Therapy with certain medications can lead to the development of lymphadenopathy, including cephalosporins, gold preparations, sulfonamides, Captopril, Atenolol, Allopurinol, Carbamazepine, Phenytoin, Penicillin, Hydralazine, Quinidine, Pyrimethamine.

The most common lymphadenopathy is observed against the background of the following diseases:

• tuberculosis of the lymph nodes;
• non-Hodgkin's lymphomas;
• lymphogranulomatosis (Hodgkin's disease);
• viral hepatitis;
• Waldenström's macroglobulinemia;
• Niemann–Pick disease;
• tularemia;
• HIV infection;
• benign lymphoreticulosis.

Enlarged lymph nodes in the right supraclavicular region are often associated with a malignant process in the esophagus, lungs, and mediastinum.

Oropharyngeal infections often lead to cervical lymphadenopathy. Typically, this condition develops in children and adolescents against the background of childhood infectious diseases and is associated with the functional immaturity of the immune system, which does not always adequately respond to infectious stimuli. The risk of developing cervical lymphadenopathy is highest in children who have not received timely vaccination against diphtheria, mumps, measles, and rubella.

The occurrence of axillary lymphadenopathy is caused by:

• purulent-inflammatory processes localized in the arms, shoulders or chest;
• some types of skin pathology (neurodermatitis, psoriasis);
• diseases of the mammary glands (mastitis, mastopathy, cancer);
• autoimmune systemic diseases (systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, systemic scleroderma).

Kinds

Depending on the number of lymph nodes involved in the pathological process, the following types of lymphadenopathy are distinguished:

• localized– enlargement of one lymph node;
• regional– enlargement of several lymph nodes located in one or two adjacent anatomical areas, for example, axillary lymphadenopathy;
• generalized– enlarged lymph nodes are localized in several non-contiguous anatomical areas, for example, inguinal and cervical adenopathy.

Localized lymphadenopathy occurs much more often (in 75% of cases) than regional or generalized ones. Approximately 1% of patients with persistent lymphadenopathy are diagnosed with malignancy during medical examination.

Depending on the etiological factor, lymphadenopathy occurs:

• primary– caused by primary tumor lesions of the lymph nodes;
• secondary– infectious, drug-induced, metastatic (secondary tumor process).

In turn, infectious lymphadenopathy is divided into specific (caused by tuberculosis, syphilis and other specific infections) and non-specific.

Inguinal lymphadenopathy is usually caused by sexually transmitted infections, and cat scratch disease is accompanied by axillary or cervical lymphadenopathy.

According to the duration of the clinical course, lymphadenopathy is divided into acute and chronic.

Signs of lymphadenopathy

With cervical, inguinal or axillary lymphadenopathy in the corresponding area, an increase in lymph nodes is observed, from insignificant to noticeable to the naked eye (from a small pea to a goose egg). Their palpation may be painful. In some cases, redness of the skin is observed above the enlarged lymph nodes.

It is impossible to detect lymphadenopathy of the visceral nodes (mesenteric, peribronchial, hepatic portal lymph nodes) visually or by palpation; it is determined only during an instrumental examination of the patient.

In addition to enlarged lymph nodes, there are a number of other signs that may accompany the development of lymphadenopathy:

• unexplained loss of body weight;
• increased body temperature;
• increased sweating, especially at night;
• enlarged liver and spleen;
• recurrent upper respiratory tract infections (tonsillitis, pharyngitis).

Diagnostics

Since lymphadenopathy is not an independent pathology, but only a symptom of intoxication in many diseases, its diagnosis is aimed at identifying the causes that led to the enlargement of the lymph nodes. The examination begins with a thorough history taking, which in many cases makes it possible to make a preliminary diagnosis:

• eating raw meat– toxoplasmosis;
• contact with cats– toxoplasmosis, cat scratch disease;
• recent blood transfusions– hepatitis B, cytomegalovirus;
• contact with tuberculosis patients– tuberculous lymphadenitis;
• intravenous drug administration– hepatitis B, endocarditis, HIV infection;
• casual sex– hepatitis B, cytomegalovirus, herpes, syphilis, HIV infection;
• working in a slaughterhouse or livestock farm– erysipeloid;
• fishing, hunting– tularemia.

For localized or regional lymphadenopathy, the area from which lymph drains through the affected lymph nodes is examined for the presence of tumors, skin lesions, and inflammatory diseases. Other groups of lymph nodes are also examined to identify possible generalized lymphadenopathy.

There are about 600 lymph nodes in the human body. However, only the inguinal, axillary and submandibular lymph nodes can be palpated.

With localized lymphadenopathy, the anatomical location of enlarged lymph nodes can significantly narrow the number of suspected pathologies. For example, sexually transmitted infections usually lead to the development of inguinal lymphadenopathy, and cat scratch disease is accompanied by axillary or cervical lymphadenopathy.

Enlarged lymph nodes in the right supraclavicular region are often associated with a malignant process in the esophagus, lungs, and mediastinum. Left supraclavicular lymphadenopathy signals possible damage to the gallbladder, stomach, prostate, pancreas, kidneys, ovaries, and seminal vesicles. A pathological process in the abdominal or pelvic cavity can lead to enlargement of the paraumbilical lymph nodes.

Clinical evaluation of patients with generalized lymphadenopathy should be aimed at searching for systemic disease. Valuable diagnostic findings are the detection of inflammation of the joints, mucous membranes, splenomegaly, hepatomegaly, and various types of rashes.

In order to identify the cause that led to lymphadenopathy, different types of laboratory and instrumental studies are performed according to indications. A standard examination usually includes:

• general and biochemical blood test;
• chest x-ray;
• Ultrasound of the abdominal and pelvic cavity;
• computed and magnetic resonance imaging.

If necessary, a biopsy of an enlarged lymph node can be performed, followed by histological and cytological examination of the resulting tissue samples.

The risk of developing cervical lymphadenopathy is highest in children who have not received timely vaccination against diphtheria, mumps, measles, and rubella.

Treatment of lymphadenopathy

Treatment of lymphadenopathy consists of eliminating the underlying disease. Thus, if enlarged lymph nodes are associated with a bacterial infection, a course of antibacterial therapy is indicated; treatment of lymphadenopathy of tuberculous etiology is carried out according to a special DOTS+ regimen; treatment of lymphadenopathy caused by cancer consists of antitumor therapy.

Prevention

Prevention of lymphadenopathy is aimed at preventing diseases and intoxications that can provoke enlargement of the lymph nodes.

Video from YouTube on the topic of the article:

Lymphadenopathy of the axillary lymph nodes is a common occurrence in the daily practice of a doctor. This symptom occurs in a number of pathologies, the treatment of which requires serious attention.

Causes of enlarged lymph nodes

There are about 1,000 lymph nodes in the human body, located in different parts of the body. The node is a peripheral organ of immunity, determined along the course of the lymph vessels.

Lymph nodes located in the wall of the cavity and near organs are called parietal and visceral. Those nodes that are identified in the neck, back of the head, popliteal fossa, elbow, armpit, groin are peripheral. They are characterized by group accumulation, for example, in the armpit their number varies from 12 to 40-45 pieces.

The size of the lymph nodes is on average up to 1 cm, depending on the age of the owner and constitutional features. The process of enlargement of a lymph node is commonly called lymphadenopathy. The causes may be various diseases. Most often this is a pathology of nearby organs, the emergence of an infectious agent in them or another pathological complex.

Lymphadenopathy can occur with painful sensations in the arms, neck, and legs. This happens because the protective function of the lymph nodes, which are a barrier between the human body and any pathological object, is performed.

This barrier arises from so-called antibodies and lymphocytes, which block the passage of bacterial or viral infections and various toxins into the bloodstream, and help destroy tumor cells. In addition, they cleanse the lymph flowing from the organs, accumulate it and distribute it throughout the body. The lymph node has an efferent path through the lymphatic vessels, along which an army of lymphocytes rushes to the pathological focus to destroy foreign bodies.

Causes of axillary lymphadenopathy

Axillary lymphadenopathy occurs when the activity of nodes increases, seeking to help the body in the fight against a foreign agent. However, the axillary area sometimes suffers from growing malignant tumor cells.

Most often, the etiological factor in the occurrence of this disease is the following.

1. Due to improper personal hygiene and excessive use of cosmetics to combat unpleasant armpit odor (deodorants, antiperspirants, sprays, creams, etc.), hyperhidrosis, diabetes and people with increased body weight, the sweat gland and hair follicle become blocked. The process is most often two-way. The inflammatory process starts, and when treated at home on your own, the process spreads deeper.
2. At the time of hormonal changes in women (pregnancy and breastfeeding), the axillary and intrathoracic lymph nodes, resembling a lobule of the mammary gland, enlarge. Not every specialist will be able to detect this, and besides, this benign process does not pose any danger to the woman’s body. The condition resolves spontaneously.
3. The presence of purulent lesions in the arms, chest and shoulders, for example, a boil and a purulent wound, lead to enlarged lymph nodes.
4. In children, viral pathology leads to changes. These are chicken pox, mononucleosis and others. Treatment of the underlying disease will have a positive effect.
5. Some skin pathologies lead to this process - these are psoriatic changes, neurodermatitis, etc.
6. Immunodeficiency conditions are manifested primarily by lymphadenopathy, and in several places at once.
7. With pathology of the mammary glands, for example, with mastitis or mastopathy, enlargement of the axillary lymph nodes occurs. In the same places, this symptom develops in a number of infectious diseases: tuberculosis, brucellosis, syphilis, plague.
8. Systemic autoimmune pathologies are also replete with lymphadenopathy of various groups of lymph nodes - these are rheumatic fever (chronic or acute), systemic scleroderma, ankylosing spondylitis, arthritis, systemic lupus erythematosus.

Judging by the serious diseases for which the symptom is characteristic, it should be remembered that with a slight increase in the axillary and other lymph nodes, consultation with a doctor is mandatory! It’s not a fact that a terrible diagnosis will be revealed, but it’s better to play it safe once again and take all the necessary tests.

Types of lymphadenopathy

Modern medicine divides pathology into 2 types: inflammatory and non-inflammatory. In addition, they can be grouped into specific and nonspecific. The former are characterized by intractable and dangerous infections - tuberculosis bacillus, treponema pallidum (syphilis), actinomycosis, plague and tularemia. The second group includes gram-positive flora and viruses.

The process can be acute or chronic. Acute is characterized by redness in the armpits, pain, swelling, and when palpated, hot skin above it. The general condition also worsens, with chills, increased general body temperature, and a feeling of malaise.

One node or a group may be involved in the inflammatory process; their mobility remains, or they grow together with the surrounding tissue. Antibacterial agents must be included in the treatment of such symptoms.

For a chronic course, such vivid clinical manifestations are not typical. Usually, a subcutaneous rounded, welded or loosely located formation is felt, which does not hurt when pressed, but only gives an unpleasant sensation. At the same time, the patient notes that pain was once noted in this area, but treatment was not carried out or was not completed.

Unfortunately, pain does not always accompany an enlarged lymph node, for example, with tuberculosis or syphilis, which significantly aggravates the process and leads to great human suffering. The absence of pain is characteristic of a non-inflammatory nature - this is lymphadenopathy of the mammary gland due to an oncological process, a blood disease.

Diagnostics

Determining the reasons on your own and speculating is extremely dangerous. Perhaps this is just a sign of the presence of a purulent wound on the corresponding arm. But hilar lymphadenopathy is not always determined so simply; it often occurs with tuberculosis, so it should be carefully checked. If there is a suspicion that this is axillary lymphadenopathy, you should consult a specialist.

When the node is enlarged for more than 21 days, and the cause cannot be found, secondary lymphadenopathy is suspected in non-inflammatory conditions in women. In this case, the patient is recommended to undergo a puncture.

During surgery for mastopathy, a biopsy of nodes is always performed, which mitigates the issue of their removal in oncology. First, the presence of metastatic cells in the sentinel lymph nodes is determined, and only if the analysis is positive, they are removed.

Treatment

Treatment is prescribed only by a doctor, selecting not only the drugs, but also the dosage individually for each patient. After determining the cause, the doctor gives a prescription, for example, treatment of tuberculosis using a special DOTS+ system, or for purulent processes - antibiotic therapy and opening the abscess.

Video

You can find out what inflamed lymph nodes and the general condition of the armpits signal from our video.

Reading time: 4 min

Axillary lymphadenopathy is an enlargement of the lymph nodes located in the armpits.

There are a number of causes for this condition, so a medical examination is necessary to determine the importance of lymphadenopathy.

Timely diagnosis will help identify the problem and, accordingly, begin its treatment, since lymph nodes can enlarge due to both benign formations and cancer.

At the same time, the reasons may be relatively trivial and do not require special treatment.

Reasons for the development of lymphadenopathy

In order to understand the causes and mechanisms of lymphadenopathy, it is important to know what lymph nodes are and what their role is.

A lymph node is a filter that conducts lymph coming from various organs.

Axillary and intramammary lymph node of the mammary gland - what is it?

Intramammary lymph nodes are located on the lateral edge.

The main part of the lymph drains into the axillary lymph nodes.

Axillary lymph nodes drain the shoulder region, the breast area and the chest wall.

The most common reason why regional lymph nodes of the mammary gland are enlarged is, as a rule, unilateral purulent traumatic lesions or lesions in the arm caused by infection with streptococci or staphylococci, less often tularemia or felinosis.

Axillary lymphadenopathy is caused by infection or malignant disease (malignant lymphoma, breast cancer, malignant melanoma).

Enlarged intramammary nodes may also accompany staphylococcal and streptococcal infections of the arm or sporotrichosis.

In any case, if this symptom occurs - enlarged lymph nodes, you should always consult a doctor and undergo a special examination!

Enlarged axillary lymph nodes

The lymph nodes through which lymph flows, as mentioned above, are a filter, since they, ensuring the outflow of lymph from the mammary gland, constantly monitor and filter it. They contain concentrated white blood cells.

The moment the regional nodes notice that there are some foreign particles such as bacteria in the lymph, the number of white blood cells that can fight infections increases, resulting in an increase in the local nodes in the axillary region.

Enlarged lymph nodes are considered to be those that have an average size of more than 1 - 1.5 cm. In some thin people, lymph nodes in the neck or armpits may even be palpable.

It should be remembered that the lymph nodes enlarge if they are fighting some disease.

We can talk about infection, inflammation, tumor, but enlarged nodes in the armpits also occur with leukemia and lymphoma.

Each group of nodes always signals a violation in a certain part of the body.

The lymph of the mammary gland and chest wall flows in the nodes in the axillary region. Their increase may be a signal of disease of these structures, including oncology.

Classification of axillary lymph nodes

Axillary lymph nodes are part of the lymphatic system, which, together with the venous system, provides drainage to the body.

The lymphatic system removes cell debris from tissues, prevents bacteria from entering the body and protects against a number of unwanted external influences.

Axillary lymph nodes are divided into the following groups:

• apical nodes are located on the upper part of the armpit;
• thoracic lymph nodes are localized in the inner (medial) axillary wall, hilar lymphadenopathy characterizes diseases of the mammary glands;
• the central nodes are located, respectively, in the central axillary part;
• lateral nodes are localized on the lateral (external) axillary wall;
• The scapular nodes are located in the posterior axillary part.

Each group of axillary nodes protects the corresponding organ, system and/or tissue. In the event of dysfunction or disease in this organ, the nodes immediately react: they become enlarged, inflammation of the lymph nodes may occur, or they become quite painful.

In most cases, the axillary nodes undergo changes in various diseases affecting the mammary gland: when it becomes inflamed for various reasons or when cancer occurs.

Sometimes it is the enlargement of nodes that is the first signal of certain disorders in the body.

Treatment of lymphadenopathy depends on the underlying cause of its occurrence - inflammation, infection, carcinoma, etc.

If the cause is unknown, changes in the size of the lymph nodes are monitored for 3 to 4 weeks to determine the source of the disease.

Inflammatory processes in the chest

Inflammation that occurs in the mammary gland is better known as mastitis. Most often the disease develops during the first few weeks after birth.

The trigger may be lactostasis or damage to the nipples (cracks and scratches caused by improper breastfeeding).

Through microtrauma, the infectious agent penetrates into the chest tissue, causes inflammation and, as a result, changes in the nodes (right or left).

At stage 1, when the inflammatory process passes without the formation of a cavity with purulent contents. In this case, if symptoms of lymphadenopathy are present, they are minor.

In the same case, if the inflammatory process progresses and moves to stage 2 with the creation of purulent foci, the lymph nodes of the armpits increase significantly. There is pain, swelling and redness of the skin.

The reason for the enlargement of nodes is also the penetration of pathogens with the lymphatic or blood flow in breast cancer in women.

If the swelling is not very pronounced, the nodes are painless. With significant swelling, irritation of the nerve endings in the lymph nodes occurs, and, accordingly, pain occurs.

Lymphadenopathy and oncology

Symptoms of lymphadenopathy that should prompt you to visit a specialist and conduct a thorough examination:

1. Enlarged and hard lymph nodes in the armpit, which are detected by palpation.
2. Change in breast size and shape (left or right). You should pay attention to abnormalities in the breast itself, such as dents, unevenness and stretched skin.
3. Discharge from the nipple: light or bloody.
4. Change in color or sensitivity of the skin of the breast, nipple or. The skin around the nipple may, for example, be of varying thickness, sagging in some places, and may show signs similar to eczema.
5. Weight loss and night sweats are common signs of diseases that eat away at the body, which include cancer or AIDS.

Due to the rapid development of metastases (sedimentation of breast tumor cells in other tissues, where they penetrate through the blood and lymphatic system, i.e., bilateral cancer can develop) to nearby lymph nodes and distant organs, it is considered a very dangerous oncology.

Measures that will ensure early detection of the disease and any changes in the mammary gland include monthly breast examinations by the woman herself and regular mammography.

If the lymph nodes for breast cancer and, accordingly, the disease itself are detected on time, then the prognostic data are quite good.

If the results of a self-examination are not conclusive, you should not delay an immediate visit to your doctor.

If breast lymphadenopathy is a sign of cancer, early diagnosis and treatment increases the chances of recovery and survival several times.

Cancer can quickly spread throughout the body without even making itself known. If, in addition to damage to the intrathoracic lymph nodes, the disease also affects other organs of the body, the chances of successful treatment are sharply reduced.

Therefore, at the slightest suspicion, you should immediately go to the doctor. Even if the suspicions turn out to be in vain, the specialist will definitely treat this with understanding.

Shame is completely inappropriate here; delay can be a huge mistake with serious consequences!

Lymphadenopathy associated with silicone implantation

A silicone implant in solid form is used to connect the fixed part of the prosthesis to the bone, in elastic form for breast augmentation.

Implantation of prostheses with attachment using solid silicone can cause enlargement of regional lymph nodes.

If used, for example, to treat rheumatic deformities of the fingers, over time a person may notice that the lymph node in the armpit has enlarged.

Similarly, inguinal lymphadenopathy may occur in some patients after implantation of silicone lower extremity prostheses.

Similarly, reactive lymphadenopathy can occur due to silicone implantation in the mammary glands, since in the case of these prostheses, silicone can leak into the surrounding tissue.

The incidence of lymphadenopathy induced by silicone implantation is estimated to be 15%.

Enlarged axillary lymph nodes in the mammary gland due to exposure to silicone are histologically proven to be reactive hyperplasia with many multinucleated giant cells, some of which contain silicon fibers.

Histologically, the lymphadenopathy induced by the elastic form of silicone used for breast augmentation is not as pronounced as the enlarged breast lymph nodes of a reactive nature when using rigid silicone for fixation of joint prostheses.

Lymphodenopathy caused by liquid silicone contains fewer multinucleated giant cells, some of which contain silicone vacuoles.

Methods for visualizing and detecting lymph nodes

Diagnostic methods aimed at detecting and examining enlarged lymph nodes in the chest include the following measures:

• chest x-ray;
• ultrasonography;
• CT scan;
• Magnetic resonance imaging;
• x-ray lymphography;
• lymphoscintigraphy;
• positron emission tomography.

An anteroposterior chest x-ray indicates enlarged lymph nodes if they reach a size of approximately 2 - 2.5 cm.

Ultrasound can detect lymphadenopathy in various locations. This test is able to detect enlargements of about 1 cm.

Indications for examination include an unclear palpable mass in the peripheral lymph nodes and monitoring the progress of the cancer patient.

Chest computed tomography (CT) is a modern and informative method of examination, especially in parts of the body that are not accessible to ultrasound.

The criteria for assessing pathological nodes are the same as for ultrasound - an increase in size above 10 mm and a change in shape.

Chest MRI (MRI) provides a different view than CT.

The greatest effort is the difference in the structure of the nodes when using a different sequence and a change in the signal after the introduction of contrast. The criteria for size and shape are approximately the same.

The greatest opportunity to show the detailed structure of lymph nodes is provided by x-ray lymphography, which highlights the nodes and their structure using an oil dye.

This makes it possible to obtain relatively accurate dimensions of the nodes, in addition, to determine whether they have a physiological structure or whether there has been a violation of the normal structure (in this case, in the image the node looks like moth-eaten fabric).

Lymphoscintigraphy - this method is more suitable for the study of lymphodema than for use in the differential diagnosis of lymphadenopathy and determination of its volume.

Positron emission tomography - with this method, pathologically infiltrated nodes are indicated. However, it is limited to a few clinics.

We recommend you find out:

Lymphadenopathy requires timely diagnosis; you should not neglect your health and allow the disease to develop. It is necessary to maintain immunity, monitor the condition of your body so that the norm of the lymph nodes does not increase.

Lymphadenopathy syndrome may indicate the presence of serious diseases in the patient, so this condition should be given special attention when diagnosing the patient.

Enlarged lymph nodes can be caused by a number of reasons, including:

Infectious lesion of lymph nodes;

Bacterial infection (most often found in cat scratch diseases, brucellosis, syphilis, tuberculosis, etc.);

Damage to lymph nodes by viruses of various origins. For example, for hepatitis, HIV infection, cytomegalovirus infection, etc.

Fungal infection (histoplasmosis, coccidioidomycosis, actinomycosis);

Chlamydial infections (with lymphogranuloma venereum);

Tumor-like processes and systemic connective tissue diseases;

Sarcoidosis, endocrinopathy, rheumatoid arthritis;

Metastasis to lymph nodes during cancer processes;

Damage to the lymph nodes caused by the use of drugs (serum sickness, etc.).

Symptoms and types of lymphadenopathy

There are about 600 lymph nodes in the human body, of which in normal condition only the axillary, submandibular and inguinal nodes should be palpated. The main symptom of lymphadenopathy is a nonspecific enlargement of the lymph nodes, both those that can be detected by palpation and those that are not detected in the normal condition of the patient. Additional symptoms of the disease are: weight loss, increased sweating (mainly at night), prolonged increase in body temperature, enlarged liver, enlarged spleen.

Depending on the location and extent of the affected lymph nodes, several types of lymphadenopathy are distinguished:

Local lymphadenopathy, in which there is a local enlargement of one lymph node in one of the areas. This type of lymphadenopathy occurs in 75% of cases.

Regional lymphadenopathy, during which several lymph nodes in one or two adjacent areas enlarge (for example, cervical and supraclavicular lymph nodes).

Generalized lymphadenopathy, in which lymph nodes are enlarged in several areas (more than three areas). For example, with cytomegalovirus infection, toxoplasmosis, HIV infections, brucellosis, tuberculosis, etc.

According to the nature of the course, acute and chronic lymphadenopathy are distinguished. The acute form of the disease is characterized by severe pain in the lymph nodes, the presence of edema, and a rapid increase in temperature. The chronic form of the disease is characterized by a long course, mild pain in the lymph nodes (or a complete absence of pain).

Diagnosis of lymphadenopathy syndrome

As a rule, the diagnosis of the disease is not carried out until the initial examination of the patient has been carried out. This is due to the fact that during the initial examination, the information necessary to begin the diagnosis is obtained. The initial examination includes a general blood test with determination of the content of red blood cells, reticulocytes, ESR and platelets, blood biochemistry with the determination of acute-phase proteins, determination of markers of HIV and hepatitis B and C, ultrasound examination of the abdominal cavity, as well as a chest x-ray.

General diagnostic criteria for the disease include the age of patients, medical history, the nature of lymphadenopathy, peripheral blood counts, as well as the presence of other clinical signs. Let's take a closer look at each of these criteria.

Patient's age.

Age is used to determine a provisional diagnosis. For example, the diagnosis of infectious mononucleosis is often detected in patients in childhood or adolescence. Among older patients, chronic lymphocytic leukemia is most common. If we are talking about regional lymphadenopathy, then in 80% of cases this disease is of infectious origin. In this case, the age of the patients does not exceed 30 years. In patients over 50 years of age, neoplastic origin is detected in 60% of cases. In any case, age alone cannot be the only criterion for diagnosis and subsequent treatment.

History data.

This data refers to information about the development of the disease, past illnesses, the patient’s living conditions, past injuries, heredity, existing allergic reactions, etc. All this information plays an important role during diagnosis.

The nature of lymphadenopathy.

In the diagnosis of lymphadenopathy, the nature of the affected lymph nodes and their location also play a special role. No less important are such parameters of the lymph nodes as: soreness, mobility, size and consistency of the lymph nodes.

Sizes of lymph nodes.

Based on the size of the lymph nodes, it is usually impossible to determine the cause of the disease. However, if an examination of children reveals pathological changes in the chest organs and the lymph nodes are enlarged by more than 2 centimeters, then this fact may mean that the child may have granulomatous processes or malignant diseases.

Soreness of the lymph nodes.

During the disease, the capsules of the lymph nodes can stretch, which in turn causes their pain. Painful sensations arise as a result of hemorrhage into the necrotic center of the lymph nodes, as well as as a result of inflammatory processes with their suppuration. However, the absence or presence of pain does not allow distinguishing malignant processes from benign processes in the lymph nodes.

Location of lymph nodes.

With localized lymphadenopathy, the search may in some cases narrow the location of the lymph nodes. For example, with sexually transmitted infections, the lymph nodes are usually affected in the groin area, while cat scratch disease is characterized by enlargement of both the axillary and cervical lymph nodes. Malignant processes can occur with supraclavicular lymphadenopathy, as well as with enlargement of the paraumbilical lymph nodes of the abdominal cavity and pelvis.

Other clinical signs.

Sometimes the key signs during a diagnostic search may be the presence of certain clinical symptoms. In particular, when diagnosing, an enlarged liver or spleen, fever, lung damage, and the presence of articular syndrome are important. Some of these signs can be obtained from an endocrinologist.

Diagnosis of diseases manifested by lymphadenopathy

Nonspecific lymphadenitis.

This disease affects the lymph nodes in the groin and axillary area. They enlarge and become immobile and unfused with each other. As the disease progresses, symptoms such as headache, fever, and chills may appear. As a result of taking blood tests, an increase in ESR is visible. The disease can cause complications in the form of an abscess, phlebothrombosis, sepsis and lymphostasis.

Tuberculosis of peripheral lymph nodes.

This disease most often occurs in children and adolescents. Most often, the disease is combined with tuberculosis, which has a different localization. In this case, the lymph nodes increase in diameter to 1.5 centimeters. The disease can begin suddenly, which is often accompanied by an increase in body temperature and severe general intoxication of the body. The hemogram shows an elevated ESR and moderate leukocytosis.

Infectious mononucleosis.

The disease is caused by the Epstein-Barr virus. The disease usually begins acutely and is accompanied by fever, intoxication, general weakness, and headache. Later, a sore throat may appear when swallowing. Body temperature can rise to 38-40 degrees. During the disease, catarrhal or lacunar tonsillitis may appear. In icteric forms of mononucleosis, patients exhibit pronounced changes in the liver.

Hodgkin's lymphoma.

Clinically, the disease is manifested by an enlargement of various groups of lymph nodes, which have a dense elastic consistency, are painless and are not fused to the skin. In most patients, the primary lesion is located above the diaphragm. The first symptoms of the disease are: difficulty breathing, cough, weight loss by 10%, fever above 38 degrees.

Non-Hodgkin's lymphomas.

This is a group of malignant tumors. The first sign of the disease is damage to one lymph node and further metastasis of the tumor. Lymph nodes are painless, dense, not fused to the skin. Their increase can lead to superior vena cava syndrome, portal hypertension, dynamic intestinal obstruction, and obstructive jaundice.

Still's disease.

Symptoms of the disease: fever, enlarged spleen and lymph nodes, skin papular and hemorrhagic rashes, etc. An increase in ESR and neutrophilic leukocytosis is observed in the blood of patients. The fever is resistant to antibiotic treatment.

Chronic viral hepatitis.

Symptoms of the disease may include fever, hemorrhagic vasculitis, lymphadenopathy, pulmonary damage, Sjogren's syndrome and polyserositis. These extrahepatic symptoms may often be the first symptoms of liver disease.

Gaucher's disease.

The disease is based on a hereditary defect in the metabolism of cerebrosides and phospholipids. The proliferation of macrophage cells leads to enlargement of the lymph nodes, as well as the spleen. When performing a puncture of the lymph nodes, spleen and bone marrow, the presence of so-called Gaucher cells is revealed.

Waldenström's macroglobulinemia.

The disease is a type of chronic leukemia. In the disease, vascular damage develops as a result of the production of monoclonal macroglobulin by tumor lymphoid cells. Symptoms of the disease are an enlarged spleen, urinary syndrome and hemorrhagic skin rashes. Anemia and a significant increase in ESR are also characteristic.

Sarcoidosis.

Granulomatous inflammation, which is characterized by enlarged lymph nodes, as well as damage to the lungs, skin, eyes, joints, liver and myocardium. Enlarged cervical lymph nodes are painless and not fused. A negative reaction occurs to intradermal administration of tuberculin, which is explained by the inhibition of cellular immunity.

Tularemia.

The causative agents of this disease enter the body through microtraumas on the skin. The first symptoms of the disease: fever up to 38-40 degrees, headache, muscle pain, weakness, lack of appetite. In severe forms: psychomotor agitation, retardation, delirium.

Lyme disease.

The onset of the disease is accompanied by itching, pain, swelling and redness at the site of tick bite. Headache, general weakness, nausea, malaise, chills, increased body temperature up to 38 degrees, loss of sensitivity at the site of tick attachment are also typical.

Streptococcal skin lesions.

The disease is characterized by the appearance of phlyctena, which spreads along the periphery. Phlyctena is filled with yellowish contents in the form of sulfur and is painful to the touch. Subsequently, erosion appears in place of the conflict.

Cat scratch disease.

The disease occurs through contact with infected cats. The disease manifests itself in the form of an ulcer or pustule appearing at the site of a scratch. Typical symptoms: fever, hepatosplenomegaly, regional lymphadenitis and exanthema.

Retroperitoneal lymphadenopathy – pathological enlargement of lymph nodes and the subsequent development of the inflammatory process in them. This condition is one of the symptoms of many diseases of various origins, but not an independent pathology.

With prolonged course of lymphadenopathy becomes an independent pathology and can lead to serious complications. In this article we will understand what retroperitoneal lymphadenopathy is and how to treat it.

Difference from lymphadenitis

Even a slight increase in lymph nodes is a clear signal about an obvious or hidden pathological process in the body. Lymph nodes perform role of natural filter associated with the circulatory system. Their main role is to cleanse the blood of potentially dangerous microorganisms.

When an infection enters the lymph nodes, an inflammatory reaction may develop, affecting one of them, several lymph nodes, or several groups.

Reaction of lymph nodes to pathological processes in the body it can develop as an independent inflammatory disease or as a concomitant symptom of another pathology. Inflammation of the lymph nodes is called reactive enlargement of the lymph node - lymphadenopathy.

Lymphadenitis occurs acutely, with symptoms characteristic of an acute process. The affected lymph node increases in size and becomes painful. The skin over the superficial lymph nodes turns red, and a local increase in temperature is observed.

The first manifestation of lymphadenopathy is an enlarged lymph node, not accompanied by pain. and other signs of an acute inflammatory process.

Watch the video about the causes of inflammation lymph nodes:

Superficial lymph nodes become very hard; when the lesion is localized in the retroperitoneal space, diagnosis is very difficult due to the absence of characteristic symptoms and the impossibility of external examination. Over time, an enlarged lymph node may become inflamed.

Causes of the disease

Retroperitoneal lymphadenopathy develops due to the entry into the lymph node of a significant amount of biological or other materials that provoke inflammation. It can be:

• Pathogenic microorganisms and their metabolic products;
• Fragments of dead cells;
• Foreign solids;
• Some products of tissue breakdown.

Most often, the introduction of a provoking agent occurs against the background of local inflammatory processes, acute, subacute or chronic, sometimes for general infectious diseases. Penetration of the pathogen is possible through direct contact, through lymph or blood.

Normal immune system handles potentially hazardous substances or particles.

Against the background of the pathological process, pathogens enter the lymph nodes in large quantities. In response, the number of lymphocytes increases and the size of the lymph node increases. The degree of enlargement of the lymph node is related to the activity of the process.

As the underlying disease progresses, inflammation may develop in the affected lymph nodes, turning into a purulent process.

Rate of progression of lymphadenopathy varies depending on the intensity and duration of exposure to pathogenic factors, as well as their quantity.

The direct cause of the development of retroperitoneal lymphadenopathy can be:

• Giardia, toxoplasma and other protozoa;
• Helminths;
• Fungal infections;
• Pathogenic bacteria;
• Viruses.

Lymphadenopathy can develop against the background of systemic connective tissue diseases, and also have an iatrogenic (drug) origin.

Enlargement of the retroperitoneal lymph nodes may occur as one of the complications of mesadenitis or part of the symptom complex of oncological diseases. In children, such complications can accompany the course of viral mumps, rubella and other childhood diseases. The clinical picture may resemble acute appendicitis.

Abdominal lymphadenopathy(enlarged lymph nodes located in the abdominal cavity) can develop against the background of mesenteric adenitis or.

Inguinal localization of the lesion occurs against the background of local infections, in particular, is a symptom of a number of sexually transmitted diseases.

Classification

According to the duration and characteristics of the flow, they are distinguished:

1. Spicy;
2. Chronic;
3. Recurrent lymphadenopathy.

Any form of pathology can also be tumor or non-tumor.

Additionally, classification of the pathological process according to the severity of lymph node hyperplasia can be used. This criterion is used relatively rarely, since the normal sizes of lymph nodes from different groups differ greatly.

By the number of lymph nodes involved in the pathological process distinguish between local, regional and generalized forms pathology.

They talk about local defeat with enlargement of one lymph node. When several lymph nodes located in adjacent groups are affected.

The most severe form of pathology– generalized, in which pathological changes affect three or more groups of lymph nodes located in different areas.

About 70% of cases of lymphadenopathy are local, developing against the background of trauma and limited infectious lesions. The generalized form of pathology indicates about serious disorders of the immune system.

Symptoms

Main feature developing lymphadenopathy - enlarged lymph nodes. An increase can be noticed during a superficial examination; with retroperitoneal localization of the lesion, it is possible to identify characteristic changes only on ultrasound or x-ray.

Indirect symptoms of localized lesions in the abdominal cavity may be:

• Sweating;
• General weakness;
• Sustained slight increase in body temperature;
• Digestive disorders, in particular diarrhea;
• Enlarged spleen and liver.

Possible short-term attacks of fever and diffuse abdominal pain. Patients may experience weight loss and severe back pain caused by mechanical compression of nerve endings or trunks.

The main symptoms of the pathology are nonspecific, additional symptoms vary greatly depending on the nature of the pathogen and the characteristics of the underlying disease.

With infectious mononucleosis, the patient develops a maculopapular type rash; the pathology that develops against the background of hepatitis is accompanied by jaundice and dyspeptic symptoms. Possible manifestations of urticaria and joint pain.

Diagnostics

Diagnosis of lymphadenopathy begins with a history. In order to identify the most likely causative agent of the pathological process, the doctor asks questions about previous injuries, blood transfusions, and organ transplants.

Since enlarged lymph nodes are one of the symptoms of some STDs adult patients are asked about the number of sexual partners and probable casual relationships. Lymphadenopathy can indicate very serious health problems, so the patient should be completely honest.

Peculiarities of professional activity, hobbies and other facts from the patient’s private life may have diagnostic significance.

It is very important to take into account the patient’s age, since the retroperitoneal localization of lesions is greater typical for children under 12 years of age. The detection of some forms of pathology in adults is a fairly rare and potentially life-threatening phenomenon.

During an external examination, the doctor palpates the affected lymph nodes, determining their number, size, consistency, pain, presence of relationships and localization.

Confirmation of the presumptive diagnosis is possible after laboratory and instrumental studies. The patient must be sent for a blood test.

The research package includes:

• General clinical analysis;
• General urine analysis;
• Biochemical analysis;
• Serological analysis;
• HIV test;
• Wasserman test.

In case of pathology in the retroperitoneal region, the following is carried out:

• X-ray examination;
• CT or MRI;
• Osteoscintigraphy.

If the oncological nature of the pathological process is suspected, histological and cytological studies and/or a tissue sample from the affected lymph node.

Due to the numerous possible causes of pathological changes, the set of diagnostic procedures may vary greatly depending on the suspected underlying disease.

Treatment

Painless enlarged lymph nodes are not always taken seriously by the patient. Manifestations of lymphadenopathy at any age – This is not the case when you can let everything take its course and self-medicate.

Treatment is prescribed only by a doctor, based on the data obtained during the survey. Tactics are selected individually, therapy is aimed at eliminating the underlying disease.

The course of treatment for lymphadenopathy may include:

When the underlying disease is eliminated, the lymph nodes quickly shrink to normal size.

If a malignant process is confirmed, the patient is prescribed a course of radiotherapy or chemotherapy. If there is no effect from conservative treatment, surgical intervention is indicated.

Prognosis of abdominal lymphadenopathy varies greatly depending on the nature of the underlying disease, the severity of the lesion and the age of the patient.

Prevention

Due to the variety of causes and factors that provoke the development of lymphadenopathy, the main preventive measure should be considered timely detection and treatment of major pathologies of various origins.