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Swollen Lymph Nodes...medical consulting

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Treatment of Swollen Lymph Nodes











Treatment is directed at the cause. For example if a bacterial infection of the lymph node is suspected a trial of antibiotics is given to see if the swelling resolves.


Causes of Swollen Lymph Nodes











Because lymph nodes participate in the body's immune response a large number of infections inflammatory disorders and cancers are potential causes. Only the more common causes are discussed here.



The most common causes of swollen lymph nodes are





Upper respiratory infections (URI)




Infections in tissues near the swollen lymph node






Sometimes doctors cannot determine the cause of the swelling (called idiopathic lymphadenopathy) but the swelling goes away on its own without causing the person any harm.



The most dangerous causes of swollen lymph nodes are





Cancer




Human immunodeficiency virus (HIV) infection




Tuberculosis






However probably less than 1% of people with swollen lymph nodes have cancer.


Evaluation of Swollen Lymph Nodes











Not every person with swollen lymph nodes requires immediate evaluation by a doctor. The following information can help people decide when a doctor's evaluation is needed and help them know what to expect during the evaluation.

Warning signs

In people with swollen lymph nodes certain symptoms and characteristics are cause for concern. They include





A node that is an inch or more (about 2.5 cm) in diameter




A node that is draining pus




A node that feels hard




Risk factors for HIV infection (such as having been stuck with a needle used by another person or having engaged in high-risk sexual activities) or tuberculosis (such as living or working with a person who has tuberculosis or having recently moved from an area where tuberculosis is prevalent)




Fever or unexplained weight loss




When to see a doctor

If a lymph node is very painful or draining pus or other material people should see a doctor right away. Other people should call their doctor. The doctor will decide how quickly they need to be seen based on the presence of warning signs and other symptoms. For people who have no warning signs and otherwise feel well a delay of a week or so is not harmful.

What the doctor does

The doctor first asks questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the swollen lymph nodes and the tests that may need to be done (see table Some Causes and Features of Swollen Lymph Nodes).





Doctors ask





Where the swollen nodes are located




How long nodes have been swollen




Whether the person has pain




Whether the person has recently had an injury (particularly cat scratches and rat bites)




Whether the person has an infection or symptoms of an infection (for example a runny nose cough fever sore throat unexplained weight loss or tooth or gum pain)






Doctors then do a physical examination. Doctors check for fever and examine areas where lymph nodes are found. Doctors check the person for any signs of infection or lumps elsewhere in the body. People who have swollen lymph nodes throughout the body usually have a disorder that affects the entire body. However people who have swollen lymph nodes in only one area may have a disorder that affects only that area (for example an infection) or more widespread disease.



Sometimes the history and physical examination findings suggest the cause as for example when the person has an upper respiratory infection or a dental infection. In other cases findings do not point to a single cause. People with warning signs are more likely to have a serious disorder but people with lymph node swelling and no other symptoms may also have a serious disorder.



Nodes that are hard very enlarged and do not move when pushed may indicate cancer. Tenderness redness and warmth in a single enlarged lymph node may indicate an infection of the node.




Table










Some Causes and Features of Swollen Lymph Nodes






Cause




Common Features*




Tests








Cancers






Leukemias (typically chronic and sometimes acute lymphocytic leukemia)




Fatigue fever and weight loss



With acute leukemia often easy bruising and/or bleeding




Complete blood count and specialized blood tests (for example peripheral smear and/or flow cytometry)



Bone marrow examination






Lymphomas




Painless lymph node swelling (local or widespread)



Nodes often rubbery and sometimes clumped together



Often fever night sweats and weight loss




Lymph node biopsy



Specialized blood tests






Metastatic cancers (often of the head and neck thyroid breast or lung)




One or several painless nodes in the neck



Nodes often hard sometimes unable to be moved when pushed




Tests to identify the primary tumor often including imaging studies blood tests and biopsy






Connective tissue disorders






Kawasaki disease




Tender swollen nodes in the neck in a child



Fever usually higher than 102° F (39° C) rash on the trunk prominent red bumps on the tongue peeling skin on the palms soles and around the nails




Only a doctor's examination






Sarcoidosis




Painless lymph node swelling that may be widespread



Often cough and/or shortness of breath fever malaise muscle weakness weight loss and joint pains




Chest imaging (plain x-ray or CT)



Sometimes lymph node biopsy






Systemic lupus erythematosus (lupus)




Widespread node swelling



Typically painful and sometimes swollen joints



Sometimes red rash affecting the nose and the cheeks and other skin sores




A doctor's examination plus blood tests






Infections






Dental infection




Neck nodes on one side are affected (often tender)



Painful tooth




Only a doctor's or dentist's examination






HIV (immediately after the person became infected—the primary infection)




Generalized lymph node swelling



Usually fever malaise rash and joint pain



Often in a person known to have been exposed to HIV or to having exposure to a high-risk activity (such as being stuck with a needle used by another person or high-risk sexual activities)




HIV blood testing






Mononucleosis




Swelling on both sides typically in the neck but sometimes under the arms or in the groin



Fever sore throat and severe fatigue



Typically in an adolescent or a young adult




Blood test for mononucleosis






Sexually transmitted diseases (STDs particularly herpes simplex chlamydia and syphilis)




Except for the secondary stage of syphilis only swollen nodes in the groin



Often urinary symptoms (such as pain during urination) and urethral or vaginal discharge



Sometimes sores on the genitals



For the secondary stage of syphilis often widespread sores on the mucous membranes and widespread lymph node swelling




STD testing






Skin and soft tissue infections (for example cellulitis abscess cat-scratch disease) including direct lymph node infection




Usually a visible cut or infection of the skin near the swollen node




Usually only a doctor's examination



Sometimes blood tests to identify antibodies to the infecting organism






Toxoplasmosis




Swollen nodes on both sides of the neck and under both arms



Sometimes flu-like symptoms and an enlarged liver and spleen



Often history of exposure to cat feces




Blood tests






Tuberculosis affecting the lymph nodes




Usually swelling of nodes in the neck or above the collarbone



Sometimes lymph nodes inflamed or draining



Often in a person who has HIV infection




Tuberculin skin testing or blood tests for tuberculosis



Usually lymph node biopsy






Upper respiratory infection (including sore throat)




Neck nodes are affected with only little or no tenderness



Sore throat runny nose or cough




Only a doctor's examination






Other






Drugs: Common drugs include allopurinol antibiotics (for example cephalosporins penicillin and sulfonamides) atenolol captopril carbamazepine phenytoin pyrimethamine and quinidine




History of using a causative drug



Except for phenytoin rash joint and muscle pain and fever




Only a doctor's examination






Silicone breast implants




Node swelling under the arms in a woman with breast implants




A doctor's examination and often tests for other causes of node swelling








* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.






CT = computed tomography; HIV = human immunodeficiency virus; STD = sexually transmitted disease.















Testing

If doctors suspect a specific disorder (for example mononucleosis in a young person with fever sore throat and an enlarged spleen) initial testing is directed at that condition (see table Some Causes and Features of Swollen Lymph Nodes).



If history and physical examination do not show a likely cause further testing depends on the nodes involved and the other findings present.



People with warning signs and those with widespread lymph node swelling should have a complete blood count and chest x-ray. Doctors may also test for tuberculosis HIV infection and mononucleosis. Sometimes blood tests are needed to detect toxoplasmosis and syphilis. In people with joint pain or stiffness or a rash blood tests are done for systemic lupus erythematosus (lupus).



If doctors suspect cancer or lymphoma the person has a lymph node biopsy. Biopsy may also be needed when widespread lymph node swelling does not resolve within 3 to 4 weeks.



Key Points about Swollen Lymph Nodes










In most cases the cause is an obvious nearby skin or tissue infection or a harmless viral infection that goes away on its own.




Testing is usually needed when there are warning signs when other symptoms or risk factors suggest a specific disorder or when widespread lymph node swelling has no apparent cause.




When lymph node swelling does not resolve within 3 or 4 weeks a biopsy may be needed.





simple explanation



Lymph nodes are tiny bean-shaped organs that filter lymph fluid. They are located throughout the body but particular collections are found just under the skin in the neck under the arms and in the groin area. Lymph nodes are part of the lymphatic system which is one of the body's defense mechanisms against the spread of infection and cancer. (See also Overview of the Lymphatic System.)


Lymph is clear fluid that is made up of water white blood cells proteins and fats that have filtered out of blood vessels into the spaces between cells. Some of the fluid is reabsorbed by the blood vessels but the rest enters the lymphatic vessels. Lymph then passes through the lymph nodes which are specific collection points where damaged cells infectious organisms and cancer cells are filtered from the fluid and destroyed. If many infectious organisms or cancer cells are present the lymph nodes swell. Sometimes organisms cause infection within a lymph node.


Lymphadenopathy is the term doctors use to refer to swollen lymph nodes.


Lymphadenitis is the term used when swollen lymph nodes are painful or have signs of inflammation (for example redness or tenderness).


A few small nodes often can be felt in healthy people. Lymph nodes that are larger and easily felt may be a sign of a disorder. Some people use the term "swollen glands" to refer to swollen lymph nodes especially when the nodes in the neck are swollen. However lymph nodes are not glands.


Lymph nodes in only one body area may be swollen or nodes in two or more body areas can be swollen. Other symptoms such as sore throat runny nose or fever may be present depending on the cause. Sometimes swollen lymph nodes are discovered when the person is being examined because of another symptom.


Because lymph nodes participate in the body's immune response a large number of infections inflammatory disorders and cancers are potential causes. Only the more common causes are discussed here.


The most common causes of swollen lymph nodes are


Upper respiratory infections (URI)


Infections in tissues near the swollen lymph node


Sometimes doctors cannot determine the cause of the swelling (called idiopathic lymphadenopathy) but the swelling goes away on its own without causing the person any harm.


The most dangerous causes of swollen lymph nodes are


Cancer


Human immunodeficiency virus (HIV) infection


Tuberculosis


However probably less than 1% of people with swollen lymph nodes have cancer.


Not every person with swollen lymph nodes requires immediate evaluation by a doctor. The following information can help people decide when a doctor's evaluation is needed and help them know what to expect during the evaluation.


In people with swollen lymph nodes certain symptoms and characteristics are cause for concern. They include


A node that is an inch or more (about 2.5 cm) in diameter


A node that is draining pus


A node that feels hard


Risk factors for HIV infection (such as having been stuck with a needle used by another person or having engaged in high-risk sexual activities) or tuberculosis (such as living or working with a person who has tuberculosis or having recently moved from an area where tuberculosis is prevalent)


Fever or unexplained weight loss


If a lymph node is very painful or draining pus or other material people should see a doctor right away. Other people should call their doctor. The doctor will decide how quickly they need to be seen based on the presence of warning signs and other symptoms. For people who have no warning signs and otherwise feel well a delay of a week or so is not harmful.


The doctor first asks questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the swollen lymph nodes and the tests that may need to be done (see table Some Causes and Features of Swollen Lymph Nodes).


Doctors ask


Where the swollen nodes are located


How long nodes have been swollen


Whether the person has pain


Whether the person has recently had an injury (particularly cat scratches and rat bites)


Whether the person has an infection or symptoms of an infection (for example a runny nose cough fever sore throat unexplained weight loss or tooth or gum pain)


Doctors then do a physical examination. Doctors check for fever and examine areas where lymph nodes are found. Doctors check the person for any signs of infection or lumps elsewhere in the body. People who have swollen lymph nodes throughout the body usually have a disorder that affects the entire body. However people who have swollen lymph nodes in only one area may have a disorder that affects only that area (for example an infection) or more widespread disease.


Sometimes the history and physical examination findings suggest the cause as for example when the person has an upper respiratory infection or a dental infection. In other cases findings do not point to a single cause. People with warning signs are more likely to have a serious disorder but people with lymph node swelling and no other symptoms may also have a serious disorder.


Nodes that are hard very enlarged and do not move when pushed may indicate cancer. Tenderness redness and warmth in a single enlarged lymph node may indicate an infection of the node.


Cause


Common Features*


Tests


Cancers


Leukemias (typically chronic and sometimes acute lymphocytic leukemia)


Fatigue fever and weight loss


With acute leukemia often easy bruising and/or bleeding


Complete blood count and specialized blood tests (for example peripheral smear and/or flow cytometry)


Bone marrow examination


Lymphomas


Painless lymph node swelling (local or widespread)


Nodes often rubbery and sometimes clumped together


Often fever night sweats and weight loss


Lymph node biopsy


Specialized blood tests


Metastatic cancers (often of the head and neck thyroid breast or lung)


One or several painless nodes in the neck


Nodes often hard sometimes unable to be moved when pushed


Tests to identify the primary tumor often including imaging studies blood tests and biopsy


Connective tissue disorders


Kawasaki disease


Tender swollen nodes in the neck in a child


Fever usually higher than 102° F (39° C) rash on the trunk prominent red bumps on the tongue peeling skin on the palms soles and around the nails


Only a doctor's examination


Sarcoidosis


Painless lymph node swelling that may be widespread


Often cough and/or shortness of breath fever malaise muscle weakness weight loss and joint pains


Chest imaging (plain x-ray or CT)


Sometimes lymph node biopsy


Systemic lupus erythematosus (lupus)


Widespread node swelling


Typically painful and sometimes swollen joints


Sometimes red rash affecting the nose and the cheeks and other skin sores


A doctor's examination plus blood tests


Infections


Dental infection


Neck nodes on one side are affected (often tender)


Painful tooth


Only a doctor's or dentist's examination


HIV (immediately after the person became infected—the primary infection)


Generalized lymph node swelling


Usually fever malaise rash and joint pain


Often in a person known to have been exposed to HIV or to having exposure to a high-risk activity (such as being stuck with a needle used by another person or high-risk sexual activities)


HIV blood testing


Mononucleosis


Swelling on both sides typically in the neck but sometimes under the arms or in the groin


Fever sore throat and severe fatigue


Typically in an adolescent or a young adult


Blood test for mononucleosis


Sexually transmitted diseases (STDs particularly herpes simplex chlamydia and syphilis)


Except for the secondary stage of syphilis only swollen nodes in the groin


Often urinary symptoms (such as pain during urination) and urethral or vaginal discharge


Sometimes sores on the genitals


For the secondary stage of syphilis often widespread sores on the mucous membranes and widespread lymph node swelling


STD testing


Skin and soft tissue infections (for example cellulitis abscess cat-scratch disease) including direct lymph node infection


Usually a visible cut or infection of the skin near the swollen node


Usually only a doctor's examination


Sometimes blood tests to identify antibodies to the infecting organism


Toxoplasmosis


Swollen nodes on both sides of the neck and under both arms


Sometimes flu-like symptoms and an enlarged liver and spleen


Often history of exposure to cat feces


Blood tests


Tuberculosis affecting the lymph nodes


Usually swelling of nodes in the neck or above the collarbone


Sometimes lymph nodes inflamed or draining


Often in a person who has HIV infection


Tuberculin skin testing or blood tests for tuberculosis


Usually lymph node biopsy


Upper respiratory infection (including sore throat)


Neck nodes are affected with only little or no tenderness


Sore throat runny nose or cough


Only a doctor's examination


Other


Drugs: Common drugs include allopurinol antibiotics (for example cephalosporins penicillin and sulfonamides) atenolol captopril carbamazepine phenytoin pyrimethamine and quinidine


History of using a causative drug


Except for phenytoin rash joint and muscle pain and fever


Only a doctor's examination


Silicone breast implants


Node swelling under the arms in a woman with breast implants


A doctor's examination and often tests for other causes of node swelling


* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.


CT = computed tomography; HIV = human immunodeficiency virus; STD = sexually transmitted disease.


If doctors suspect a specific disorder (for example mononucleosis in a young person with fever sore throat and an enlarged spleen) initial testing is directed at that condition (see table Some Causes and Features of Swollen Lymph Nodes).


If history and physical examination do not show a likely cause further testing depends on the nodes involved and the other findings present.


People with warning signs and those with widespread lymph node swelling should have a complete blood count and chest x-ray. Doctors may also test for tuberculosis HIV infection and mononucleosis. Sometimes blood tests are needed to detect toxoplasmosis and syphilis. In people with joint pain or stiffness or a rash blood tests are done for systemic lupus erythematosus (lupus).


If doctors suspect cancer or lymphoma the person has a lymph node biopsy. Biopsy may also be needed when widespread lymph node swelling does not resolve within 3 to 4 weeks.


Treatment is directed at the cause. For example if a bacterial infection of the lymph node is suspected a trial of antibiotics is given to see if the swelling resolves.


In most cases the cause is an obvious nearby skin or tissue infection or a harmless viral infection that goes away on its own.


Testing is usually needed when there are warning signs when other symptoms or risk factors suggest a specific disorder or when widespread lymph node swelling has no apparent cause.


When lymph node swelling does not resolve within 3 or 4 weeks a biopsy may be needed.
  • The Author: wikbe
 
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