Conglomerate of mediastinal lymph nodes. Medical educational literature

• What are the causes of enlarged and inflamed lymph nodes in the groin in men and women?
• When does enlargement and inflammation of the lymph nodes under the arms develop in women?
• What could be the reasons for enlarged and inflamed lymph nodes in the neck?
• I'm expecting a baby (fourth month of pregnancy). I recently caught a cold, a severe sore throat, and a fever. Today I noticed enlargement and inflammation of the lymph nodes under the jaw. How dangerous is it during pregnancy?
• What antibiotic is prescribed for enlarged and inflamed lymph nodes?
• Is ichthyol ointment and Vishnevsky ointment used for enlarged and inflamed lymph nodes?
• The child has symptoms of enlargement and inflammation of the lymph nodes behind the ear. Which doctor should I contact? Are there any traditional treatments?

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What does enlarged and inflamed lymph nodes mean?

Lymph nodes– the most important link of the lymphatic system, performing a drainage and protective function.

The lymph nodes receive interstitial fluid from the lymphatic capillary system, containing elements that do not enter the blood (coarsely dispersed proteins, fragments of dead cells, microorganisms and their metabolic products, etc.).

In case of cancer, tumor cells linger in the lymph nodes, which often settle there and begin to multiply, forming tumor metastasis. In this case it happens enlarged lymph nodes, as a rule, not accompanied by inflammation.

The occurrence of this pathology, as a rule, indicates a weakening of the body’s defense reactions caused by one reason or another (senile age or infancy, the presence of concomitant diseases, previous infections, physical or psychological trauma, hypothermia, etc.).

Inflammation and enlargement of the lymph nodes occurs both with nonspecific infections (streptococcus, staphylococcus, etc.) and with infections caused by specific microflora (tuberculosis, cat scratch disease, etc.).

It should be noted that the importance of lymph nodes for the body is not limited to the drainage function alone. Lymph nodes contain lymphocytes that produce antibodies against foreign proteins. When a sufficient number of microorganisms enter the lymph node, its working hypertrophy occurs.

In such cases, the enlargement of the lymph node is not associated with inflammation of its tissue, but with an increase in the number of lymphocytes that produce antibodies against this infection, as well as macrophages that absorb microorganisms, their waste products and dead cells.

Working hypertrophy of the lymph nodes occurs both in regional infections (chronic tonsillitis, pharyngitis, etc.) and in chronic septicemia (blood poisoning), which most often develops in severe blood diseases that occur with a decrease in the level of normal leukocytes in the blood (aplastic anemia , chronic agranulocytosis, etc.).

Systemic autoimmune diseases (systemic lupus erythematosus, etc.) are also characterized by working hypertrophy of the lymph nodes that produce antibodies against the tissues of the body’s own. In this case, the degree of enlargement of the lymph nodes indicates the activity of the process.

And finally, like any tissue of the human body, lymph nodes can undergo tumor degeneration. In such cases (lymphogranulomatosis, lymphomas), an enlargement of the lymph nodes of a non-inflammatory nature also occurs.

Signs of enlargement and inflammation of the lymph nodes. How to determine enlarged lymph nodes yourself?

There are the following most important groups of lymph nodes that you should pay attention to if you suspect a pathology of the lymphatic system:
1. Occipital.
2. Parotid.
3. Cervical.
4. Submandibular.
5. Supraclavicular.
6. Axillary.
7. Elbows.
8. Inguinal.
9. Popliteal.

It is believed that normally the size of lymph nodes should not exceed 1 cm. The size of lymph nodes depends on their location and the individual characteristics of the body. It should be noted that most lymph nodes in normal condition cannot be palpated at all.

When diagnosing pathological enlargement of lymph nodes, other signs are also taken into account. Normal lymph nodes:
1. Absolutely painless on palpation.
2. They have a densely elastic consistency.
3. Movable (easily move when palpated).

With enlargement and inflammation, the lymph nodes often become painful and lumpy, lose elasticity, and in the case of a chronic process, they often unite into one conglomerate of irregular shape and become fused with the surrounding tissues.

In addition, in some cases, with inflammation and enlargement of the lymph nodes, the skin over them undergoes pathological changes: pain, swelling and hyperemia (redness) are observed.

It is quite possible to determine the described signs independently by palpation, however, to make a diagnosis, additional examination and consultation with a specialist is necessary.

Reasons

All reasons for enlarged lymph nodes can be divided into several large groups:
1. Infection.
2. Systemic autoimmune diseases (systemic lupus erythematosus, autoimmune thyroiditis, etc.).
3. Oncological pathology of lymphoid tissue (lymphogranulomatosis, lymphomas).
4. Oncological diseases of other organs and tissues (metastatic lesions of lymph nodes).

Thus, the list of diseases in which lymph node enlargement occurs is quite long, so that in case of suspected inflammation of the lymph nodes, it is often necessary to carry out a differential diagnosis with non-inflammatory enlargement (tumor metastases to the lymph nodes, lymphogranulomatosis, etc.).

Inflammation of the lymph nodes - symptoms, causes, complications and what to do? - video

How to determine inflammation of the lymph nodes? Pain, temperature and enlargement as symptoms of acute inflammation of the lymph nodes

Any inflammatory reaction is accompanied by tissue swelling - this is one of the obligatory signs of inflammation, known since the time of Hippocrates.

Thus, when the lymph nodes become inflamed, their size always increases. However, there are many pathologies that occur with regional or systemic enlargement of the lymph nodes, which are not accompanied by inflammation.

Therefore, when making a diagnosis, you have to take into account other signs that indicate this symptom. So, a mandatory sign of any inflammatory process is pain. Therefore, in case of acute inflammation, the lymph nodes are always painful to the touch. In addition, with severe inflammation, patients complain of pain in the affected lymph node, which intensifies with movement.

If inflammation of the lymph node develops acutely and violently, then the gate of infection can be easily detected - the source of inflammation from which, through the flow of lymphatic vessels, pathogenic microorganisms entered the affected node. This could be a wound on the surface of the skin, a sore throat, an inflammatory lesion of the external genitalia (vaginitis, balanitis), etc.

And finally, with acute inflammation of the lymph node, a general reaction of the body is observed:

• increased body temperature (sometimes to very high numbers);
• chills;
• headache;
• weakness;

However, in the case of subacute or chronic inflammation of the lymph nodes, pain and general reaction of the body may be absent. Moreover, recurrent inflammatory reactions (for example, chronic tonsillitis, accompanied by an increase in regional submandibular lymph nodes) lead to their irreversible degeneration. Such nodes are often palpated as absolutely painless formations of varying sizes (sometimes the size of a hazelnut).

Thus, the differential diagnosis of inflammatory and non-inflammatory lymph node enlargement can be very difficult.

Therefore, if the lymph nodes are inflamed, it is necessary to consult a doctor to undergo a thorough examination, identify the cause of their enlargement and promptly begin adequate therapy.

Nonspecific infections as a cause of enlargement and inflammation of the submandibular, cervical, axillary, elbow, inguinal, femoral, or popliteal lymph nodes: symptoms and treatment

Nonspecific infection, as one of the most common causes of pathology

Nonspecific infection is one of the most common causes of enlarged and inflamed lymph nodes. A nonspecific infection is a pathology caused by the so-called opportunistic microflora.

These are microorganisms that often inhabit the human body, usually without causing signs of disease. However, when favorable conditions arise (hypothermia, illness, stress, injury, etc.), opportunistic microflora begins to multiply intensively, which leads to the development of the disease.

Most often, nonspecific inflammation of the lymph nodes is caused by so-called pyogenic cocci:

• less often - E. coli;
• even less often - other opportunistic microorganisms.

A nonspecific infection in uncomplicated cases causes a regional rather than a general process - that is, there is an enlargement and inflammation of one or a group of nearby lymph nodes:

• submandibular;
• cervical;
• axillary;
• elbows;
• inguinal;
• femoral;
• popliteal

According to the nature of the course, acute and chronic inflammation of the lymph nodes caused by nonspecific flora is distinguished.

Infection during acute inflammation enters from a local focus (carbuncle, furuncle, open infected wound, felon, etc.) into the lymph node, and causes an acute reaction there, for which the following clinical and morphological classification exists:
1. Acute catarrhal lymphadenitis.
2. Acute purulent lymphadenitis.
3. Adenophlegmon.

These types of acute inflammation of the lymph nodes represent stages of a pathological process, which, with timely and adequate treatment, can be stopped at the stage of catarrhal lymphadenitis.

Chronic nonspecific inflammation of the lymph nodes, as a rule, occurs as a local complication of chronic foci of infection. Less commonly, it develops as a result of untreated acute catarrhal lymphadenitis.

The course of chronic inflammation of the lymph nodes is productive (connective tissue grows inside the lymph node), so that over time, the enlargement of the affected lymph node is replaced by its degenerative shrinkage. In this case, suppuration occurs extremely rarely.

What does acute purulent inflammation of the lymph nodes look like?

Acute catarrhal inflammation begins with moderate pain in enlarged and inflamed lymph nodes. The general reaction of the body is not expressed sharply. There may be a slight low-grade fever (temperature rise to 37 - 37.5 degrees), weakness, and fatigue. The skin over the inflamed lymph nodes is without pathological changes.

If the patient does not receive adequate treatment, the catarrhal process can turn purulent. Purulent lymphadenitis is characterized by sharp pain in the affected area, which intensifies with movement. Palpation of the lymph nodes is extremely painful; a dense infiltrate is felt in the affected area, consisting of inflamed nodes and edematous surrounding tissues. Redness and swelling appear above the inflamed formations. The general reaction of the body intensifies: the temperature rises to febrile levels (38-39), patients complain of increasing weakness and headache.

Then, in the center of the infiltrate, a purulent melting of tissue forms, which is palpated in the form of a softening focus. With further development, adenophlegmon is formed - diffuse purulent inflammation of the tissues surrounding the affected lymph node. The patient's condition worsens: movements in the affected part of the body are severely difficult due to pain, fever with chills increases, heart rate increases, blood pressure may decrease, headache intensifies, nausea and dizziness appear.

Consequences

Adequate treatment of acute purulent inflammation of the lymph nodes, as a rule, leads to complete recovery without any consequences for the body. Melting of a purulent focus is an indication for emergency surgical intervention, since generalization of the infection is possible with the appearance of purulent foci in distant organs and tissues.

In addition, if acute inflammation of the lymph nodes is not treated in a timely manner, there is a risk of developing purulent thrombophlebitis (purulent inflammation of the veins of the affected part of the body), which, in turn, can be complicated by pulmonary embolism (clogging of the pulmonary vessels with fragments of blood clots and/or fragments of pus entering the bloodstream ) or sepsis.

How to treat?

In cases where it is possible to find the primary source of infection, its sanitation is carried out (opening the abscess, treating an infected wound, etc.).

Most often, acute inflammation of the lymph node occurs on the extremities. In such cases, immobilization (immobilization) of the affected arm or leg is performed. This measure prevents the spread of infection and alleviates the general condition of the patient.

At the stage of catarrhal inflammation, conservative treatment is carried out. Antibiotic therapy is indicated, taking into account the sensitivity of microflora to antibiotics, dry heat (compresses, UHF, etc.).

In case of purulent melting of the lymph node and lymphophlegmon, the resulting abscess is opened, followed by drainage of the cavity.

Long-term painless enlargement of lymph nodes in chronic inflammation caused by nonspecific microflora

In case of chronic inflammation of the lymph nodes caused by nonspecific microflora, the only clinical symptom may be their enlargement, which is usually detected by a doctor during an examination for the underlying disease:

• chronic tonsillitis;
• pharyngitis;
• trophic ulcer of the leg;
• chronic inflammatory diseases of the external genitalia, etc.

If you discover enlarged lymph nodes on your own and suspect its connection with a source of chronic infection, you should consult a doctor. Since clinical data for chronic inflammation of the lymph nodes are quite scarce, an examination is prescribed to exclude other diseases that occur with enlarged lymph nodes.

How to cure?

Treatment of chronic inflammation of the lymph nodes consists, first of all, in sanitation of the source of chronic infection that caused the inflammation.

Antibiotics are prescribed. At the same time, samples are taken from the source of infection to determine the sensitivity of microorganisms to drugs (nonspecific microflora is often resistant to many antibacterial agents).

In addition, they carry out activities that strengthen the body's defenses: vitamin therapy, general tonics, herbal medicine, spa treatment, etc.

Is chronic enlargement and inflammation of lymph nodes caused by nonspecific microflora dangerous?

Chronic inflammation of the lymph nodes caused by nonspecific microflora indicates a decrease in the body's defenses. This condition in itself poses a threat to the patient's health.

Long-term chronic inflammation of the lymph nodes leads to their degeneration. Sometimes, as a result of the proliferation of connective tissue, lymph drainage is disrupted in the affected lymph node and lymphostasis develops, which is clinically manifested by chronic swelling and trophic disorders in the affected area of ​​the body.

In severe cases of chronic lymphostasis, elephantiasis develops - a pathological proliferation of connective tissue, leading to significant enlargement and disfigurement of the affected area of ​​the body. Most often, elephantiasis is observed on the lower extremities, which in such cases visually resemble the legs of an elephant - hence the name.

Specific infections as a cause of enlargement and inflammation
lymph nodes

Tuberculosis

Symptoms of enlargement and inflammation of intrathoracic lymph nodes
Tuberculosis of the intrathoracic lymph nodes is a form of primary tuberculosis (a disease that develops immediately after infection), in which the intrathoracic lymph nodes become enlarged and inflamed, while the lung tissue remains intact.

This is the most common form of primary tuberculosis (about 80% of all cases). This increased incidence is associated with vaccination against the disease. That is why tuberculosis of the intrathoracic lymph nodes is more common in children, adolescents and young people, when artificial immunity is still quite strong.

Symptoms of tuberculous inflammation of the intrathoracic lymph nodes depend on the degree of their enlargement, the localization of the process and its prevalence.

A common process is manifested by a severe whooping cough, worsening at night. At first the cough is dry, then sputum appears. In addition, signs of tuberculosis intoxication are characteristic: weakness, lethargy, fever (sometimes up to high numbers), night sweats, irritability.

In minor forms, which are more often observed in vaccinated children, the disease is practically asymptomatic and is detected only during routine examinations.

Enlargement and inflammation of the lymph nodes in the lungs
When infected with tuberculosis, the so-called primary tuberculosis complex often forms in the lung tissue - inflammation of an area of ​​the lung tissue, combined with lymphangitis (inflammation of the lymphatic vessel) and lymphadenitis.

It should be noted that in many cases, the primary tuberculosis complex is asymptomatic and is often not diagnosed - at this stage self-healing is possible (resorption or calcification of the lesion).

In addition to enlargement and inflammation of the lymph nodes in the lungs, during primary infection, a reactive enlargement of the superficial lymph nodes (reaction to infection) often occurs, which has important diagnostic value.

If the course of the disease is unfavorable, further spread of the infection occurs. In this case, the lung tissue is affected and other nodes become enlarged and inflamed.

Signs of enlargement and inflammation of the lymph nodes are detected radiographically, but clinical manifestations depend on the location and degree of their enlargement. Thus, when the airways are compressed, an obsessive dry cough is possible, and when the trachea is partially blocked, noisy breathing occurs.

The clinical picture of tuberculous lymphadenitis, as a rule, develops against the background of severe intoxication and symptoms of lung damage (cough, shortness of breath, chest pain).

Enlargement and inflammation of the submandibular, cervical, axillary, inguinal and ulnar lymph nodes
Infectious and inflammatory lesions of superficial lymph nodes in tuberculosis develop when the infection spreads throughout the body some time after the initial infection.

Most often, enlargement and inflammation of the submandibular and cervical lymph nodes occur. At the initial stage of the process, symptoms of tuberculosis intoxication are observed, as well as pain in the area of ​​the affected nodes, which during this period are palpable as mobile elastic formations.

Subsequently, the lymph nodes fuse together and with surrounding tissues, and then suppuration occurs with the formation of an external long-term non-healing fistula.

In addition to the formation of fistulas and abscesses, enlargement and inflammation of the superficial lymph nodes during tuberculosis can lead to bleeding (when the vessel wall is infiltrated) and to the generalization of the process.

Symptoms of enlargement and inflammation of the lymph nodes in the abdominal cavity (mesenteric lymph nodes) with abdominal tuberculosis
Abdominal tuberculosis is a fairly rare form of tuberculosis that affects the abdominal organs. As a rule, abdominal tuberculosis occurs with mesadenitis - enlargement and inflammation of the lymph nodes of the abdominal cavity.

There are acute and chronic courses of tuberculous mesadenitis. In the acute form, patients complain of severe abdominal pain, which, as a rule, is localized along the intestinal mesentery, to which the inflamed lymph nodes are attached: in the navel, in the left hypochondrium and in the right iliac region (to the right and below the navel). A characteristic symptom is shifting pain when the patient turns to the left side.

Chronic mesadenitis occurs with remissions and exacerbations, and can manifest itself as attacks of intestinal colic or constant dull aching pain. Patients often complain of bloating, which increases in the evening.

A serious complication of chronic enlargement and inflammation of the lymph nodes of the abdominal cavity is the formation of bedsores of the neurovascular bundle due to prolonged pressure from calcified nodes.

Enlargement and inflammation of the inguinal, mandibular and mental lymph nodes in primary syphilis

Primary syphilis, as a rule, develops approximately a month after infection (cases of the development of the disease 6 days and 6 months after contact with the infection have been described). In this case, at the site of penetration of Treponema pallidum (the causative agent of the disease), a so-called chancre appears - an ulcer on a compacted base.

A few days after the appearance of hard chancre, enlargement and inflammation of the nearest lymph nodes develop. Since infection most often occurs during sexual intercourse and kissing, the inguinal lymph nodes are most often affected (if the chancre is located on the genitals), as well as the mandibular or chin (if the primary ulcer is located on the lips or in the oral cavity).

Enlargement of the inguinal and mandibular lymph nodes is usually bilateral, up to the size of a hazelnut or bean. At the same time, the affected nodes retain a hard-elastic consistency, are mobile and absolutely painless. Often, concomitant lymphangitis develops - inflammation of the lymphatic vessel leading to the enlarged node. The inflamed lymphatic vessel is palpable in the form of a hard thin cord, sometimes with distinct thickenings.

Much less commonly, a primary ulcer occurs on the fingers (possible infection through damaged skin if hygiene rules are not followed during the examination) or on the body (most often due to bites). In such cases, the corresponding regional lymph nodes become inflamed.

The duration of primary syphilis is about 12 weeks. All its manifestations are painless and disappear on their own, without treatment. Rarely (when the body is weakened and hygiene rules are violated), a secondary infection occurs and inflammation of the chancre occurs. In such cases, the development of purulent lymphadenitis is possible.

Enlargement and inflammation of the occipital, cervical, parotid, popliteal and axillary lymph nodes as an important diagnostic sign of rubella

Enlargement and inflammation of the lymph nodes with rubella occurs in the first hours of the disease, when there is no rash yet, and therefore is an important diagnostic sign of this disease.

Most often with rubella, enlargement and inflammation of the occipital, posterior cervical and parotid lymph nodes occur. In this case, patients complain of neck pain, which increases with head movements.

Palpation reveals a painful enlargement of the lymph nodes (usually to the size of a bean), while their elastic consistency and mobility are preserved.

Chickenpox

Enlargement and inflammation of the lymph nodes with chickenpox develops at the height of the characteristic rashes (vesicles on the skin and mucous membranes filled with serous fluid), and has no independent diagnostic value.

It should be noted that this symptom does not develop in all cases, and in adult patients, as a rule, it indicates the severity of the disease.

HIV

Generalized enlargement of lymph nodes is a frequent companion to the subclinical stage of HIV. This stage of the disease occurs after a short manifest flu-like period, which not all patients notice.

Apart from enlarged lymph nodes, no other manifestations are noted at this time, although laboratory tests can already detect the disease. That is why clinicians often call this stage the stage of generalized lymphadenopathy.

The most commonly affected are the cervical, occipital and axillary lymph nodes. It is believed that the enlargement of two or more groups of extra-inguinal lymph nodes (size more than 1 cm) for more than three months should raise suspicion of HIV.

Of course, generalized enlargement of lymph nodes occurs in many diseases, so this sign cannot be considered an absolute marker of HIV, therefore further examination is necessary for a correct diagnosis.

Enlargement and inflammation of the lymph nodes is a constant sign of the advanced clinical stage of AIDS. It should be noted that during this period, lymphadenopathy can be caused by both HIV and infectious complications that develop at this stage of the disease.

What is the danger of enlarged and inflamed lymph nodes during specific infections?

Enlargement and inflammation of the lymph nodes during specific infections is, first of all, of important diagnostic value. The danger here depends on the cause of the disease. Therefore, specific treatment of an infectious disease (tuberculosis, syphilis, HIV, etc.) is necessary. In addition, precautions should be taken so as not to endanger others, including family and friends.

Causes of enlargement and inflammation of lymph nodes in children

In children, enlargement and inflammation of the lymph nodes is much more common than in adults. First of all, this is due to physiological reasons: the child’s body reacts more violently to infection.

In addition, some infections that cause enlargement and inflammation of the lymph nodes develop mainly in children (rubella, chickenpox, measles).

The cause of non-inflammatory lymph node enlargement at an early age can be severe hematological diseases (acute leukemia, lymphoma, lymphogranulomatosis, congenital blood pathology).

But cancerous lesions of the skin, gastrointestinal tract, and mammary gland, which can metastasize to the lymph nodes, are practically never found in children.

Answers to the most popular questions

What are the causes of enlarged and inflamed lymph nodes in the groin in men and women?

The inguinal lymph nodes receive intercellular fluid from the lower abdominal wall, external genitalia, perineum, gluteal region and extremities. Any purulent focus in this area can cause enlargement and inflammation of the lymph nodes (boil of the buttock, purulent wound of the limb, etc.).

However, the most common cause of enlargement and inflammation of the lymph nodes in the groin is inflammatory processes of the external genital organs (vaginitis in women, balanitis in men), which can be caused by both specific (gonorrhea, syphilis, chancroid, genital herpes) and nonspecific microflora (with colds and violation of personal hygiene rules).

When making a diagnosis, the possibility of non-inflammatory lymph node enlargement should be taken into account. It is necessary to exclude their metastatic damage during the tumor process in the pelvic organs, as well as malignant transformation of lymphoid tissue (lymphoma).

When does enlargement and inflammation of the lymph nodes under the arms develop in women?

Enlargement and inflammation of the lymph nodes under the armpits in women most often develops with pathology of the mammary glands. In this case, the increase can be of both inflammatory (complication of mastitis) and tumor genesis (breast cancer metastases).

In addition, enlargement and inflammation of the axillary lymph nodes in women may be a consequence of the presence of silicone implants.

And finally, in women, as well as in men, enlargement and inflammation of the lymph nodes under the armpits develops with tumors (melanoma) and infectious diseases of the external skin of the upper extremities and chest (infected wounds, ulcers, cat scratch disease, etc.).

A differential diagnosis with lymphoma is routinely performed.

What could be the reasons for enlarged and inflamed lymph nodes in the neck?

The lymph nodes located on the front surface of the neck receive lymph from the eyelids, conjunctiva, temporal surface of the head, and external auditory canal. Enlargement and inflammation of the nodes on the front of the neck, as a rule, indicate the presence of an infectious process in these areas.

Differential diagnosis of enlargement and inflammation of the lymph nodes located in the back of the neck is much more difficult. In addition to a banal infection, such lymphadenitis may indicate rubella or tuberculosis.

In addition, the possibility of developing lymphoma and metastatic lesions of the lymph nodes in malignant neoplasms of the head and neck should be taken into account.

Which doctor should I contact?

If you suspect enlarged and inflamed lymph nodes, consult a general practitioner (general practitioner, pediatrician or family doctor). He will conduct an additional examination and, if necessary, refer you to a specialist doctor (surgeon, oncologist, infectious diseases specialist, rheumatologist, hematologist, etc.).

I'm expecting a baby (fourth month of pregnancy). I recently caught a cold, a severe sore throat, and a fever. Today I noticed enlargement and inflammation of the lymph nodes under the jaw. How dangerous is it during pregnancy?

Judging by your symptoms, you most likely have acute pharyngitis (inflammation of the pharynx), complicated by enlargement and inflammation of regional lymph nodes.

This condition, in itself, does not pose a danger to pregnancy, however, it is necessary to urgently seek medical help and undergo a course of treatment, since with untimely or inadequate treatment, complications may develop - such as, for example, suppuration of the lymph node or the development of streptococcal glomerulonephritis.

Complications of this kind can threaten pregnancy, and it will be much more difficult to cure them without harm to the child.

What tests are prescribed?

The examination program for enlarged and inflamed lymph nodes depends on factors such as:

• type of course (acute or chronic inflammation);
• prevalence (generalized or regional enlargement of lymph nodes);
• the presence of other symptoms of lymph node pathology (pain on palpation, loss of consistency, adhesion to surrounding tissues, etc.);
• the presence of specific signs that allow one to suspect a specific pathology (characteristic intoxication syndrome in tuberculosis, chancroid in syphilis, rash in measles, focus of infection in acute inflammation of the lymph node, etc.).

There is a general examination program, including standard tests (general and biochemical blood tests, general urinalysis). If necessary, it can be supplemented with other studies (chest x-ray if tuberculosis or lymphogranulomatosis is suspected, serological tests for syphilis or HIV, lymph node puncture if metastatic lesion or lymphoma is suspected, etc.).

What antibiotic is prescribed for enlarged and inflamed lymph nodes?

The choice of antibiotic for enlarged and inflamed lymph nodes is determined by the causative agent of the disease. In case of an infectious-inflammatory process caused by a specific microflora (tuberculosis, syphilis, etc.), treatment is prescribed according to developed regimens.

In case of nonspecific inflammation, it is recommended to test the sensitivity of the pathogen to antibiotics. The fact is that many strains (varieties) of opportunistic microorganisms (especially staphylococci) develop resistance to antibiotics.

The sample is easy to take if there is a gate of infection (infected wound, boil, acute tonsillitis, etc.). In the absence of an open source of infection (healed wound), and before receiving the test results, antibiotics that have proven their effectiveness against nonspecific microflora are prescribed.

In cases where the antibiotic does not have the desired effect (there are no signs of clinical improvement), another medication is prescribed. Of course, all medications for enlarged and inflamed lymph nodes are prescribed by a doctor, taking into account contraindications.

Is it possible to apply compresses?

Compresses for enlarged and inflamed lymph nodes are used in the complex treatment of the initial stage of acute lymphadenitis. In case of suppuration, they are strictly contraindicated, since they contribute to the spread of infection throughout the body.

An absolute contraindication to this type of procedure is malignant neoplasms (metastases to the lymph node, lymphoma), so if the lymph nodes are enlarged and inflamed, you should never self-medicate.

Treatment of enlarged and inflamed lymph nodes using compresses is carried out on the recommendation and under the supervision of a doctor.

Is ichthyol ointment and Vishnevsky ointment used for enlargement and inflammation?
lymph nodes?

Vishnevsky ointment has pronounced antiseptic properties (destroys microorganisms) and has a mild irritant effect on receptors, helping to increase the speed of regeneration processes.

The drug is used in combination with other medical measures in the treatment of enlargement and inflammation of the lymph nodes in cases where the cause of the pathology is the existence of long-term non-healing wounds, abrasions, trophic ulcers or bedsores. The ointment is applied to the affected surfaces that have become the gateway to infection. In the case of chronic inflammation, therapy of the primary lesion is essentially a treatment of lymphadenopathy.

Ichthyol ointment is a rather weak antiseptic, but has a pronounced anti-inflammatory and soothing effect, so it is often used for local treatment in the initial stage of acute enlargement and inflammation of the lymph nodes caused by a nonspecific infection.

Local treatment is necessarily supplemented with antibiotic therapy; drugs and dosage regimens are prescribed by the doctor after an examination.

The child has symptoms of enlargement and inflammation of the lymph nodes behind the ear. Which doctor should I contact? Are there any traditional treatments?

Enlargement and inflammation of the lymph nodes behind the ear is one of the important diagnostic signs of rubella, so it is best to immediately contact an infectious disease specialist.

Of course, this is not the only possible diagnosis. The parotid lymph nodes receive tissue fluid from the temporal region of the head, the auricle and the external auditory canal, so enlargement and inflammation of the lymph node behind the ear may indicate infections of the scalp (boils, wounds) or acute or chronic inflammation of the external auditory canal (this pathology occurs quite often in children).

Thymus cysts

Cysts can be localized in the neck, in the mediastinum, or have a cervical-mediastinal localization.

These are thin-walled single-chamber or multi-chamber formations. They can contain up to 1 - 2 liters of liquid. They are most often localized in the anterior mediastinum, partly in the neck area. Sometimes only in the neck area. The clinic does not have typical features. If they reach large sizes, they compress neighboring organs, and patients complain of chest pain and shortness of breath. Small cysts may not be clinically apparent.

During X-ray examination pay attention to the localization, change in the shape of the shadow when changing position; when breathing, one can suggest the presence of a thin-walled thymus cyst.

Lymph nodes of the mediastinum (according to Zhdanov)

I. Group visceral:

1. Paratracheal.

2. Tracheobronchial.

3. Bifurcation.

4. Bronchopulmonary.

5. Mediastinal:

A. anterior (near the mediastinal organs),

B. posterior (on the border of the upper and middle third of the esophagus)

II. Group parietal:

1. Parietal-retrosternal (for breast cancer).

2. Parietal-prevertebral.

3. Parietal-phrenic anterior and posterior.

In systemic diseases, the lymph nodes of the entire visceral group are affected.

Signs of enlarged lymph nodes:

1. Expansion of the mediastinum (can be symmetrical, asymmetrical as in lymphogranulomatosis, more on the right).

2. Polycyclicity of circuits.

3. Backstage symptom.

Diseases that occur with enlarged lymph nodes:

I. Group of diseases - systemic:

· Lymphosarcoma.

· Hodgkin's lymphoma.

· Lymphoadenosis.

(for diseases of the reticuloendothelial system)

· Beck's sarcoidosis.

II. Group. Specific diseases:

· Tuberculous bronchoadenitis.

· Metastases to lymph nodes.

III. Group. Nonspecific diseases:

· Inflammatory hyperplasia of lymph nodes.

IV. Group. Occupational diseases:

· Pneumoconiosis.

Hodgkin's disease (lymphogranulomatosis, malignant granuloma) is a large group of primary tumors of the lymphatic system (lymphomas), which are local lesions limited to one area or one organ, or have a generalized nature, spreading to the entire lymphatic system, bone marrow, spleen, liver and other organs. Lymphomas are tumors of the immune system and usually arise from the tissue of the lymph nodes. Lymphomas account for about 4% of all newly diagnosed malignant tumors. Hodgkin's lymphoma accounts for about 40% of all lymphomas. In the Russian Federation, the absolute number of patients diagnosed with LM in 2001 was 1607 men and 1603 women.

Hodgkin's disease can affect people of any age, but most often between 20 and 40 years of age. The disease occurs with tumor-like growths of the lymph nodes, is characterized by an undulating course and intoxication, fever, sweating, itching of the skin and gradually increasing cachexia. 65–70% of initially diagnosed patients with Hodgkin lymphoma have damage to the chest organs. The mediastinum is involved in the process in 90% of patients. Isolated mediastinal damage is observed in 25% of patients.

According to the WHO classification of lymphoid neoplasia, there are 4 classic variants of Hodgkin lymphoma:

1. Nodular sclerosis.

2. Classic Hodgkin's disease (rich in lymphocytes).

3. Mixed-cell variant.

4. Lymphoid depletion.

Hodgkin's disease tends to spread to adjacent groups of lymph nodes. The cure rate for patients with Hodgkin's lymphoma is 75–80% for all stages. There is a direct relationship between stage and prognosis. 98% of patients with stages 1 - 2 of LGM without mediastinal involvement have a 5-year survival rate (more than 5 years - 78%), and 88% of patients with damage to the mediastinal lymph nodes have a 5-year survival rate (more than 5 years - 66%). Patients with stage 3 disease have only a 75% 5-year survival rate. Survival of Hodgkin's disease is associated with early and adequate treatment. The main treatment is radiation therapy and chemotherapy treatment.

Primary lymphogranulomatosis of the lung is extremely rare. Lung damage during LGM is usually secondary. It is a consequence of the transition from the lymph nodes of the mediastinum to the lungs. According to A.I. Abrikosov (1947), this transition can occur in different ways:

I. The process spreads from the lymph nodes “by contact” to the lung or generally through the mediastinal pleura.

II. The process can go from the bronchial lymph glands deep into the lung along the bronchi, i.e. peribronchial, sometimes breaks into the bronchus and then intrabronchially. These cases are characterized by growth that goes from the roots deep into the lung along the bronchial tree in the form of strands, forming several nodes of the lobular, confluent type, usually in the lower lobe.

III. Lymphogenous retrograde spread from the roots of the lung and gives nodular forms or diffuse infiltration of the lung tissue.

IV. Hematogenous spread, when miliary dissemination appears in both lungs, reminiscent of miliary pulmonary tuberculosis.

According to L.S. Rosenstrauch distinguishes the following types of lymphogranulomatosis:

1. Mediastinal.

2. Mediastinal-pulmonary.

3. Pulmonary.

4. Mediastinal-pulmonary-pleural.

5. Pleural.

The main methods for diagnosing lung damage in lymphoma are traditional X-ray examination and CT. If there are changes in radiographs, a CT scan is performed to clarify the diagnosis, extent of the lesion and clarify the stage of the process.

X-ray picture. The disease begins with damage to the cervical and subclavian lymph nodes. In the mediastinum, the anterior mediastinal and anterior paratracheal, tracheobronchial lymph nodes are affected. Therefore, the shadow is localized in the upper and middle part of the mediastinum and occupies the upper half of the mediastinum, and also extends to the entire length of the anterior mediastinum. The lesion can be bilateral, less often – unilateral. In the initial stages, it often produces a chain of rounded shadows along the right contour of the trachea. Often there is an isolated lesion of one or two lymph nodes in the mediastinum. The shadow in this case has a regular oval shape, and it is very difficult to differentiate it from other diseases.

A pathological shadow caused by enlarged lymph nodes is usually located in the anterior mediastinum, and the localization of a pathological shadow in the posterior mediastinum is more likely to speak against lymphogranulomatosis. However, with a sharp increase in lymph nodes, the latter can reach the posterior mediastinum. The nature of the shadow contour is determined by the number of affected lymph nodes and their relationship to neighboring organs. With expansive growth, the contours of the nodes are clear. If enlarged nodes are located at different depths, then the “backstage” symptom appears. If there is a whole conglomerate of mediastinal lymph nodes, then they can push back the mediastinal pleura, and the mediastinum has the appearance of a “pipe”. The trachea and esophagus are displaced posteriorly.

The mediastinal shadow becomes visible on the contour of the tube. This is due to enlarged lymph nodes and tension of the mediastinal pleura. On the contour of the mediastinum there may be polycyclic contours (due to the lymph nodes), the contours may be unclear, stringy - this is due to the germination of the mediastinal pleura, uneven enlargement of the lymph nodes. With enlargement of the paravasal and paratracheal lymph nodes, there is unevenness of the contours of the heart and blood vessels and their expansion. In the lateral projection there is a narrowing and darkening of the retrosternal space, since with lymphogranulomatosis the enlargement of the lymph nodes located in front of the trachea predominates. This is a distinguishing feature from cancer and sarcoidosis. Lymph nodes on tomograms are not differentiated from each other; they merge and form a conglomerate.

Enlarged lymph nodes cause displacement of the esophagus and narrowing of the trachea.

With enlargement of the basal lymph nodes, there may be a paradoxical movement of the dome of the diaphragm and its relaxation.

Often the picture resembles mediastinal cancer - unilateral expansion of the mediastinum. A lateral radiograph helps in diagnosis - enlarged lymph nodes anterior to the trachea. With central cancer, the lymph nodes around the trachea are enlarged and hypoventilation is noted.

Hodgkin's lymphoma can spread to lung tissue. This is most often observed in young people and in children between 7 months and 3 years after detection of enlarged mediastinal lymph nodes. The process is progressing. Spread to lung tissue may be due to ingrowth through the mediastinal pleura. At the same time, on radiographs the shadow of an expanded vascular bundle is visible, which does not have clear boundaries, and in the form of rough strands, transversely located and growing into the lung tissue. These strands narrow towards the periphery and are lost against the background of the transparent lung. Strands and linear shadows also extend from the roots of the lungs, which are a reflection of lymphogranulomatous muffs covering the bronchi and vessels.

In the lungs, rounded shadows of 3–5 cm with clear and fuzzy contours appear - granulomas. They can retain clear contours for a long time and resemble metastases. But unlike metastases, there are few of them, they are located far from each other, the lesion can be unilateral or bilateral. Shadows can merge into large infiltrates, which are complicated by decay. There may be small focal shadows located in the lower parts of the lungs against the background of dense interstitial tissue and resemble miliary carcinomatosis.

Large infiltrates may occur in the lungs. The granuloma grows into the alveoli with the organization of fibrous effusion, and resembles pneumonia. May occupy a segment or share. The contours of the shadow are often unclear. Single nodular formations of lymphogranulomatosis can be localized in any part of the lung, and if there are no enlarged lymph nodes in the root and mediastinum, it is difficult to make a diagnosis, and a diagnosis is made peripheral cancer.

Often, along with changes in the lungs, an inexhaustible effusion appears in the pleural cavity. Sometimes dry pleurisy is observed, which leads to complete obliteration of the pleural cavity.

The isolated pleural form of lymphogranulomatosis is rare. It manifests itself as thickening of the pleura and accumulation of exudate.

Complications of Hodgkin's lymphoma

1. Atelectasis as a result of compression and germination of the walls of the bronchi.

2. Decay – in the terminal stage.

3. Pneumonia.

4. Esophageal-bronchial fistulas.

Metastasis is the most important characteristic of any malignant tumor. This process is associated with the progression of the disease, which often ends in the death of the patient. When the lymphatic system is affected by carcinoma of another organ, the average person can designate this phenomenon as “cancer of the lymph nodes”; from a medical point of view, this is, that is, a secondary lesion.

Malignant tumor cells have a number of differences from healthy ones, including not only a local destructive effect in a tissue or organ, but also the ability to separate from each other and spread throughout the body. The loss of specific protein molecules that provide a strong connection between cells (adhesion molecules) leads to the separation of the malignant clone from the primary tumor and its penetration into the blood vessels.

Epithelial tumors, that is, metastasize predominantly by the lymphogenous route, through lymphatic vessels that carry lymph away from the organ. Sarcomas (connective tissue neoplasms) can also affect lymph nodes, although the predominant route of metastasis for them is hematogenous.

Along the path of lymph flow, nature provides “filters” that retain everything “extra” - microorganisms, antibodies, destroyed cellular fragments. Tumor cells also fall into such a filter, but they are not neutralized, and instead the malignant clone begins to actively divide, giving rise to a new tumor.

metastasis

Initially, signs of secondary tumor lesions are found in regional lymph nodes, that is, those that are closest to the organ affected by the tumor and which are the first to encounter lymph carrying carcinomatous elements. With further progression of the disease, metastases spread further, capturing more distant lymphatic groups. In some cases, lymph nodes located in another part of the body are affected, which indicates an advanced stage of the tumor and an extremely unfavorable prognosis.

Enlargement of lymph nodes in cancer is a consequence of the proliferation of tumor cells in them, which displace healthy tissue, filling the lymph node. Inevitably, lymphatic drainage becomes difficult.

According to the histological structure, metastases usually correspond to the primary tumor, but the degree of differentiation in some cases is lower, so the secondary lymph node cancer grows faster and more aggressively. There are often cases when the primary tumor manifests itself only as metastases, and the search for their source does not always bring results. Such a defeat is referred to as cancer metastasis from an unknown source.

Having all the features of malignancy, cancer (metastasis) in the lymph node poisons the body with metabolic products, increases intoxication, and causes pain.

Any malignant tumor sooner or later begins to metastasize; when this happens depends on a number of factors:

• Age – the older the patient, the earlier metastases appear;
• Concomitant diseases in a chronic form, weakening the body's defenses, immunodeficiencies - contribute to more aggressive tumor growth and early metastasis;
• Stage and degree of differentiation - large tumors that grow into the wall of the organ and damage blood vessels metastasize more actively; The lower the degree of cancer differentiation, the earlier and faster the metastases spread.

Not every tumor cell that enters a lymph node will divide and metastasize. With good immunity, this may not happen or will happen after a long period of time.

In the diagnosis, an indication of metastatic disease of the lymph nodes is indicated by the letter N: N0 – lymph nodes are not affected, N1-2 – metastases in regional (nearby) lymph nodes, N3 – distant metastasis, when lymph nodes are affected at a considerable distance from the primary tumor, which corresponds to severe, fourth stage of cancer.

Manifestations of lymphogenous metastasis

Symptoms of lymph node cancer depend on the stage of the disease. Usually the first sign is their increase. If superficial lymph nodes are affected, they can be palpated in the form of enlarged single nodules or conglomerates, which are not always painful.

Such metastases to the lymph nodes are easily determined in the axillary region in case of breast cancer, in the groin in case of tumors of the genital tract, in the neck in case of diseases of the larynx, oral cavity, above and below the collarbone in case of stomach cancer.

If the tumor affects an internal organ, and metastasis occurs in the lymph nodes lying deep in the body, then detecting their enlargement is not so easy. For example, enlarged lymph nodes of the mesentery with intestinal cancer, the porta hepatis with hepatocellular carcinoma, the lesser and greater curvature of the stomach with tumors of this organ are inaccessible to palpation, and additional examination methods come to the aid of the doctor - ultrasound, CT, MRI.

Large groups of metastatic lymph nodes inside the body may manifest symptoms of compression of the organs or vessels next to which they are located. With enlarged mediastinal lymph nodes, shortness of breath, heart rhythm disturbances and chest pain are possible; mesenteric enlarged lymphatic collectors contribute to pain and bloating, and indigestion.

When the portal vein is compressed, portal hypertension will occur - the liver and spleen will enlarge, and fluid will accumulate in the abdominal cavity (ascites). Signs of difficulty in the outflow of blood through the superior vena cava - swelling of the face, cyanosis - may indicate that the lymph nodes are affected by cancer.

Against the background of metastasis, the patient’s general condition also changes: weakness and weight loss increase, anemia progresses, fever becomes constant, and the emotional background is disturbed. These symptoms indicate increased intoxication, which is largely facilitated by the growth of cancer in the lymph nodes.

Lymphogenous metastasis in certain types of cancer

The most common types of cancer are carcinomas of the stomach, breast in women, lungs, and genital tract. These tumors tend to metastasize to the lymph nodes, and the routes of spread of cancer cells and the sequence of damage to the lymphatic system are quite well studied.

At the first metastases can be detected in the axillary lymph nodes already in the second stage of the disease, and in the fourth they are present in distant organs. Lymphogenic spread begins early and often the reason for searching for a tumor is not a palpable formation in the chest, but enlarged lymph nodes in the axillary region.

Breast cancer is manifested by damage to several groups of lymph nodes - axillary, peri-sternal, supraclavicular and subclavian. If carcinoma grows in the outer parts of the gland, then it is logical to expect cancer metastases in the lymph nodes armpit, damage to the internal segments leads to the entry of cancer cells into the lymph nodes along the sternum. Distant metastasis will be considered to be metastasis to the specified groups of lymph nodes on the side opposite to the tumor, as well as damage to the nodes of the mediastinum, abdominal cavity, and neck.

At groups of regional lymph nodes affected first and distant ones involved in advanced stages have been identified. Regional are considered paratracheal, bifurcation, peribronchial lymph nodes located near the bronchi and trachea, distant - supra- and subclavian, mediastinal, cervical.

In the lungs, lymphogenous spread of cancer occurs early and quickly, this is facilitated by a well-developed network of lymphatic vessels necessary for the proper functioning of the organ. Central cancer growing from large bronchi is especially prone to such dissemination.

At metastases in the lymph nodes may have a peculiar location. The nodes along the greater and lesser curvature and antrum are the first to be affected, then the cells reach the celiac lymph nodes (second stage); gastric cancer can be detected in the lymph nodes along the aorta and portal vein of the liver.

Peculiar types of lymphogenous metastases of stomach cancer are named after the researchers who described them or first encountered them. Virchow's metastasis affects the left supraclavicular lymph nodes, Schnitzler's - the tissue of the rectal region, Krukenberg's - the ovaries, Irish's - the lymph nodes of the armpit. These metastases indicate distant dissemination of the tumor and a severe stage of the disease, when radical treatment is impossible or no longer practical.

Lymph nodes in the neck are affected by tumors of the fundus, gums, palate, jaws, and salivary glands. The pathological process involves the submandibular, cervical, and occipital groups of lymph nodes. Distant metastasis to the cervical lymph nodes is possible with carcinomas of the breast, lungs, and stomach. For cancer located in the face or oral cavity, lymphatic spread occurs quickly, which is associated with excellent lymph supply to this area.

In addition to metastases, in the lymph nodes of the neck primary tumors can form - lymphogranulomatosis, which the average person would also call cervical lymph node cancer. In some cases, determining whether the primary tumor or metastasis has affected the nodes in the neck is only possible with additional examination, including a biopsy.

Lymph nodes in the neck tend to enlarge not only with metastases. Probably, each of us can find at least one enlarged nodule under the lower jaw or between the neck muscles, but this does not necessarily indicate cancer. There is no need to panic, although it won’t hurt to find the reason.

Cervical and submandibular lymph nodes collect lymph from the oral cavity, larynx, pharynx, jaws, which very often have inflammatory changes. All kinds of tonsillitis, stomatitis, caries are accompanied by chronic inflammation, so it is not surprising that the regional lymph nodes are enlarged. In addition, the area of ​​the mouth and upper respiratory tract is constantly encountered with various microorganisms, which enter with the lymph flow and are neutralized in the lymph nodes. Such increased work can also lead to lymphadenopathy.

Diagnosis and treatment of metastases to lymph nodes

Diagnosis of metastases in the lymph nodes is based on their palpation, if possible. If there is a suspicion of damage to the axillary or cervical inguinal lymph nodes, the doctor will be able to palpate them along their entire length; in some cases, palpation of internal lymph nodes - celiac, mesenteric - is possible.

Ultrasound of neck vessels

To confirm metastatic lesions, additional examination methods are used:

• Ultrasound– is especially informative when there is an increase in lymphatic collectors located inside the body - near the stomach, intestines, at the gates of the liver, and in the retroperitoneal space, in the chest cavity;
• CT, MRI– allow you to determine the number, size and exact location of the changed lymph nodes;
• Puncture and biopsy– the most informative methods that allow you to see cancer cells in a lymph node; with a biopsy, it becomes possible to guess the source, clarify the type and degree of differentiation of cancer.

lymph node biopsy

Molecular genetic studies are aimed at establishing the presence of certain receptors or proteins on cancer cells, which can most likely be used to determine the type of cancer. Such analyzes are especially indicated when detecting metastases from an unknown source, the search for which was unsuccessful.

Treatment of cancer metastases in the lymph nodes includes surgical removal, radiation and chemotherapy, which are prescribed individually according to the type and stage of the disease.

Surgical removal of the affected lymph nodes is performed simultaneously with excision of the tumor itself, while lymph node dissection is performed on the entire group of regional collectors into which cancer cells have entered or could have entered.

For many tumors, so-called “sentinel” lymph nodes are known, where metastasis occurs most early. These nodes are removed for histological examination, and the absence of cancer cells in them with a high degree of probability indicates the absence of metastasis.

When manipulating the tumor itself and the lymph nodes, the surgeon acts extremely carefully, avoiding tissue compression, which can provoke dissemination of tumor cells. To prevent cancer cells from entering the vessels, they are ligated early.

For metastases it is almost always prescribed. The choice of drugs or their combination depends on the type of primary tumor and its sensitivity to specific drugs. For stomach cancer, 5-fluorouracil and doxorubicin are most effective; for breast tumors, cyclophosphamide and adriamycin are prescribed; non-small cell lung cancer is sensitive to etoposide, cisplatin, taxol.

chemotherapy

If the primary focus of the cancer tumor cannot be identified, cisplatin, paclitaxel, gemcitabine, and etoposide are prescribed. For poorly differentiated carcinomas affecting the lymph nodes, platinum drugs (cisplatin) are effective; for neuroendocrine tumors, cisplatin and etoposide are included in the treatment regimen.

The goal of chemotherapy for metastatic tumors is to inhibit the growth and further spread of the malignant process. It is prescribed before surgery (neoadjuvant chemotherapy) to prevent metastasis and destroy micrometastases in the lymph nodes and after surgery (adjuvant) to prevent further metastasis, the risk of which increases after surgery on the affected organ.

radiation therapy

It is more important for hematogenous metastases than lymphogenous ones, but for lymph nodes radiosurgery, or cyber-knife, when cancer in a lymph node is removed using a beam of radiation acting strictly on the affected tissue, can be effective. This method is justified for late single metastases that appear years after treatment, when reoperation can be avoided.

Metastasis to lymph nodes in cancer, regardless of the type of primary tumor, characterizes the progression of the disease, and the worse the prognosis, the more lymph collectors are involved in cancer growth. Metastases respond to treatment only in a fifth of patients, in whom the prognosis may be favorable; in the remaining 80%, treatment at the metastasis stage is aimed at relieving symptoms or prolonging life. With multiple lymphogenous metastases of low- and undifferentiated carcinomas, life expectancy is on average six months to a year; in the case of highly differentiated cancers, the prognosis is slightly better.

Video: removal of lymph nodes in the treatment of breast cancer

The author selectively answers adequate questions from readers within his competence and only within the OnkoLib.ru resource. Face-to-face consultations and assistance in organizing treatment are not provided at this time.

Click on pictures to enlarge.

Drawing. Outside, the lymph node is covered with a fibrous capsule, from which trabeculae extend. The afferent lymphatic vessels approach from the convex side. The efferent lymphatic vessel, veins and artery pass through the hilum of the lymph node. Lymph nodes of the cortical layer are located along the periphery, and trabeculae, vascular cords and sinuses of the medulla are located in the center. In the intermediate zone, blood lymphocytes pass into the stroma through the walls of special venules. The zones of the lymph node are populated by strictly defined cells.

Lymph nodes on ultrasound

Lymph nodes are examined with a 7.5-12 MHz linear sensor. For inspection of large conglomerates, a 3-5 MHz convex probe may be useful. See mesenteric lymph nodes

A third of healthy people have small lymph nodes, and the length of individual specimens reaches 3.5 cm. The size and shape of the lymph nodes depend on the location, as well as the age and constitution of the patient.

A normal lymph node on ultrasound is a small (less than 1 cm) hypoechoic formation with a hyperechoic scar in the center; bean-shaped or oval; the contour is clear, smooth or wavy. The hypoechoic zone along the periphery is the cortex, the hyperechoic linear structure is vessels, trabeculae, fatty inclusions, and partially the medulla. At the hilum, the hyperechoic triangle “cuts” into the parenchyma; here, with color circulation, vessels can be seen.

Drawing. Ultrasound shows normal lymph nodes in the posterior triangle of the neck in a 9-year-old girl (1), a jugular chain lymph node in an elderly woman (2), and an axillary lymph node (3). In areas limited by fascia, the lymph nodes are more elongated in length than those located in loose tissue.

A cross-section of a muscle or vessel can be mistaken for a lymph node. In the color flow mode it is easy to distinguish a lymph node from a vessel. If the sensor is rotated 90°, then the vessels and muscles are a tubular structure, and the lymph node has an oval shape, regardless of the cut.

Drawing. On ultrasound, hypoechoic round formations similar to lymph nodes (1). The sensor is rotated 90°, showing a hypoechoic oval lymph node on the left (red arrow), and a longitudinal section of the mouse on the right (yellow arrows).

Drawing. Ultrasound shows a hypoechoic lymph node surrounded by three anechoic vessels. The color flow mode confirms our guess.

In the elderly, sclerosis of the lymph nodes often occurs - round or oval formations with a pronounced hyperechoic heterogeneous central part and a thin hypoechoic rim; the capsule of the node can be visible in fragments. Some lymph nodes grow together, forming large ribbon-like formations.

Drawing. A 65-year-old woman with a painless “tumor” in the armpit. Ultrasound reveals a round formation with a clear and even contour, size 20x10x15 mm; hypoechoic rim along the periphery and an expanded hyperechoic central part; with CDK, blood flow is in the hyperechoic zone. Conclusion: Axillary lymph node with fatty infiltration of the medulla and transition zone.

Angioarchitecture of a normal lymph node - a portal artery is distinguished, which passes into a linearly located vessel in the central part. If the vascular bed can be traced to the capsule, and the PSV on the portal vein is above 5 cm/sec, the lymph node is said to have a high degree of activity.

Lymphadenopathy on ultrasound

Lymphadenopathy is an increase in size, as well as a change in the shape of one or a group of lymph nodes. This is a symptom of a wide variety of viral and bacterial infections, but can also be a sign of a malignant process.

When fighting the infection, the lymph nodes become inflamed. Inflamed lymph nodes rapidly “grow” at the beginning of the disease and quickly “deflate” during recovery. On ultrasound, the lymph node is enlarged due to the cortical and pericortical zone, hypoechoic in the periphery and hyperechoic in the center, oval in shape, clear contour, blood flow only in the hilum or absent. If the inflammation extends into the surrounding tissue (periadenitis), an abscess may form.

Drawing. In children with ultrasound, enlarged cervical lymph nodes with preserved architecture are oval in shape, the contour is clear and even, hypoechoic along the periphery with a hyperechoic center. Conclusion: Lymphadenopathy of the cervical lymph nodes.

Drawing. A 6-month-old boy with severe dermatitis. On ultrasound, the cervical (1) and submandibular (2) lymph nodes are enlarged, elongated, hypoechoic along the periphery with a hyperechoic linear structure in the center. Note the submandibular lymph node with a wavy outline. Conclusion: Lymphadenopathy of the cervical and submandibular lymph nodes.

Drawing. On ultrasound, the lymph nodes are enlarged, oval in shape, with a clear and even contour, reduced echogenicity, the cortical zone is somewhat expanded, the central scar is clearly visible; the blood flow in the hilum is increased, the vessels are located correctly - they diverge radially, the subcapsular blood flow is not determined. Conclusion: Lymphadenopathy with signs of a high degree of activity.

Drawing. A child with a high fever, sore throat and a bilateral “tumor” on the neck; a general blood test shows 25% atypical mononuclear cells. On ultrasound, the anterior and posterior cervical lymph nodes are enlarged (maximum size 30x15 mm), round in shape, heterogeneous. Please note that the central scar is clearly visible, and the blood flow at the level of the gate is increased. Conclusion: Lymphadenopathy with signs of a high degree of activity. Large groups of enlarged lymph nodes in the neck are characteristic of infectious mononucleosis. Considering the course of the disease and the presence of atypical mononuclear cells, it is likely that the child infectious mononucleosis.

Drawing. A woman complains of a “tumor” in her armpit and elbow. A week ago I had an argument with my neighbor’s cat. On ultrasound, the axillary (top) and ulnar (bottom) lymph nodes are enlarged, round in shape, pronounced hyperplasia of the cortical and pericortical zone, the hyperechoic central scar is preserved; the blood flow is noticeably increased, the vessels are located correctly - radially. Conclusion: Lymphadenopathy with signs of a high degree of activity. At cat scratch disease At the site of a bite or scratch, small pustules form and at the same time nearby lymph nodes become inflamed. One or a group of lymph nodes increase in size to 5-10 cm, become painful, and become denser. Self-healing occurs after 2-4 weeks. Sometimes abscesses and fistulas form.

Tuberculosis of lymph nodes on ultrasound

Tuberculosis most often affects the lymph nodes of the neck, axillary and groin areas. Typically, tuberculous lymphadenitis develops slowly, the lymph nodes are painless, the average size is 3 cm, but sometimes they can reach 10 cm. On ultrasound, the affected lymph nodes are enlarged, hypoechoic, with an unclear contour; pronounced periadenitis and fused lymph node packages can often be seen. Tuberculous lymphadenitis is characterized by a heterogeneous echostructure - anechoic cystic cavities and calcifications. As the disease progresses, an abscess and fistulas may form.

Drawing. An ultrasound scan of the neck reveals a group of enlarged lymph nodes of irregular shape; echogenicity is reduced, there is no central scar; heterogeneous due to anechoic avascular zones - foci of necrosis; blood flow is increased, the course of blood vessels is irregular, subcapsular blood flow is pronounced. Conclusion According to the results of the biopsy: Tuberculosis of the lymph nodes.

Drawing. Ultrasound shows enlarged lymph nodes, irregular in shape with blurred boundaries; echogenicity is reduced, there is no central scar; heterogeneous due to small cystic cavities and hyperechoic inclusions with an acoustic shadow behind (calcifications). Conclusion According to the results of the biopsy: Damage to the lymph nodes by atypical mycobacteria. Histologically, foci of infection with M. tuberculosis and atypical mycobacteria are often indistinguishable. The classic morphological manifestation in both cases is granuloma with caseous necrosis.

"God is in the details"

Calcifications in the lymph nodes are characteristic not only of tuberculosis, but also of metastases of papillary thyroid carcinoma.

10 signs of a malignant lymph node on ultrasound

1. Large sizes, more than 10 mm;
2. Round shape, long/short size ratio (L/S)<2;
3. Echogenicity is diffusely or locally reduced down to anechoic;
4. Concentric or eccentric expansion of the cortex;
5. The hyperechoic central scar is thinned or absent;
6. Heterogeneous echostructure due to hyperechoic calcifications and/or anechoic zones of necrosis;
7. An uneven and blurred outline when tumor cells grow into the capsule;
8. Often form large conglomerates;
9. Defective blood flow - the vessels are displaced, chaotically organized, the diameter does not decrease towards the capsule, pronounced subcapsular blood flow, avascular zones, etc.;
10. High resistance index (RI >0.8) and pulsation (PI >1.5).

"God is in the details"

When a lymph node grows slowly, is painless, very dense and literally grows into the tissues surrounding it, there is a high probability of a malignant process.

Lymph nodes in the occipital and parotid regions, as a rule, have a round shape. When evaluating knots, rely not only on shape.

With abscess, tuberculosis, actinomycosis, the central hyperechoic scar in the lymph nodes may be absent.

Sometimes completely hyperechoic lymph nodes are encountered, which is characteristic of fatty infiltration, but cancer cannot be ruled out.

Extracapsular tumor growth often leads to the union of several affected lymph nodes into a shapeless conglomerate with the involvement of surrounding tissues.

Drawing. On ultrasound, lymphadenopathy with echo signs of a malignant process: enlarged (28x16 mm) lymph node, round in shape (D/C<2), гипоэхогенный без центрального рубчика; определяется подкапсульный кровоток, диаметр сосудов не уменьшается по направлению к капсуле, RI 0,88.

Drawing. A 63-year-old man discovered a “tumor” on his neck: it is growing slowly without pain or fever. Ultrasound in the area of ​​the sternocleidomastoid muscle reveals a group of sharply hypoechoic lymph nodes without a central scar, size 10-20 mm; some lymph nodes are round; There are lymph nodes with sharply increased blood flow. Conclusion According to the results of the biopsy: Lymphoma.

Drawing. A 32-year-old woman with a “tumor” on her neck. Ultrasound in the left supraclavicular region reveals one large and several small hypoechoic lymph nodes, round in shape, with a thin central hyperechoic scar; the blood flow is noticeably increased, the vessels are located chaotically, the diameter does not decrease towards the capsule, subcapsular blood flow is pronounced. In the left iliac fossa a “sandwich” is visible - a conglomerate of enlarged hypoechoic lymph nodes, between which lie the mesenteric vessels. Conclusion: Lymphadenopathy with echo signs of a malignant process. A biopsy of altered lymph nodes is recommended.

Drawing. A 50-year-old man complains of hoarseness and a “tumor” on the left side of his neck. Ultrasound reveals a round formation on the neck with a large anechoic cavity in the center—a zone of necrosis. The CT scan shows a large tumor in the supraglottic region on the left. Conclusion based on the biopsy results: Enlarged lymph node with metastases of squamous cell carcinoma. Central necrosis of the lymph nodes is typical for squamous cell carcinoma.

Drawing. Ultrasound of a lymph node with metastases of papillary thyroid cancer: heterogeneous echostructure - small anechoic cavities and microcalcifications; the central scar is not defined; subcapsular blood flow is visible.

Drawing. Ultrasound shows a group of enlarged round lymph nodes in the neck: hypoechoic, heterogeneous due to small and large anechoic, avascular zones - foci of necrosis. Conclusion according to the results of the biopsy: Lymph nodes with metastases of adenocarcinoma. The primary tumor could not be found.

Drawing. On ultrasound, metastases of lung adenocarcinoma destroyed the normal architecture of the lymph node: heterogeneous due to the alternation of hyper- and hypoechoic areas, the central scar is absent, the shape of the lymph node is uncertain, the contour is unclear, which indicates infiltrative growth into the surrounding tissues.

Drawing. Ultrasound shows lymphoma (1,2) between the angle of the lower jaw and the submandibular salivary gland, as well as a lymph node (3) with metastases.

Lymphogranulomatosis or Hodgkin's lymphoma is a malignant hyperplasia of lymphoid tissue. The tumor develops from a single focus, most often in the cervical, supraclavicular, and mediastinal lymph nodes. Ultrasound shows a pack of enlarged lymph nodes, clearly demarcated, not growing into the capsule and not merging with each other.

Drawing. Massive lymph nodes in the neck were biopsied and turned out to be Hodgkin's lymphoma.

Take care of yourself Your Diagnosticer!

A lymph node is a collection of lymphoid tissue surrounded by a capsule. There are more than 500 lymph nodes in the human body. They are located near all organs and along large blood vessels. The abdominal cavity and retroperitoneal space contain almost all vital organs that are constantly actively functioning. Due to their active activity and abundant blood supply, a lot of lymph is formed, which is absorbed and filtered by the lymph nodes. For this reason, the lymph nodes of the abdominal cavity are of important functional importance.

Anatomy of the lymph nodes of the retroperitoneum

For ease of study, retroperitoneal lymph nodes are divided into several groups, based on which organ they collect lymph from:

• Celiacs - 10-15 in number, located at the root of the celiac trunk.
• Gastric - located on the lesser and greater curvature of the stomach, and in the area of ​​the pylorus.
• Splenic - located in the area of ​​the hilum of the spleen.
• Upper and lower pancreatic - located along the upper and lower edges of the body of the pancreas.
• Hepatic - a conglomerate of lymph nodes in the area of ​​the gates of the liver and gallbladder.
• Mesenteric - located between the layers of the mesentery of the small intestine.
• Lymph nodes of the colon - lie retroperitoneally along the lymphatic vessels of the colon loop.
• Lumbar - single lymph nodes that are located along the abdominal aorta.
• Lower diaphragmatic - located near the legs of the diaphragm.
• Lower epigastric - lie along the initial part of the lower epigastric artery.

Each lymph node is responsible for filtering the lymph of the organ near which it is located. Organ disease also affects the functional state of not only the regional lymph node, but also the distant one.

Causes of inflammation of the lymph nodes in the abdominal cavity

Inflammation of the lymph nodes is a protective mechanism that occurs in the organ when it is influenced by provoking factors. The main causes of inflammation of the retroperitoneal lymph nodes are:

• Infectious diseases - tuberculosis, salmonellosis, yersiniosis.
• Tumors - carcinoma, sarcoma, lymphoma.
• Diseases of the immune system - histiocytosis, mononucleosis.
• Intra-abdominal inflammatory processes - adnexitis, glomerulonephritis, pancreatitis.

The lymph node is a very sensitive structure and plays the role of a sentry point in the body. Enlargement of the retroperitoneal lymph nodes is an indicator of inflammation, which is easy to determine yourself at home. With the development of the inflammatory process, the immune system is activated. The first echelon is represented by lymph nodes. Here, the cells responsible for immunity destroy microbes and prevent their further spread. In this case, hyperplasia of the lymph node occurs - its size exceeds the normal size.

In addition to inflammation, the lymph nodes of the abdominal cavity also respond to tumors by proliferation. Most neoplasms spread metastases through the lymphatic vessels. With the flow of lymph, cancer cells reach the nearest lymph node and become fixed there. Active enzymes in the lymph node try to kill cancer cells.

Symptoms of inflammation of intra-abdominal and retroperitoneal lymph nodes

Symptoms and treatment of inflammation of the lymph nodes are varied. Pathological changes in the lymph node are diagnosed as lymphadenopathy, and its inflammation is called lymphadenitis. Despite the small size of the lymph nodes, hyperplastic lymphadenitis is a serious medical problem. If treatment is delayed, emergency surgery may be needed within a few days. Therefore, it is necessary to be alert and clearly know the symptoms of possible inflammation of the lymph nodes in the intestines. These include:

• A sharp increase in body temperature to 39-40˚ C.
• Sharp pain in the lower abdomen, reminiscent of contractions.
• Loss of appetite and nausea, possible vomiting; stomach discomfort.
• Changes in stool (diarrhea, constipation).
• Intoxication of the body, poor health.

It should be noted that these symptoms are not specific enough. Similar complaints may occur with other diseases of the abdominal organs, for example with appendicitis. This once again confirms the need to immediately go to the hospital if such symptoms are present.

Diseases occurring with lymphadenitis in the abdomen and retroperitoneum

Inflammation of a group of lymph nodes in the abdomen is observed in both children and adults. The causes of lymphadenitis differ depending on the age of the patient. For children it is:

However, in most cases it will be reactive lymphadenopathy. This means that after the primary disease is eliminated, the condition of the inflamed lymph nodes will return to normal. In women, lymph node hyperplasia can occur as a reaction to diseases of the uterus and its appendages.

Adults, due to better immunity, are less susceptible to infectious diseases. In adults, inflammation of the lymph nodes in the abdominal cavity is often caused by another dangerous pathology. Malignant neoplasms of the gastrointestinal tract quickly metastasize to the retroperitoneal lymph nodes. In pancreatic cancer, hyperplasia of the retroperitoneal and lymph nodes of the small intestine is noted.

Methodology for examining patients with lymphadenitis

After the doctor listens to the patient’s complaints, he must immediately begin the examination. It usually begins with simple methods such as palpation of the abdomen. Despite its simplicity, palpation allows an experienced doctor to make a preliminary diagnosis and prescribe a further thorough examination.

A mandatory procedure is a general and biochemical analysis of blood, urine and feces. In a blood test, the number of leukocytes increases. This is a clear sign of inflammation. The patient is diagnosed with the Mantoux test to make sure that the lymph nodes are inflamed and not due to tuberculosis.

Further examinations are carried out using devices that help determine inflammation of the lymph nodes in the abdominal cavity. Of the instrumental visualization methods, the following are of particular diagnostic importance:

• Ultrasound examination (ultrasound) - makes it possible to determine the size of lymph nodes that have increased, their density, and their relationship with organs, such as the kidneys or uterus. Relatively inexpensive, fast and informative method.
• X-ray - X-ray contrast agent is injected into the intestinal tract and an image is taken. Helps distinguish lymphadenitis from diseases such as peritonitis and intestinal obstruction. Lymph nodes are not visualized on x-ray.
• Computer (CT) and magnetic resonance imaging (MRI) - allows you to obtain a high-quality layer-by-layer image of the lower or entire abdominal cavity. The method is absolutely indispensable if a tumor or distant metastases are suspected, which are clearly visualized.

Most modern treatment centers and clinics offer to undergo the necessary diagnostic procedures and obtain highly accurate results.

How are patients with inflammation of the lymph nodes treated?

Depending on the stage of development of the disease the patient sought help, the doctor determines the concept of treatment. If the disease has just begun, conservative treatment prescribed by the therapist will be sufficient. If the process lasts longer and has entered the purulent stage, the pills will no longer help. Surgery will be required to remove a group of enlarged lymph nodes in the abdominal cavity.

Treatment of lymphadenitis is complex. It begins with the treatment of the primary disease that led to the occurrence of lymphadenitis. Antimicrobial and anti-inflammatory drugs are used in the form of tablets or injections. To relieve intoxication of the body, increase the intake of tea and compotes, and in difficult cases, droppers with saline solutions. Vitamins and restoratives are also included in the list of prescriptions to activate the patient’s immune system. For acute pain, the doctor will prescribe painkillers.

Preparation	Representative	Reception features
Antimicrobial	Sumamed, Suprax, Cefotaxime, Tsiprolet	Minimum course of admission - from 5 days
Anti-inflammatory	Xefocam, Movalis, Celebrex, Dynastat	Take for several days during severe symptoms
Infusion solutions	Reamberin, Reopoliglyukin, Voluven, Venozol	Prescribed for intensive care at the beginning of treatment
Vitamin	Ascorutin, Riboflavin, Nicotinic acid	Long-term use for 1-2 months
Hyposensitizing	Claritin, Telfast, Calcium pantothenate	Prescribed to relieve hypersensitivity for 5-10 days

Physiotherapeutic procedures have a good effect if used in the early stages of the disease. The following methods have been proven to be effective in the treatment of lymphadenitis:

• Ultraviolet irradiation.
• UHF therapy.
• Laser irradiation.
• Medicinal electrophoresis.
• Darsonvalization.

The surgical treatment method consists of a typical abdominal operation. After opening the abdominal cavity, access is made to the nodes that are inflamed. They are removed, thereby preventing the spread of pus to surrounding organs.

Despite the danger of lymphadenitis, the likelihood of death from this disease is extremely low. And with the use of modern drugs and treatment methods, inflammation of the lymph nodes of the intestine and peritoneum no longer poses a serious problem for doctors.