Index
It is an acute or chronic disorder of the size or consistency of the lymph nodes, also called lymphadenopathy.
This pathological state of inflammation in the lymph nodes anywhere in the body occurs due to inflammatory, infectious or carcinogenic diseases.
They are of different types, and depending on the cause that causes them; they require another treatment.
The points of infection or inflammation can be located by the proximity to the place where localized adenopathy occurs.
Persistent generalized adenopathy affects several lymph nodes and lasts for an extended period.
The ganglia come in contact through the plasma with antigens from bacteria, viruses, or any microorganism, with B and T lymphocytes responsible for the immune system’s specific defense, developing an immune response.
The continuous circulation of the lymph through the lymph nodes allows the dissemination of this response to the entire body.
The ganglia or nodules are oval structures shaped like a kidney and are enclosed by a fibrous capsule that belongs to the lymphatic system and whose primary activity is to filter and drain the lymph that runs through the lymphatic vessels.
The lymph nodes are connected by lymphatic vessels and are small filters located throughout the body.
Their size is variable; some can be palpated easily and are found more abundantly in the neck (behind the ears and under the jaw), the armpits, on the clavicle, behind the elbows, and behind the knees and in the groin.
Others are only seen through procedures, such as x-rays, and are located within the thorax.
The body has about six hundred lymph nodes.
The nodes under normal conditions usually have a diameter of less than 1.0 cm and tend to decrease with growth or remain stable in size.
The lymph is mobilized through lymphatic vessels and passes through at least one lymph node before flowing into the veins.
When an infection causes an alarm, the ganglion begins to release lymphocytes.
If these microorganisms exceed this barrier of host resistance, the infectious process can spread to more distant lymph nodes or the bloodstream.
Causes
Lymphadenopathy is usually caused by the accumulation of fluid inside the lymph nodes by the immune cells as a response of the organism to the occurrence of an infection.
It can also be caused by an abnormal buildup of immune cells, caused by cancer, an infection, or some other inflammatory trigger.
Bacterial and viral infections are infections caused by fungi or parasites, mononucleosis, infections by bacteria or viruses, sexually transmitted diseases, and the presence of staphylococci or streptococci.
Another cause of adenopathy includes hypersensitivity to medications.
Inflammation also occurs in response to the presence of a foreign body due to the proliferation of lymphoid tissues, the occurrence of metastases, or systemic autoimmune diseases such as Besnier-Boeck disease or systemic lupus erythematosus.
Thus the lymphadenopathies are caused by various microorganisms, and the place where it manifests allows us to infer the pathology:
Generalized lymphadenopathies
Caused by viral type infections
- Common respiratory infections.
- The mononucleosis.
- Acute cytomegalovirus infections.
- Hepatitis types A, B, and C.
- Acquired immunodeficiency syndrome (AIDS).
- Rubella virus.
- Varicella virus.
- Measles virus.
Caused by bacterial infections
- Serious infections
- Intestinal infectious diseases such as typhoid fever.
- Tuberculosis.
- Syphilis
Protozoa
- Toxoplasmosis.
Mushrooms
- Coccidioidomycosis.
Autoimmune disorders and hypersensitivity states
- The JRA.
- Systemic lupus erythematosus.
- Drug reactions such as allopurinol and phenytoin.
- Allergic diseases such as serum sickness.
Storage diseases
- Gaucher’s disease
- Niemann-Pick’s disease
Proliferative and neoplastic disorders
- Acute leukemia
- Lymphomas ( Hodgkin ).
- Los neuroblastomas.
- The histiocytosis.
Regional lymphadenopathies
Cervical
- An infection in the upper respiratory tract.
- Infectious mononucleosis
- Rubella.
- The strep throat.
- Acute bacterial lymphadenitis
- Toxoplasmosis
- Tuberculosis or atypical micro-bacterial infections.
- Acute leukemia
- The lymphoma
- El neuroblastoma.
- Rhabdomyosarcoma
- Kawasaki disease
Submaxilar y submental
- Dental and oral infections.
- Acute lymphadenitis
Occipital
- La pediculosis capitis.
- Latino leaders.
- A local skin infection
- Rubella.
- The roseola.
Preauricular
- Local infection of the skin.
- A chronic ophthalmic illness.
Mediastinal
- Acute lymphoblastic leukemia.
- The lymphoma
- La sarcoidosis.
- Cystic fibrosis
- Tuberculosis.
- La histoplasmosis.
- La coccidioidomicosis.
Supraclavicular
- The lymphomas.
- The tuberculosis.
- La histoplasmosis.
- La coccidioidomicosis.
Axillary
- The local infection.
- The disease of Catscratch.
- Brucellosis
- Reactions to immunizations.
- The lymphomas.
- Juvenile rheumatoid arthritis.
Abdominal
- Acute mesenteric adenitis.
- The lymphomas.
Inguinal
- Local infections
- Diaper rash
- The insect bites
- Syphilis
- Lymphogranuloma venereal.
symptom
The symptomatology that reveals the appearance of adenopathy is characterized by a swelling of the ganglion, painful spontaneously or when the palpation is performed.
The main symptoms are:
- Sore throat.
- Swelling of the lymphatic glands
- Frequent cough and accompanied by sputum with blood.
- Pain in the ears
- Tumors or swelling in the neck.
- Symptoms of a common cold.
- Headaches.
- Pain in the neck
- General aches or pains.
- Abdominal pains
- Cramp and spasms.
- Facial pains
- Lumbalgias.
- The sensation of discomfort.
- Vomiting
- Back pains.
- Pelvic pain.
- Accumulation of liquids under the skin.
- Fevers
- Pains in the chest
- Atypical discoloration or pigmentation in the skin.
- Hearing loss
- Pain and tenderness in the breasts.
- Nasal congestion.
- Rigidity or limited movement of the neck.
- Pain and tumor in the arm.
- Swelling in the jaw
- Bulks in the ear.
- Herpes labial.
- Restlessness
- Vulvar ulcer.
Diagnosis of adenopathies
For the correct diagnosis of adenopathy, it is necessary to perform a thorough examination that involves:
Palpation of the ganglia
The adenopathy is examined by palpating at the level of superficially lymph nodes, such as axillary, carotid-ridge, inguinal, post cervical, submandibular, supraclavicular, epitrochlear, and retro rural.
The characteristics of adenopathy that may indicate a pathological cause are:
- The size of the adenopathy is greater than 1 cm.
- They are often isolated.
- The one-sidedness
- The firmness or hardness, and rarely the adherence in a deep plane, suggests malignancy.
- The presence of inflammation or sensitivity makes presume an infectious cause.
Inguinal and bilateral adenopathies are very common and frequent in children and adolescents, and bilateral axillary lymph nodes are more common in pre-menopausal women.
Some adenopathies in places where the lymph nodes are not visible, like those of the cervix, can be detected by ultrasound.
If it is not possible to detect adenopathy using these techniques, it can be attempted by performing a biopsy.
The characteristics of the ganglion should be specified: if it is isolated or grouped, the size it presents, the evolution it offers, and the associated symptomatology.
Presence of an infectious entry in the drainage area.
And the general symptoms such as fever, sweating, pruritus, and weight loss.
Differential clinical diagnosis
Some diseases have symptoms similar to adenopathies, such as:
- The subcutaneous nodules and lipomas.
- The hypertrophy of the salivary glands.
- The thyroglossal cyst.
- Latent carotid aneurysms.
- A bony prominence.
- The axillary hidradenitis.
- The inguinal hernia .
- Cold abscesses
Tests
Biologíca
The leukocyte formula can reveal hyperleukocytosis, lymphoblastoid, lymphocytosis, mononucleosis, or polynucleotides.
Search for an inflammatory syndrome
The practice of a cyst puncture is a rapid and straightforward diagnostic orientation procedure.
Images
This method detects abdominal, mediastinal, deep, or pelvic adenopathies inaccessible in physical examinations.
The diagnosis begins with a chest x-ray or abdominal ultrasound.
Lymph node biopsy
It is done according to the possible cause and the degree of evolution it presents.
The biopsy allows a bacteriological and immunohistochemical study.
Thus, in the case of isolated acute adenopathy, the diagnosis is evident: they are inflammatory and located within the infected site’s drainage area.
For the appearance of benign polyadenopathies, a preliminary diagnosis is made, such as infectious mononucleosis, toxoplasmosis, and rubella, since they originate in a scenario that suggests the presence of an infection.
Post-cervical and spinal adenopathies suggest that the origin is inflammatory and sensitive; in this case, the differential diagnosis is provided by the percentage of each type of white blood cell through the hemo-leukocyte formula.
As well as the performance of the serodiagnostic of some infectious diseases, such as for the diagnosis of toxoplasmosis and the presence of immunoglobulin.
If there is suspicion of lymphoblastic leukemia, this possibility can be eliminated if blasts are absent in the hemoleukocyte formula.
In chronic lymphadenopathies, a high or submandibular cervical adenopathy, a dental panoramic radiograph allows us to investigate if there are dental infections, and x-rays of the paranasal sinuses will enable the diagnosis of chronic sinusitis.
They also reveal the existence of a cephalic skin tumor, especially the presence of malignant melanoma on the scalp.
When there is basal cervical adenopathy, tumors are suggested in the larynx, pharynx, esophagus, and thyroid.
The supraclavicular adenopathy, according to the lateralization, can be inferred from the following:
- If the adenopathy appears on the left where the sentinel lymph node or Troisier’s ganglion is, it can be a good indicator of cancer in the digestive system, renal system, testicles, pelvis, and the lymphomas located in the abdomen.
- If the adenopathy appears on the right, it can be in the presence of mediastinal and lung lymphoma, so it is essential to perform a chest x-ray.
- If we are in the presence of axillary adenopathies, these suggest breast cancer. Another diagnosis could be a malignant melanoma located in the upper extremities.
- When adenopathies are inguinal diseases such as syphilis, lymphomas, or tumors in the lower extremities are inferred.
After the systematic search for certain infections by serology such as toxoplasmosis, brucellosis, syphilis, and chronic lymphocytic leukemia in disseminated chronic lymphadenopathies by platelet count.
The diagnosis should be aimed at surgical biopsy, emphasizing the cervical or axillary areas.
If these tests do not yield any results, a surgical biopsy is performed due to the suspicion of a tumor problem.
Treatment of adenopathies
Medications usually recommended for adenopathy involve treatment for the underlying disease, and the lymph nodes are allowed to recover.
If the patient presents cancer cells in the lymph nodes, surgery is necessary to remove them.
The wide variety of causes of adenopathy causes the treatment to vary. Any bacterial infection would surely lead to antibiotic therapy.
The autoimmune disorders are treated with specific drugs that can help reduce inflammation.
