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

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

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

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

The reasons

Infectious diseases lead to the development of lymphadenopathy:

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

The most frequently expressed 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;
• macroglobulinemia Waldenström;
• Niemann-Pick disease;
• tularemia;
• HIV infection;
• benign lymphoreticulosis.

An increase in lymph nodes in the right supraclavicular region is often associated with a malignant process in the esophagus, lungs, and mediastinum.

Oropharyngeal infections often lead to cervical lymphadenopathy. Usually 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 highest risk of developing cervical lymphadenopathy in children who have not been timely vaccinated against diphtheria, mumps, measles, rubella.

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

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

Depending on the etiological factor, lymphadenopathy can be:

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

In turn, infectious lymphadenopathy is divided into specific (due to 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, acute and chronic lymphadenopathy is distinguished.

Signs of lymphadenopathy

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

It is impossible to detect lymphadenopathy of the visceral nodes (mesenteric, perebronchial, lymph nodes of the hilum of the liver) visually or by palpation, it is determined only during the 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 weight loss;
• increase in body temperature;
• excessive sweating, especially at night;
• enlargement of the liver and spleen;
• recurrent infections of the upper respiratory tract (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 allows a preliminary diagnosis to be made:

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

With localized or regional lymphadenopathy, the area from which lymph outflows through the affected lymph nodes occurs 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 inguinal, axillary and submandibular lymph nodes can be palpated.

In localized lymphadenopathy, the anatomical localization 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.

An increase in lymph nodes in the right supraclavicular region is often associated with a malignant process in the esophagus, lungs, and mediastinum. Left supraclavicular lymphadenopathy indicates a possible lesion of the gallbladder, stomach, prostate, pancreas, kidneys, ovaries, seminal vesicles. A pathological process in the abdominal or pelvic cavity can lead to an increase in paraumbilical lymph nodes.

Clinical examination of patients with generalized lymphadenopathy should be directed to the search for systemic disease. Valuable diagnostic findings are the detection of inflammation of the joints, mucous membranes, splenomegaly, hepatomegaly, various types of rash.

In order to identify the cause that led to lymphadenopathy, according to indications, various types of laboratory and instrumental studies are carried out. The standard examination scheme usually includes:

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

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

The highest risk of developing cervical lymphadenopathy in children who have not been timely vaccinated against diphtheria, mumps, measles, rubella.

Treatment of lymphadenopathy

Treatment of lymphadenopathy is to eliminate the underlying disease. So, if an increase in lymph nodes is associated with a bacterial infection, a course of antibiotic therapy is indicated, treatment of lymphadenopathy of tuberculous etiology is carried out according to a special DOTS + scheme, treatment of lymphadenopathy caused by cancer consists of antitumor therapy.

Prevention

Prevention of lymphadenopathy is aimed at preventing diseases and intoxications that can provoke an increase in lymph nodes.

Video from YouTube on the topic of the article:

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

Causes of enlarged lymph nodes

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

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

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

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

This barrier arises from the so-called antibodies and lymphocytes, which block the passage of a bacterial or viral infection into the bloodstream, various toxins, and help destroy tumor cells. In addition, they cleanse the lymph flowing from the organs, its accumulation and distribution throughout the body. The lymph node has a efferent path through the lymphatic vessels, through which the army of lymphocytes hurries to the pathological focus to destroy foreign bodies.

Causes of axillary lymphadenopathy

Axillary lymphadenopathy occurs with an increase in the activity of nodes that seek to help the body in the fight against a foreign agent. However, the axillary region sometimes suffers from proliferating cells of a malignant neoplasm.

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 the unpleasant smell of the armpits (deodorants, antiperspirants, sprays, creams, etc.), hyperhidrosis, diabetes and people with overweight blockage of the sweat gland and hair follicle. The process is usually two-way. The inflammatory process starts, and when treated at home, the process spreads deeper on its own.
2. At the time of hormonal changes in women (pregnancy and lactation), there is an increase in the axillary and intrathoracic lymph nodes, resembling a breast lobule. Not every specialist will be able to detect this, moreover, this benign process does not pose any danger to the woman's body. The state spontaneously resolves.
3. The presence of purulent lesions in the arms, chest and shoulders, for example, a boil and a purulent wound, lead to an increase in lymph nodes.
4. In children, viral pathology leads to changes. These are chicken pox, mononucleosis and others. The treatment of the underlying disease will give a positive effect.
5. Some skin pathologies lead to this process - these are psoriatic changes, neurodermatitis, and so on.
6. Immunodeficiency states are manifested primarily by lymphadenopathy, and in several places at once.
7. With the pathology of the mammary glands, for example, with mastitis or mastopathy, there is an increase in the axillary lymph nodes. In the same places, this symptom develops in a number of infectious diseases: tuberculosis, brucellosis, syphilis, plague.
8. Systemic autoimmune pathologies also abound with lymphadenopathy of various groups of lymph nodes - these are rheumatic fever (chronic or acute), systemic scleroderma, Bechterew's disease, 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, a doctor's consultation is required! It is not a fact that a terrible diagnosis will be revealed, but it is better to play it safe once again and pass all the necessary tests.

Types of lymphadenopathy

Modern medicine divides pathology into 2 types: inflammatory nature and non-inflammatory. In addition, they can be grouped into specific and non-specific. The former are characterized by an intractable and dangerous infection - a tubercle bacillus, pale treponema (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, soreness, swelling, when palpated - hot skin over it. The general condition at the same time also worsens, there is a chill, an increase in the overall body temperature, a feeling of malaise.

In the inflammatory process, 1 node or a group can be included, their mobility is preserved, or they grow together with the surrounding tissue. In the treatment of such symptoms, it is necessary to include antibacterial agents.

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

Unfortunately, pain does not always accompany an increase in the lymph node, for example, with tuberculosis pathology or syphilis, which greatly 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 during an oncological process, a blood disease.

Diagnostics

It is extremely dangerous to independently determine the reasons, to sit in conjectures. Perhaps this is just a sign of the presence of a purulent wound on the corresponding arm. But intrathoracic lymphadenopathy is not always defined so simply, it often occurs with tuberculosis, so you should carefully check. If there is a suspicion that this is axillary lymphadenopathy, it is necessary to consult a specialist.

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

During surgical intervention for mastopathy, a biopsy of the nodes is always performed, which softens the issue of their removal in oncology. To begin with, the presence of metastatic cells in the sentinel lymph nodes is determined, and only with a positive analysis, they are removed.

Treatment

Treatment is prescribed only by a doctor, choosing not only drugs, but also the dosage individually for each patient. After determining the cause, the doctor gives an appointment, for example, treatment of tuberculosis according to the special DOTS + system, or in case of purulent processes, antibiotic therapy and opening of the abscess.

Video

What the inflamed lymph nodes and the general condition of the armpits signal, you can find out from our video.

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Lymphadenopathy of the axillary lymph nodes is an increase in the lymph nodes located in the armpits.

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

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

At the same time, the causes can be relatively banal, not requiring 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 breast - what is it?

Intramammary lymph nodes are located on the lateral margin.

Most of the lymph drains into the axillary lymph nodes.

The axillary lymph nodes drain the shoulder region, the region of the mammary gland and the chest wall.

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

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

Enlarged intramammary nodes, in addition, may accompany staphylococcal and streptococcal infections of the hand or sporotrichosis.

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

Enlarged axillary lymph nodes

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

At the moment when the regional nodes notice that there are some foreign particles in the lymph, such as bacteria, the number of white blood cells that can fight infections is multiplied, resulting in an increase in 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 in the armpits can even be palpated.

It should be remembered that the lymph nodes increase if they are fighting some kind of disease.

We can talk about infection, inflammation, tumor, but the increase in armpit nodes also occurs with leukemia and lymphoma.

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

In the nodes in the armpit, the lymph of the mammary gland and chest wall flows. Their increase may be a signal of the 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 residues from tissues, prevents bacteria from entering the body and protects against a number of undesirable 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, intrathoracic 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;
• scapular nodes are located in the back axillary part.

Each group of axillary nodes protects the corresponding organ, system and/or tissues. In the event of a malfunction or disease in this organ, the nodes immediately react: their increase is observed, inflammation of the lymph nodes may occur, or they become quite painful.

In most cases, the axillary nodes undergo changes in various diseases that affect the mammary gland: when it becomes inflamed for various reasons or an oncological disease occurs.

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

Treatment of lymphadenopathy depends on the main 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 find 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 childbirth.

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 there are symptoms of lymphadenopathy, then they are insignificant.

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

The reason for the increase in 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 a significant expression of edema, irritation of the nerve endings in the lymph nodes occurs, and, accordingly, pain occurs.

Lymphadenopathy and oncology

Symptoms of lymphadenopathy, which should be the reason for visiting a specialist and conducting a thorough examination:

1. Enlarged and hard lymph nodes in the armpit, which are detected by palpation.
2. Change in the size and shape of the breast (left or right). Attention should be paid to violations in the chest itself, such as dents, irregularities and stretching of the 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 be, for example, of varying density, in some place lowered, it may show signs similar to eczema.
5. Weight loss and night sweats are among the common signs of body-eating diseases that include cancer or AIDS.

Due to the rapid development of metastases (settlement 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 in the ranks of a very dangerous oncology.

Measures that will ensure early detection of the disease and any changes in the breast include monthly breast examination by the woman herself and regular mammograms.

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

If the results of self-examination are not conclusive, an immediate visit to the doctor should not be postponed.

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

Cancer can quickly spread throughout the body without even making itself felt. If, in addition to the defeat of the intrathoracic lymph nodes, the disease has also affected 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 out of place here, a 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, in solving rheumatic deformities of the fingers, over time a person may notice that the lymph node in the armpit has increased.

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

Likewise, reactive lymphadenopathy may result from implantation of silicone into the mammary glands, as these prostheses may leak silicone into the surrounding tissues.

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

Enlarged axillary lymph nodes in the breast due to silicone exposure are histologically evidence of 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 enlarged mammary lymph nodes of a reactive nature when using rigid silicone for fixing joint prostheses.

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

Ways to visualize and locate lymph nodes

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

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

An anteroposterior chest x-ray reveals enlarged lymph nodes when they reach a size of approximately 2 to 2.5 cm.

Ultrasonography can detect lymphadenopathy in various locations. This study is able to recognize magnified ones of about 1 cm.

Indications for examination include an obscure palpable mass in the peripheral lymph nodes and monitoring the dynamics of the cancer patient's process.

Computed tomography of the chest (CT) is a modern and informative method of examination, especially in parts of the body that are inaccessible 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.

The chest (MRI) provides a different view than CT.

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

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

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

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

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

We recommend to know:

Lymphadenopathy requires timely diagnosis, you should not neglect your health and allow the development of the disease. 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.

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

Infectious lesions of the lymph nodes;

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

The defeat of the lymph nodes by viruses of various origins. For example, with hepatitis, HIV infection, cytomegalovirus infection, etc.

Fungal infection (histoplasmosis, coccidioidomycosis, actinomycosis);

Chlamydial infections (with venereal lymphogranuloma);

Tumor-like processes and systemic diseases of the connective tissue;

Sarcoidosis, endocrinopathy, rheumatoid arthritis;

Metastasis to the lymph nodes in cancerous 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 only the axillary, submandibular and inguinal nodes should be probed in the normal state. The main symptomatology of lymphadenopathy is a non-specific enlargement of the lymph nodes, both those that can be detected by probing, and those that, in the normal state of the patient, are not detected. Additional symptoms of the disease are: weight loss, excessive sweating (mainly at night), a prolonged increase in body temperature, an increase in the size of the liver, and an increase in the size of the spleen.

Depending on the location and prevalence of the affected lymph nodes, there are several types of lymphadenopathy:

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

Regional lymphadenopathy, during which several lymph nodes are enlarged in one or two adjacent areas (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 is distinguished. The acute form of the disease is characterized by severe soreness of 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 soreness of the lymph nodes (or the complete absence of soreness).

Diagnosis of the syndrome of lymphadenopathy

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 start the diagnosis is obtained. The initial examination includes a general blood test with the determination of the content of erythrocytes, reticulocytes, ESR and platelets, blood biochemistry with the determination of acute phase proteins, the determination of markers of HIV and hepatitis B and C, an ultrasound examination of the abdominal cavity, as well as an X-ray of the chest.

The 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 has an infectious origin. In this case, the age of patients does not exceed 30 years. In patients over the age of 50, neoplastic genesis is detected in 60% of cases. In any case, age alone cannot be the only criterion for diagnosis and subsequent treatment.

History data.

These data are understood as information about the development of the disease, past diseases, the patient's living conditions, past injuries, heredity, existing allergic reactions, and so on. All this information plays an important role during the diagnosis.

The nature of the lymphadenopathy.

In the diagnosis of lymphadenopathy, the nature of the affected lymph nodes and their localization 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.

The size of the lymph nodes.

By the size of the lymph nodes, as a rule, it is impossible to determine the cause of the disease. However, if the examination of children reveals pathological changes in the organs of the chest and at the same time 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 them to become sore. Pain occurs as a result of hemorrhage in 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 distinguish malignant processes from benign processes in the lymph nodes.

Location of lymph nodes.

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

Other clinical signs.

Sometimes the presence of some clinical symptoms may become the key features during a diagnostic search. In particular, in the diagnosis, 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.

With this disease, the lymph nodes in the groin and axillary zone are affected. They increase and become motionless and unsoldered among themselves. With the progression of the disease, symptoms such as headache, fever, chills may appear. As a result of taking blood tests, an increase in ESR is seen. The disease can give a complication in the form of an abscess, phlebothrombosis, sepsis and lymphostasis.

Tuberculosis of peripheral lymph nodes.

This disease is most often seen 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 up 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 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, there may be pain in the throat when swallowing. Body temperature can rise to 38-40 degrees. During the disease, catarrhal or lacunar tonsillitis may occur. In icteric forms of mononucleosis, pronounced liver changes are determined in patients.

Hodgkin's lymphoma.

Clinically, the disease is manifested by an increase in various groups of lymph nodes, which have a densely elastic consistency, are painless and are not soldered to the skin. In most patients, the primary lesion is located above the diaphragm. The first symptoms of the disease are: difficulty breathing, coughing, 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 the defeat of one lymph node and further metastasis of the tumor. Lymph nodes are painless, dense, not soldered to the skin. Their increase can lead to the syndrome of the superior vena cava, portal hypertension, dynamic intestinal obstruction, as well as 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 may include fever, hemorrhagic vasculitis, lymphadenopathy, lung involvement, Sjögren's syndrome, and polyserositis. These extrahepatic symptoms can often be the first symptoms of liver disease.

Gaucher disease.

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

Macroglobulinemia Waldenström.

The disease is one of the types of chronic leukemia. With the disease, as a result of the production of monoclonal macroglobulin by tumor lymphoid cells, vascular damage develops. 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 an increase in lymph nodes, as well as damage to the lungs, skin, eyes, joints, liver and myocardium. Enlarged cervical lymph nodes are painless and not soldered. A negative reaction occurs to the intradermal administration of tuberculin, which is explained by the suppression 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, lethargy, delirium.

Lyme disease.

The onset of the disease is accompanied by itching, soreness, swelling and redness at the site of tick suction. Headache, general weakness, nausea, malaise, chills, fever up to 38 degrees, loss of sensitivity at the site of tick suction are also characteristic.

Streptococcal skin lesions.

The disease is characterized by the appearance of conflict, which spreads along the periphery. The conflict is filled with yellowish contents in the form of sulfur and is painful to the touch. In the future, erosion appears on the site 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 at the site of a scratch. Typical symptoms are fever, hepatosplenomegaly, regional lymphadenitis, and exanthema.

Retroperitoneal lymphadenopathy - pathological enlargement of the 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 a prolonged course of lymphadenopathy turns into an independent pathology and can lead to serious complications. In the article we will understand what it is - retroperitoneal lymphadenopathy, and how to treat it.

Difference from lymphadenitis

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

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

The reaction of the lymph nodes to pathological processes in the body 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 is acute, with symptoms characteristic of an acute process. The affected lymph node increases in size, becomes painful. The skin over the superficial lymph nodes turns red, there is a local increase in temperature.

The first manifestation of lymphadenopathy is an enlargement of the 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 harden strongly, with localization of the lesion 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 can become inflamed.

Causes of the disease

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

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

Most often, the introduction of a provoking agent occurs against the background of local inflammatory processes, acute, subacute or chronic, sometimes - with infectious diseases of a general nature. Penetration of the pathogen is possible with its direct contact, through the 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 associated with the activity of the process.

As the underlying disease progresses, inflammation may develop in the affected lymph nodes with a transition to a purulent process.

The rate of progression of lymphadenopathy varies depending on the intensity and duration of exposure to pathogenic factors, as well as their number.

The immediate 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 diseases of the connective tissue, and also have an iatrogenic (medicinal) 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 may accompany the course of viral parotitis, rubella and other childhood diseases. The clinical picture may resemble acute appendicitis.

Abdominal lymphadenopathy(an increase in lymph nodes located in the abdominal cavity) may develop against the background of mesenteric adenitis or.

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

Classification

According to the duration and features of the flow, there are:

1. acute;
2. chronic;
3. Recurrent lymphadenopathy.

Any of the forms of pathology can also be tumor or non-tumor.

Additionally, the 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 are very different.

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

They talk about local damage with an increase in one lymph node. With the defeat of several lymph nodes located in adjacent groups.

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 injuries and limited infectious lesions. The generalized form of pathology indicates about serious violations of the functions of the immune system.

Symptoms

Main feature developing lymphadenopathy - an increase in lymph nodes. An increase can be seen with 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 the localization of the lesion in the abdominal cavity can be:

• sweating;
• General weakness;
• Sustained slight increase in body temperature;
• Digestive disorders, in particular diarrhea;
• Enlargement of the spleen and liver.

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

The main symptoms of pathology are nonspecific, additional ones vary greatly. depending on the nature of the pathogen and the course 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, pain in the joints.

Diagnostics

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

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

Features of professional activity, hobbies and other facts from the patient's private life may have diagnostic value.

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

On external examination, the doctor palpates the affected lymph nodes, determining their number, size, consistency, soreness, the 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 complex of studies 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 performed:

• 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 complex of diagnostic procedures can vary greatly depending on the alleged underlying disease.

Treatment

Painless enlarged lymph nodes are not always taken seriously by the patient. Manifestations of lymphadenopathy at any age - 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.

Treatment for lymphadenopathy may include:

When the underlying disease is eliminated, the lymph nodes quickly decrease to normal sizes.

With a confirmed malignant process, the patient is prescribed a course of radiotherapy or chemotherapy. In the absence of the effect of 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.