Enlarged lymph nodes

are a frequent cause for concern, since everyone knows that if the lymph node is enlarged, it means something has gone wrong in the body.

Lymph nodes are an important part of the immune system, which is responsible for forming the body’s defenses against infectious agents and any foreign molecules. Our immune system consists of lymphatic vessels (organs such as the thymus and spleen, lymphatic tissue of the nasopharynx (tonsils, adenoids) and gastrointestinal tract, immune cells circulating in the blood, as well as numerous lymph nodes located throughout the body.

The lymph nodes

are in groups, and each group receives lymph fluid from a specific area of ​​the body. Large collections of lymph nodes are found in the head and neck area, as well as in the armpits and groin. Localization of enlarged lymph nodes usually helps determine the cause of the disease.

Changes in the size and structure of lymph nodes can accompany a wide range of diseases. Most often, there is an increase in size and compaction. Most cases of enlarged lymph nodes are harmless and recovery occurs without medical intervention, but there are a number of situations when you need to be wary and consult a doctor.

Common signs and symptoms associated with lymph node disease and the most common causes

Sign Description Additional symptoms Cause
When lymph nodes are involved in the disease process, most often:
Enlargement of lymph nodes You may feel an enlarged lymph node the size of a pea or bean, or even larger. Both single and multiple lymph nodes throughout the body can be enlarged.
Single lymph nodes in the submandibular and cervical occipital areas are enlarged to the size of beans, elastic, moderately painful Runny nose, sore throat, headache, fever, muscle pain and other signs of an upper respiratory tract infection ARVI or cold
A few lymph nodes in the submandibular region, parotid region or upper third of the neck, varying degrees of density and pain, up to 1-1,5 cm in size, long-term, increasing in size against the background of ARVI Frequent ARVI, sore throats, pharyngitis, dental problems Chronic infection of the oral cavity and ENT organs: chronic tonsillitis, pharyngitis, dental caries, chronic inflammatory odontogenic processes, odontogenic cysts
Multiple lymph nodes in the submandibular, cervical, occipital, inguinal and other areas are enlarged to the size of beans, soft, often painless Weakness, fever, possibly enlarged liver and/or spleen, as well as skin rash Acute and chronic viral infections, toxoplasmosis, severe parasitic infestations
Various symptoms depending on the specific disease – joint pain, fever, skin rashes, abdominal pain, increased blood pressure, etc. Autoimmune diseases such as lupus, periarteritis nodosa or rheumatoid arthritis, etc.
There are no symptoms or are not associated with enlarged lymph nodes Long-term use of certain medications, such as allopurinol, atenolol, captopril, enalopril (less commonly), carbamazepine, some antibiotics; sulfonamides; phenytoin, etc.
A single dense, painful lymph node, most often in the submandibular region, upper third of the neck, axillary region Symptoms of the inflammatory process of varying severity – from diffuse swelling and redness of the skin over the lymph node, fever, varying severity of local pain. More often, the source of inflammation is obvious. Regional lymphadenitis, the presence of entrance gates of infection in the form of damage to the skin of the hands with axillary lymphadenitis, carious teeth with submandibular lymphadenitis, inflammation of the tonsils with cervical lymphadenitis.
A single lymph node or several adjacent lymph nodes are enlarged. The nodes are dense, more often completely painless, inactive due to the fact that they are welded to the surrounding tissue or to each other. The localization of enlarged lymph nodes can be any, in particular – the axillary region, the lower third of the neck, the supraclavicular region. Additional symptoms may be absent or be represented by general clinical symptoms, such as weight loss, fever, weakness, itching, excessive sweating, or local symptoms, such as pain, hardening and deformation of the affected organ, swelling of the limb, etc. Often, such an enlargement of lymph nodes is a sign of a tumor of the lymphatic system, such as lymphoma (in particular, Hodgkin lymphoma), or a tumor of internal organs (stomach, intestines, reproductive system, etc.).
Induration of the lymph nodes You may feel a lymph node or multiple nodes, which can be of varying degrees of density: from soft and barely noticeable to the touch, to dense like wood or stone.
Dense, most often painless, non-displaceable lymph nodes of any location, especially in such unusual places as the lower part of the neck, armpits Additional complaints may be completely absent or may be represented by general symptoms (weakness, sweating, fever, weight loss, itchy skin, rash), or local signs (pain when squeezing, swelling of surrounding tissues and extremities; changes in the skin over the lymph nodes and etc.). First of all, it is necessary to exclude the presence of a tumor, the localization of which may be remote from the enlarged lymph nodes. The diagnostic search also includes infections such as tuberculosis and syphilis.
Soreness of the lymph nodes Enlarged lymph nodes may or may not be painful. Soreness of the lymph nodes can be associated both with their inflammation and with rapid growth due to stretching of the node capsule, as well as compression of surrounding tissues and nerve endings.
A single dense lymph node, sharply painful when touched, the skin over the node is red and hot to the touch. Most often, the entrance gates of infection are obvious: a sore throat with an enlarged lymph node in the neck, skin damage on an arm or leg, panaritium, etc. Infectious lymphadenitis, if not treated immediately, may require surgical treatment.
One or several dense lymph nodes, painless or slightly painful when palpated, often fused together and inactive, or completely not displaced when palpated; the skin over the nodes is not changed. Additional complaints may be completely absent or may be represented by general symptoms (weakness, sweating, fever, weight loss, itchy skin, rash). Local symptoms are not common, but can be caused by compression of surrounding tissues (pain, swelling). Often, such an enlargement of lymph nodes is a sign of a tumor of the lymphatic system, such as lymphoma (in particular, Hodgkin lymphoma), or a tumor of internal organs (stomach, intestines, reproductive system, etc.).
Several dense lymph nodes, painless or slightly painful when touched, not welded together, movable, which are sometimes compared to “potatoes in a bag.” Additional complaints may be completely absent or may be represented by general symptoms (weakness, fever, cough, weight loss, etc.). The skin over the nodes may not be changed, or have a bluish tint, be fused with the lymph nodes, and external fistulas with a cheesy discharge may form. A rare condition these days is tuberculosis of the lymph nodes. However, due to massive refusals of vaccination and uncontrolled migration from regions unfavorable for tuberculosis, we cannot forget about the likelihood of this disease
A single painless, densely elastic lymph node, mobile on palpation, ranging in size from 1 to 3 and even 5 cm, the skin over it is not changed. The most common location is in the groin, cervical or submandibular region, which depends on the entrance gate of the infection. The entrance gates of infection can most often be localized on the genitals, in the anus, in the mouth, on the tonsils and appear as a dense, painless ulcer with a whitish bottom. Sometimes, upon examination, the ulcer is in the healing stage and is difficult to notice. Primary syphilis. Unfortunately, this is a common situation nowadays. See a doctor urgently! At this stage, the disease is easily curable.
Additional signs Additional signs may be changes in the skin over the lymph nodes, the presence of additional symptoms, both local and general, as well as the characteristics of the patient’s life, his age, heredity, professional activity and travel. A holistic picture of changes in the body of a patient who complains of enlarged lymph nodes should be assessed by an experienced doctor. Most often it is necessary to consult a physician, pediatrician or general practitioner. After examination and initial examination, the patient is prescribed dynamic observation, treatment, or additional consultations with specialists. Depending on the picture of the disease, the patient may need to make an appointment with a hematologist or receive a referral to a surgeon, dermatovenereologist, infectious disease specialist, phthisiatrician, ENT specialist, dentist or oncologist.

When to see a doctor immediately:

Most cases of enlarged lymph nodes resolve on their own along with recovery from the infectious disease that caused their enlargement. However, if this condition is alarming, you can consult a doctor to clear your doubts.

If at least one of the following signs is present, the patient is advised to urgently consult a specialist:

  1. Enlarged lymph nodes appeared for no apparent reason;
  2. The size of the lymph node exceeds 2,5 cm and continues to grow rapidly;
  3. The enlarged node is very painful and/or the skin over it is red;
  4. There is an increase in lymph nodes in unusual places, for example, the lower third of the neck, supraclavicular area, axillary or groin area;
  5. Lymph nodes, the enlargement of which was associated with a minor infection of the upper respiratory tract, exist for more than 3-4 weeks, without decreasing or increasing in size;
  6. The knot is very tight and does not move when you press on it;
  7. Several enlarged lymph nodes are fused together and are inactive relative to the surrounding tissues;
  8. The appearance of enlarged lymph nodes is accompanied by persistent or intermittent fever, night sweats, rash, or unexplained weight loss;
  9. Enlarged lymph nodes are accompanied by severe sore throat or difficulty swallowing or breathing;

Is there any way to relieve the symptoms before consulting a doctor?

While you are waiting for a doctor’s consultation, to relieve the symptoms that bother you (if any, of course), you can use anti-inflammatory and painkillers (paracetamol, ibuprofen) in accordance with the included instructions. As a local treatment, you can use dry heat, but in no case, compresses or active heating. Compresses and active heating can accelerate and aggravate the pathological process.

In addition, try to ensure that you rest and get enough sleep. This recommendation will be useful to everyone in any case.

How can you prepare in advance to make your visit to the doctor as beneficial as possible?

Since your appointment time is limited, advance preparation will help you get the most out of your medical consultation. It is better if you remember in advance and record the features of the course of the disease, as well as the questions you want to ask a specialist.

  • Write down what symptoms bother you and for how long? Your doctor will want to know if you have had flu-like symptoms, such as fever or sore throat, or if you have noticed changes in weight. List every symptom you have noticed since your lymph nodes have swollen;
  • Remember all the recent sources of infection with which you have had contact, including travel abroad, hiking, eating dried or half-raw fish or meat; contact with animals; medical procedures or sex with a new partner;
  • It is better to write down what medications you have taken recently, for what diseases and in what dosages. Don’t forget to include vitamins, nutritional supplements and sports nutrition;
  • Bring your medical test results with you to your appointment if you have had them within the last year;

Write down questions you would like to ask your doctor.

If your main complaint is enlarged lymph nodes, you need to ask your hematologist the following questions:

  • What is causing my symptoms?
  • Are there other possible reasons?
  • What examination and treatment do you recommend for me?
  • How quickly can I expect improvement?
  • Are there any alternative treatments?
  • Can I be contagious to my loved ones? How can I reduce the risk of infecting other people?
  • I have underlying health conditions, do I need to make adjustments to the treatment I am already receiving?
  • Do you recommend any additional sources of information about my condition?

What diagnostic methods are used to determine the cause of enlarged lymph nodes?

  • First, the doctor will need to review your medical history and will ask questions about the timing of symptoms, comorbidities, family history, your work and travel history;
  • A clinical examination, which will allow the doctor to assess the number, size, density of enlarged nodes, accompanying changes, the presence of entrance gates of infection, etc. A clinical examination will allow the specialist to make a preliminary judgment about the cause of the disease or make a preliminary diagnosis;
  • Laboratory blood tests. Depending on what preliminary judgment your doctor has about the cause of enlarged lymph nodes, he may order some blood tests. This is done in order to confirm or exclude a preliminary diagnosis.
  • In some cases, other laboratory tests may be needed, such as skin tests to diagnose tuberculosis or microbiological testing of the discharge source of infection;
  • Imaging tests may include ultrasound, x-rays, and/or computed tomography (CT) scans. Ultrasound diagnostics will allow you to quickly and accurately record the size of the lymph nodes for further dynamic monitoring, as well as determine whether additional groups of lymph nodes are enlarged that are not accessible to clinical assessment during examination. An X-ray examination of the chest will assess the condition of the lymph nodes inside the chest cavity, which are not accessible to ultrasound diagnostics.

    In more complex cases, computed tomography (CT), magnetic resonance imaging (MRI), and mammography may be prescribed.

  • If laboratory tests and imaging studies do not provide a definitive diagnosis, a lymph node biopsy may be required for microscopic examination. The exact method of biopsy, as well as the extent of examination of lymph node tissue, is determined by the doctor who determines the indications for biopsy;

The most common treatments for enlarged lymph nodes are:

  1. The most common form of enlarged lymph nodes, virus-associated lymphadenopathy, goes away on its own, in parallel with recovery from the viral infection;
  2. Antibiotics are used to treat infectious lymphadenopathy or lymphadenitis caused by a bacterial infection. This treatment may be prescribed to you by a general practitioner, pediatrician, surgeon or ENT specialist, depending on the location of the enlarged lymph node;
  3. If a bacterial infection of the lymph node leads to the development of acute lymphadenitis and purulent melting of the lymph node tissue, then, along with antibiotics, surgical treatment is performed – opening and drainage of the lymph node. Surgeons treat purulent lymphadenitis;
  4. If virus-associated lymphadenopathy is a symptom of HIV infection, the patient is indicated for specialized antiretroviral therapy. Infectious disease doctors treat HIV infection;
  5. Lymphadenopathy accompanying autoimmune disorders, such as systemic lupus erythematosus or rheumatoid arthritis, then treatment should be aimed at the underlying disease. This treatment is carried out by a rheumatologist or immunologist;
  6. Enlarged lymph nodes caused by tuberculosis are treated as inpatients. In such cases, it is necessary to contact TB doctors;
  7. Enlarged lymph nodes, which are a manifestation of a protozoal infection or a reaction to helminthic infestation, also do not require separate treatment. In such cases, when the cause of enlarged lymph nodes has been established, the patient is referred to a parasitologist who treats the underlying disease;
  8. Hematological diseases and cancer that cause enlarged lymph nodes require treatment in a specialized hospital. Depending on the type of disease, treatment may include surgery, radiation, chemotherapy, and even a bone marrow transplant.

The hero of Jerome K. Jerome, while reading medical reference books, discovered that he had all the diseases except puerperal fever. Therefore, if suddenly, after studying this article, you feel suspicious lymph nodes, do not rush to panic. Calmly and confidently make an appointment with a doctor – let all your fears be dispelled.

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