Lymphadenopathy: Definition, Causes, Symptoms, Diagnosis and Treatment

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 as a consequence of inflammatory, infectious or carcinogenic diseases.

They are of different types and depending on the cause that causes them, they require a different treatment.

The points of infection or inflammation can be located by the proximity to the place where localized adenopathy occurs.

A persistent generalized adenopathy affects several lymph nodes and lasts for a long period of time.

The ganglia come in contact through the plasma with antigens from bacteria, viruses or any microorganism, with B and T lymphocytes that are responsible for the specific defense of the immune system, 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 is enclosed by a fibrous capsule that belong 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, 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 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 finally flowing into the veins.

When there is an alarm caused by an infection, 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 to the bloodstream.

Causes

The 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 of 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 to infer the pathology:

Generalized lymphadenopathies

Caused by viral type infections
  • Common respiratory infections.
  • The mononucleosis.
  • Acute cytomegalovirus infections.
  • Hepatitis type A, B and C.
  • Acquired immunodeficiency syndrome (AIDS).
  • Rubella virus.
  • Varicella virus.
  • Measles virus.
Caused by bacterial infections
Protozoa
  •  Toxoplasmosis.
Mushrooms
  • Coccidioidomicosis.
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
  • The rubella.
  • The strep throat .
  • Acute bacterial lymphadenitis
  • Toxoplasmosis
  • Tuberculosis or atypical microbacterial 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
  • The rubella.
  • The roseola.
Preauricular
  • A local infection of the skin.
  • A chronic ophthalmic infection.
Mediastinal
  • Acute lymphoblastic leukemia.
  • The lymphoma
  • La sarcoidosis.
  • Cystic fibrosis
  • The 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
  • Lymphogranulomas venereal.

symptom

The symptomatology that reveals the appearance of an 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.
  • 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 / or 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 an 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 lymph nodes that are located superficially, such as: axillary, carotid-ridge, inguinal, postcervical, submandibular, supraclavicular, epitrochlear and retrocrural.

The characteristics of adenopathy that may indicate a pathological cause are:

  • The size of the adenopathy greater than 1 cm.
  • They are often isolated.
  • The one-sidedness
  • The firmness or hardness, and very rarely the adherence in a deep plane that suggests malignancy.
  • Presence of inflammation or sensitivity that makes presume an infectious cause.

Inguinal and bilateral adenopathies are very common and frequent in children and adolescents, as well as 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 an 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 presents, and what is the associated symptomatology.

Presence of an infectious entry in the drainage area.

And the general symptoms such as fever, sweating, pruritus, weight loss.

Differential clinical diagnosis

There are diseases that 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 presence of hyperlinfocytosis, lymphoblastosis, lymphocytosis, mononucleosis, or polynucleosis can be revealed through the leukocyte formula.

Search for an inflammatory syndrome

The practice of a cytopuncture is a simple and rapid diagnostic orientation procedure.

Images

This method allows the detection of abdominal, mediastinal, deep or pelvic adenopathies, inaccessible in a physical examination.

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 that 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 in nature and are located within the drainage area of ​​the infected site.

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 serodiagnostics of some infectious diseases, such as for the diagnosis of toxoplasmosis the presence of immunoglobulin.

In the case that there is suspicion of lymphoblastic leukemia, this possibility can be eliminated if there is an absence of blasts 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 allow the diagnosis of a chronic sinusitis.

They also reveal the existence of a cephalic skin tumor, especially the existence of a malignant melanoma on the scalp.

When there is a basal cervical adenopathy, tumors are suggested in the larynx, pharynx, esophagus and thyroid.

The supraclavicular adenopathy, according to the lateralization can be inferred 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 a cancer located in the digestive system, the renal system, the testicles, the 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 important to perform a chest x-ray.
  • If we are in the presence of axillary adenopathies, these suggest a 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 located in the lower extremities are inferred.

In disseminated chronic lymphadenopathies, after the systematic search for certain infections by serology such as toxoplasmosis, brucellosis, syphilis and chronic lymphocytic leukemia by platelet count.

The diagnosis should be aimed at surgical biopsy with more emphasis on 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 that are usually recommended for adenopathy usually involve treatment for the underlying disease and the lymph nodes are allowed to recover.

In the case that 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 treatment.

The  autoimmune disorders  are treated with specific drugs  that can help reduce inflammation.

The forms of cancer that could lead to lymphadenopathy are treated with the most aggressive means possible to try to cure the patient, which may consist of radiotherapy, chemotherapy, surgery or targeted therapy.