Anatomy, Shoulder and Upper Limb, Axillary Lymph Nodes – StatPearls

Introduction

The axilla is a small anatomical space located between the upper thoracic wall and the arm. The main contents include the brachial plexus, axillary artery and vein, and axillary lymph nodes.[1] Lymph nodes contain a range of immune cells, including lymphocytes and macrophages. These remove damaged cells, foreign material, and microorganisms from the lymphatic fluid before returning it to the venous circulation.[2] The axillary lymph nodes arrange into five groups based on their anatomical relations. Collectively, they drain the wall of the thorax, breast, arm, and upper abdominal wall above the umbilicus. The axillary lymph nodes are of particular clinical significance as they are often the first site of breast cancer metastasis.[3] Axillary node involvement is the single most significant prognostic variable for breast cancer patients.[4] Axillary lymphadenopathy is also associated with hematological malignancies, infection, and various autoimmune etiologies. [5] It is, therefore, crucial to have a thorough understanding of this region.

In this article, we will focus primarily on the axillary lymph nodes respective to their anatomical features, relations, drainage, surgical considerations, and clinical significance.

Structure and Function

The axillary lymph nodes reside in the axillary pad of fat and fall into five groups.[3] Every group of lymph nodes receives lymph from a specified, nearby region.

1. Anterior (pectoral) lymph nodes are along the inferior border of pectoralis minor, near the lateral thoracic vessels. They receive lymph from the breast, skin, and muscles of the supraumbilical anterolateral body wall. They drain into the central and apical nodes.

2. Posterior (subscapular) lymph nodes are located on the posterior wall of the axilla along the inferior border of the subscapularis. They receive lymph from the scapular region, as well as the posterior thoracic wall. They drain into the central and apical nodes.

3. Lateral (humeral) lymph nodes are over the lateral wall of the axilla. They receive lymph from the arm and drain into the central, apical, and deep cervical nodes.

4. Central lymph nodes appear in the base of the axilla. They receive lymph from the anterior, posterior, and lateral groups, and drain to the apical lymph nodes.

5. Apical (terminal) lymph nodes are located deep in the apex of the axilla. They receive lymph from all of the groups mentioned above, in addition to the upper breast. The efferent vessels from the apical group converge to form the subclavian lymphatic trunk. On the left, this drains directly drains into the thoracic duct, and on the right, the subclavian trunk drains into the right venous angle via the right lymphatic duct.[6]

The function of the axillary lymph nodes, like that of the rest of the lymphatic system, is to defend against foreign particles, provide immunity against microorganisms, and return excess interstitial fluid back to the systemic circulation. [2] Lymph enters the lymph node through the afferent lymphatic vessel and subsequently flows through a system of sinuses within the node. The series of sinuses begin with the subcapsular sinus and continues to the cortical sinuses and finally, the medullary sinuses. Lymph then exits the node via the efferent lymphatic vessel.

Structurally a lymph node consists of three basic compartments; a cortex, paracortex, and medulla.[7] There are many types of specialized cells within the lymph node concentrated in these areas.[7] The B cell lymphocytes are classically found in the outer cortex and may form lymphoid follicles, while T cells and dendritic cells are classically present in the paracortex. The medulla contains macrophages, plasma cells, and B cells. Activation of a lymph node leads to the development of germinal centers within lymphoid follicles. These are areas in which mature B cells hypermutate, proliferate, and differentiate, to mount an immune response.[7]

Further, the area in the axilla divides into three levels based on where the lymph nodes are traceable. They are:

Level I: In this level, the lymph nodes are traced inferior and lateral to the pectoralis minor muscleLevel II: The lymph nodes are traced deep to the pectoralis minor muscleLevel III: Lymph nodes here can be traced medial and deep to the medial border of the muscle of pectoralis minor.[8]

Embryology

The axillary lymph nodes, like other components of the lymphatic system, develop from hemangioblastic stem cells. There is a close relationship between the lymphatic and vascular systems in early development.[9] Animal studies suggest that lymphatic sacs arise from primitive veins.[10] This activity may occur around week 5 of gestation in humans. By the end of the embryonic period, six primary lymph sacs form. These are the cisterna chyli, two jugular lymph sacs, two iliac lymph sacs, and a retroperitoneal lymph sac.[11] 

Mesenchymal buds invaginate into these lymphatic sacs but do not penetrate the lymphatic endothelium lining the sacs. The mesenchymal buds are then covered by endothelial cells and enlarge. As a result, the initial lymphatic sac becomes the capsule of the mature lymph node, and the mesenchymal invagination becomes the hilus. The sac lumen also forms the sinuses inside the developing lymph node, while the mesenchymal tissue forms the lobules.[7] Lymph sacs are connected by channels to create a network of lymphatic vessels that join to form the early lymphatic system.

Blood Supply and Lymphatics

Lymph nodes are generally found in close association with blood vessels. The axillary lymph nodes receive their blood supply from the axillary artery, and venous drainage occurs via branches of the axillary vein. Interestingly, it has been shown that stage II breast cancer and above are associated with a significant increase in the number of blood vessels in axillary lymph nodes.[12]

Nerves

Lymph nodes do not contain their nervous supply; however, they are often near many different nerves. For example, the axillary lymph nodes are situated near the cords and branches of the brachial plexus, which innervate the muscles of the upper limb. Anatomically, the brachial plexus divisions become cords at the mid-clavicle, while the branches typically originate at the level of the pectoralis minor muscle.[13] The long thoracic nerve, which originates from C5-7 nerve roots, is also located within the axilla.[14] It is important to be aware of these structures as they are vulnerable to injury during axillary lymph node surgery.[15][16]

Muscles

The axilla is a pyramidal shaped area with five anatomical borders, based mainly on the musculature in this region [1]:

• Medial border: the serratus anterior muscle and the first four ribs.

• Lateral border: coracobrachialis and the short head of the biceps muscle.

• Anterior border: pectoralis major and pectoralis minor muscles

• Posterior border: subscapularis, latissimus dorsi, and teres major muscles 

• Superior border: clavicle, scapula, and the first rib

Physiologic Variants

In total, there are between 20 to 30 axillary lymph nodes, though the exact number varies between individuals. The commonest arrangement of these lymphatic pathways is a single linear chain, then a chain branching into two linear chains, and, least common, is a network configuration.[17] Tracing these lymph nodes becomes still difficult due to the high variation in the quantity of subcutaneous adipose tissue.[18] There is also physiological variation in other axillary structures such as the medial cutaneous nerve of the arm and intercostobrachial nerves.[18] Surgeons need to be aware of these when operating on the axilla to avoid iatrogenic injury.

Surgical Considerations

Patients with suspected breast cancer should have an examination for axillary lymphadenopathy. Those with enlarged lymph nodes may be considered for a sentinel lymph node biopsy (SLNB) and/or axillary lymph node dissection (ALND). The sentinel node is the first lymph node into which a primary tumor drains.[19] The identification of this node allows for prognostication.

If an ALND is performed, there are classically three surgical levels of removal:

• Level I: lateral to the pectoralis minor muscle

• Level II: posterior to the pectoralis minor muscle

• Level III (infraclavicular): medial to the pectoralis minor muscle[20]

There are many possible complications of an ALND for carcinoma of the breast. These usually affect the ipsilateral upper limb and may include numbness (39%), pain (39%), arm swelling (25%), and limitation of arm movement (16%).[21] Arm swelling due to interruption of the lymphatic drainage of the upper limb is also known as lymphedema. In this condition, lymph accumulates in the subcutaneous tissue leading to symptoms such as pain and altered sensation, limb heaviness, and difficulty fitting into clothing.[22] A winged scapula may also be observed postoperatively due to injury to the long thoracic nerve, especially in patients with a low body mass index.[16] This nerve innervates the serratus anterior, which acts to pull the scapula forward.

Despite these complications, ALNDs commonly occur unnecessarily in women without nodal involvement. Some authors, therefore, recommend that the clinician perform an SLNB first to confirm the nodal status of the patient.[23] Importantly, the data shows that there is no change in survival in early-stage breast cancer patients treated with SLNB compared to ALND. [24] SLNB may, therefore, spare many women of the morbidity associated with an axillary dissection.

Clinical Significance

Lymph nodes can enlarge in response to numerous etiologies, including malignancy, infections, and autoimmune disease.[5] Cancer of the lymph nodes can subdivide into primary cancers such as lymphoma, as well as secondary cancers, classically of the breast. Management of these tumors may involve the surgical removal of lymph nodes and/or radiotherapy, both of which can damage the lymphatic drainage system.[25]

Infections can be thought of as local or systemic, or classified according to the causative organism. While a significant proportion of lymphadenopathy occurs as a result of bacterial and viral infections, it is important not to forget parasitic infections. Lymphatic filariasis is said to be one of the leading causes of disfigurement and the second most common reason behind permanent disability in the world.[26] In this condition, filarial worms infiltrate and damage the lymphatic system resulting in significant lymphedema (elephantiasis) of the arms, legs, breasts, or genitals. [27]

It has been noted that axillary lymphadenopathy is usually due to infectious conditions like sarcoidosis, cat scratch disease, Staphylococcal, and Streptococcal skin infections, or malignancies like breast cancer, leukemia, and lymphoma.[5]

In breast cancer cases, it is essential to note the number of lymph nodes involved, as the prognosis is worst (in case of relapse) if four or more axillary lymph nodes are involved.  Thus axillary metastasis is not only a marker of diagnosis but also indicates its aggressive phenotype.[4]  Three factors, being tumor size, young age, and poor histology, are significant predictors of axillary lymph node metastatic grading.[28]

The radiological examination of the axillary group of lymph nodes in the case of breast cancers is possible by the computed tomography (CT) scan and magnetic resonance imagining (MRI) that gives high-resolution images. The ultrasound is good to detect morphological abnormalities such as hilar infiltration, cortical thickening, peripheral vascularization, and destruction of the kidney-shaped appearance. [29] But the most specific results are obtained by ultrasound coupled with the fine-needle aspiration needle biopsy (FNAB).[30]

Other Issues

Below is the staging of carcinoma of the breast, primarily based on the axillary lymph nodes’ involvement.

• Stage O: No involvement of axillary lymph nodes. Few cancer cells are present in breast ductules or lobules.

• Stage 1A: No involvement of axillary lymph nodes. Tumor size in the breast is less than 2 cm.

• Stage 1B: Very few lymph nodes are involved, but their size is less than 2mm (micrometastases). The tumor might or might not be present in the breast. If present, it will be less than 2 cm in size. 

• Stage 2A: 1 to 3 axillary lymph nodes show cancer cells and are larger than 2mm with tumor size in breast less than 2cm. Or the size of the tumor in the breast is less than 5 cm without the involvement of lymph nodes. 

• Stage 2B: 1 to 3 axillary lymph nodes involved with a tumor less than 5 cm. Or the tumor is larger than 5 cm in size with no lymph node involvement.

• Stage 3A: 4 to 9 axillary lymph nodes are seen with a tumor less than 5 cm. Or 1 to 9 axillary lymph nodes are involved with the tumor being bigger than 5 cm.

• Stage 3B: Involvement of up to 9 axillary lymph nodes with tumor involving surrounding muscles and skin of the breast. 

• Stage 3C: Here ten or more axillary lymph nodes are involved with also the involvement of the surrounding lymph nodes (like infraclavicular, internal mammary, or supraclavicular lymph nodes)

• Stage 4: Involvement of almost all axillary lymph nodes with distant metastatic spread to organs like lungs, liver, bone, brain, etc.[31]

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Figure

Lymph nodes of the arm, Deltoid pectoral glands, Axillary glands, Supratrochlear gland. Contributed by Gray’s anatomy Plates

Figure

Axillary lymph nodes, Deltoideo Pectoral glands, lateral group, Subclavicular group, Central group, Subscapular group, Pectoral group, Cutaneous collecting trunk fro the thoracic wall, Cutaneous collecting trunks, Subareolar plexus, Pectoral group, Mammary (more…)

References

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Dialani V, James DF, Slanetz PJ. A practical approach to imaging the axilla. Insights Imaging. 2015 Apr;6(2):217-29. [PMC free article: PMC4376818] [PubMed: 25534139]

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Bautch VL, Caron KM. Blood and lymphatic vessel formation. Cold Spring Harb Perspect Biol. 2015 Mar 02;7(3):a008268. [PMC free article: PMC4355271] [PubMed: 25731762]

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Butler MG, Isogai S, Weinstein BM. Lymphatic development. Birth Defects Res C Embryo Today. 2009 Sep;87(3):222-31. [PMC free article: PMC2755610] [PubMed: 19750516]

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Ilahi M, St Lucia K, Ilahi TB. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 25, 2022. Anatomy, Thorax, Thoracic Duct. [PubMed: 30020599]

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Maiborodin IV, Kozyakov AE, Babayants EV, Krasil’nikov SE. Features of Blood Supply to Axillary Lymph Nodes in Breast Cancer Patients. Bull Exp Biol Med. 2017 May;163(1):82-86. [PubMed: 28580489]

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Gasparotti R, Shah L. Brachial and Lumbosacral Plexus and Peripheral Nerves. In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Diseases of the Brain, Head and Neck, Spine 2020–2023: Diagnostic Imaging [Internet]. Springer; Cham (CH): Feb 15, 2020. pp. 241–254. [PubMed: 32119244]

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Lung K, Lui F. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 25, 2022. Anatomy, Thorax, Long Thoracic Nerve. [PubMed: 30571017]

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Lucci A, McCall LM, Beitsch PD, Whitworth PW, Reintgen DS, Blumencranz PW, Leitch AM, Saha S, Hunt KK, Giuliano AE., American College of Surgeons Oncology Group. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol. 2007 Aug 20;25(24):3657-63. [PubMed: 17485711]

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Belmonte R, Monleon S, Bofill N, Alvarado ML, Espadaler J, Royo I. Long thoracic nerve injury in breast cancer patients treated with axillary lymph node dissection. Support Care Cancer. 2015 Jan;23(1):169-75. [PubMed: 25035064]

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Peters AM, Fowler JC, Britton TB, Solanki CK, Ballinger JR, Ravichandran D, Mortimer PS, Purushotham AD. Functional variation in lymph node arrangements within the axilla. Lymphat Res Biol. 2009;7(3):139-44. [PubMed: 19778201]

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Soares EW. Anatomical variations of the axilla. Springerplus. 2014;3:306. [PMC free article: PMC4093907] [PubMed: 25045608]

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Nieweg OE, Tanis PJ, Kroon BB. The definition of a sentinel node. Ann Surg Oncol. 2001 Jul;8(6):538-41. [PubMed: 11456054]

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Rinaldi RM, Sapra A, Bellin LS. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 8, 2022. Breast Lymphatics. [PubMed: 31971733]

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Brar P, Jain S, Singh I. Complications of Axillary Lymph Node Dissection in Treatment of Early Breast Cancer: A Comparison of MRM and BCS. Indian J Surg Oncol. 2011 Jun;2(2):126-32. [PMC free article: PMC3244199] [PubMed: 22693405]

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Yen TWF, Laud PW, Pezzin LE, McGinley EL, Wozniak E, Sparapani R, Nattinger AB. Prevalence and Consequences of Axillary Lymph Node Dissection in the Era of Sentinel Lymph Node Biopsy for Breast Cancer. Med Care. 2018 Jan;56(1):78-84. [PMC free article: PMC5725235] [PubMed: 29087982]

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Giuliano AE, Ballman K, McCall L, Beitsch P, Whitworth PW, Blumencranz P, Leitch AM, Saha S, Morrow M, Hunt KK. Locoregional Recurrence After Sentinel Lymph Node Dissection With or Without Axillary Dissection in Patients With Sentinel Lymph Node Metastases: Long-term Follow-up From the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomized Trial. Ann Surg. 2016 Sep;264(3):413-20. [PMC free article: PMC5070540] [PubMed: 27513155]

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Warren LE, Miller CL, Horick N, Skolny MN, Jammallo LS, Sadek BT, Shenouda MN, O’Toole JA, MacDonald SM, Specht MC, Taghian AG. The impact of radiation therapy on the risk of lymphedema after treatment for breast cancer: a prospective cohort study. Int J Radiat Oncol Biol Phys. 2014 Mar 01;88(3):565-71. [PMC free article: PMC3928974] [PubMed: 24411624]

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Lourens GB, Ferrell DK. Lymphatic Filariasis. Nurs Clin North Am. 2019 Jun;54(2):181-192. [PubMed: 31027660]

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Shenoy RK. Clinical and pathological aspects of filarial lymphedema and its management. Korean J Parasitol. 2008 Sep;46(3):119-25. [PMC free article: PMC2553332] [PubMed: 18830049]

28.

Rivadeneira DE, Simmons RM, Christos PJ, Hanna K, Daly JM, Osborne MP. Predictive factors associated with axillary lymph node metastases in T1a and T1b breast carcinomas: analysis in more than 900 patients. J Am Coll Surg. 2000 Jul;191(1):1-6; discussion 6-8. [PubMed: 10898177]

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Maxwell F, de Margerie Mellon C, Bricout M, Cauderlier E, Chapelier M, Albiter M, Bourrier P, Espié M, de Kerviler E, de Bazelaire C. Diagnostic strategy for the assessment of axillary lymph node status in breast cancer. Diagn Interv Imaging. 2015 Oct;96(10):1089-101. [PubMed: 26372221]

30.

Lernevall A. Imaging of axillary lymph nodes. Acta Oncol. 2000;39(3):277-81. [PubMed: 10987221]

31.

Akram M, Iqbal M, Daniyal M, Khan AU. Awareness and current knowledge of breast cancer. Biol Res. 2017 Oct 02;50(1):33. [PMC free article: PMC5625777] [PubMed: 28969709]

Disclosure: Harry Kyriacou declares no relevant financial relationships with ineligible companies.

Disclosure: Yusuf Khan declares no relevant financial relationships with ineligible companies.

Anatomy, Shoulder and Upper Limb, Axillary Lymph Nodes – StatPearls

Introduction

The axilla is a small anatomical space located between the upper thoracic wall and the arm. The main contents include the brachial plexus, axillary artery and vein, and axillary lymph nodes.[1] Lymph nodes contain a range of immune cells, including lymphocytes and macrophages. These remove damaged cells, foreign material, and microorganisms from the lymphatic fluid before returning it to the venous circulation.[2] The axillary lymph nodes arrange into five groups based on their anatomical relations. Collectively, they drain the wall of the thorax, breast, arm, and upper abdominal wall above the umbilicus. The axillary lymph nodes are of particular clinical significance as they are often the first site of breast cancer metastasis.[3] Axillary node involvement is the single most significant prognostic variable for breast cancer patients.[4] Axillary lymphadenopathy is also associated with hematological malignancies, infection, and various autoimmune etiologies.[5] It is, therefore, crucial to have a thorough understanding of this region.

In this article, we will focus primarily on the axillary lymph nodes respective to their anatomical features, relations, drainage, surgical considerations, and clinical significance.

Structure and Function

The axillary lymph nodes reside in the axillary pad of fat and fall into five groups.[3] Every group of lymph nodes receives lymph from a specified, nearby region.

1. Anterior (pectoral) lymph nodes are along the inferior border of pectoralis minor, near the lateral thoracic vessels. They receive lymph from the breast, skin, and muscles of the supraumbilical anterolateral body wall. They drain into the central and apical nodes.

2. Posterior (subscapular) lymph nodes are located on the posterior wall of the axilla along the inferior border of the subscapularis. They receive lymph from the scapular region, as well as the posterior thoracic wall. They drain into the central and apical nodes.

3. Lateral (humeral) lymph nodes are over the lateral wall of the axilla. They receive lymph from the arm and drain into the central, apical, and deep cervical nodes.

4. Central lymph nodes appear in the base of the axilla. They receive lymph from the anterior, posterior, and lateral groups, and drain to the apical lymph nodes.

5. Apical (terminal) lymph nodes are located deep in the apex of the axilla. They receive lymph from all of the groups mentioned above, in addition to the upper breast. The efferent vessels from the apical group converge to form the subclavian lymphatic trunk. On the left, this drains directly drains into the thoracic duct, and on the right, the subclavian trunk drains into the right venous angle via the right lymphatic duct.[6]

The function of the axillary lymph nodes, like that of the rest of the lymphatic system, is to defend against foreign particles, provide immunity against microorganisms, and return excess interstitial fluid back to the systemic circulation.[2] Lymph enters the lymph node through the afferent lymphatic vessel and subsequently flows through a system of sinuses within the node. The series of sinuses begin with the subcapsular sinus and continues to the cortical sinuses and finally, the medullary sinuses. Lymph then exits the node via the efferent lymphatic vessel.

Structurally a lymph node consists of three basic compartments; a cortex, paracortex, and medulla.[7] There are many types of specialized cells within the lymph node concentrated in these areas.[7] The B cell lymphocytes are classically found in the outer cortex and may form lymphoid follicles, while T cells and dendritic cells are classically present in the paracortex. The medulla contains macrophages, plasma cells, and B cells. Activation of a lymph node leads to the development of germinal centers within lymphoid follicles. These are areas in which mature B cells hypermutate, proliferate, and differentiate, to mount an immune response.[7]

Further, the area in the axilla divides into three levels based on where the lymph nodes are traceable. They are:

Level I: In this level, the lymph nodes are traced inferior and lateral to the pectoralis minor muscleLevel II: The lymph nodes are traced deep to the pectoralis minor muscleLevel III: Lymph nodes here can be traced medial and deep to the medial border of the muscle of pectoralis minor.[8]

Embryology

The axillary lymph nodes, like other components of the lymphatic system, develop from hemangioblastic stem cells. There is a close relationship between the lymphatic and vascular systems in early development.[9] Animal studies suggest that lymphatic sacs arise from primitive veins. [10] This activity may occur around week 5 of gestation in humans. By the end of the embryonic period, six primary lymph sacs form. These are the cisterna chyli, two jugular lymph sacs, two iliac lymph sacs, and a retroperitoneal lymph sac.[11] 

Mesenchymal buds invaginate into these lymphatic sacs but do not penetrate the lymphatic endothelium lining the sacs. The mesenchymal buds are then covered by endothelial cells and enlarge. As a result, the initial lymphatic sac becomes the capsule of the mature lymph node, and the mesenchymal invagination becomes the hilus. The sac lumen also forms the sinuses inside the developing lymph node, while the mesenchymal tissue forms the lobules.[7] Lymph sacs are connected by channels to create a network of lymphatic vessels that join to form the early lymphatic system.

Blood Supply and Lymphatics

Lymph nodes are generally found in close association with blood vessels. The axillary lymph nodes receive their blood supply from the axillary artery, and venous drainage occurs via branches of the axillary vein.  Interestingly, it has been shown that stage II breast cancer and above are associated with a significant increase in the number of blood vessels in axillary lymph nodes.[12]

Nerves

Lymph nodes do not contain their nervous supply; however, they are often near many different nerves. For example, the axillary lymph nodes are situated near the cords and branches of the brachial plexus, which innervate the muscles of the upper limb. Anatomically, the brachial plexus divisions become cords at the mid-clavicle, while the branches typically originate at the level of the pectoralis minor muscle.[13] The long thoracic nerve, which originates from C5-7 nerve roots, is also located within the axilla.[14] It is important to be aware of these structures as they are vulnerable to injury during axillary lymph node surgery.[15][16]

Muscles

The axilla is a pyramidal shaped area with five anatomical borders, based mainly on the musculature in this region [1]:

• Medial border: the serratus anterior muscle and the first four ribs.

• Lateral border: coracobrachialis and the short head of the biceps muscle.

• Anterior border: pectoralis major and pectoralis minor muscles

• Posterior border: subscapularis, latissimus dorsi, and teres major muscles 

• Superior border: clavicle, scapula, and the first rib

Physiologic Variants

In total, there are between 20 to 30 axillary lymph nodes, though the exact number varies between individuals. The commonest arrangement of these lymphatic pathways is a single linear chain, then a chain branching into two linear chains, and, least common, is a network configuration.[17] Tracing these lymph nodes becomes still difficult due to the high variation in the quantity of subcutaneous adipose tissue.[18] There is also physiological variation in other axillary structures such as the medial cutaneous nerve of the arm and intercostobrachial nerves.[18] Surgeons need to be aware of these when operating on the axilla to avoid iatrogenic injury.

Surgical Considerations

Patients with suspected breast cancer should have an examination for axillary lymphadenopathy. Those with enlarged lymph nodes may be considered for a sentinel lymph node biopsy (SLNB) and/or axillary lymph node dissection (ALND). The sentinel node is the first lymph node into which a primary tumor drains.[19] The identification of this node allows for prognostication.

If an ALND is performed, there are classically three surgical levels of removal:

• Level I: lateral to the pectoralis minor muscle

• Level II: posterior to the pectoralis minor muscle

• Level III (infraclavicular): medial to the pectoralis minor muscle[20]

There are many possible complications of an ALND for carcinoma of the breast. These usually affect the ipsilateral upper limb and may include numbness (39%), pain (39%), arm swelling (25%), and limitation of arm movement (16%).[21] Arm swelling due to interruption of the lymphatic drainage of the upper limb is also known as lymphedema. In this condition, lymph accumulates in the subcutaneous tissue leading to symptoms such as pain and altered sensation, limb heaviness, and difficulty fitting into clothing.[22] A winged scapula may also be observed postoperatively due to injury to the long thoracic nerve, especially in patients with a low body mass index.[16] This nerve innervates the serratus anterior, which acts to pull the scapula forward.

Despite these complications, ALNDs commonly occur unnecessarily in women without nodal involvement. Some authors, therefore, recommend that the clinician perform an SLNB first to confirm the nodal status of the patient.[23] Importantly, the data shows that there is no change in survival in early-stage breast cancer patients treated with SLNB compared to ALND.[24] SLNB may, therefore, spare many women of the morbidity associated with an axillary dissection.

Clinical Significance

Lymph nodes can enlarge in response to numerous etiologies, including malignancy, infections, and autoimmune disease. [5] Cancer of the lymph nodes can subdivide into primary cancers such as lymphoma, as well as secondary cancers, classically of the breast. Management of these tumors may involve the surgical removal of lymph nodes and/or radiotherapy, both of which can damage the lymphatic drainage system.[25]

Infections can be thought of as local or systemic, or classified according to the causative organism. While a significant proportion of lymphadenopathy occurs as a result of bacterial and viral infections, it is important not to forget parasitic infections. Lymphatic filariasis is said to be one of the leading causes of disfigurement and the second most common reason behind permanent disability in the world.[26] In this condition, filarial worms infiltrate and damage the lymphatic system resulting in significant lymphedema (elephantiasis) of the arms, legs, breasts, or genitals.[27]

It has been noted that axillary lymphadenopathy is usually due to infectious conditions like sarcoidosis, cat scratch disease, Staphylococcal, and Streptococcal skin infections, or malignancies like breast cancer, leukemia, and lymphoma. [5]

In breast cancer cases, it is essential to note the number of lymph nodes involved, as the prognosis is worst (in case of relapse) if four or more axillary lymph nodes are involved.  Thus axillary metastasis is not only a marker of diagnosis but also indicates its aggressive phenotype.[4]  Three factors, being tumor size, young age, and poor histology, are significant predictors of axillary lymph node metastatic grading.[28]

The radiological examination of the axillary group of lymph nodes in the case of breast cancers is possible by the computed tomography (CT) scan and magnetic resonance imagining (MRI) that gives high-resolution images. The ultrasound is good to detect morphological abnormalities such as hilar infiltration, cortical thickening, peripheral vascularization, and destruction of the kidney-shaped appearance.[29] But the most specific results are obtained by ultrasound coupled with the fine-needle aspiration needle biopsy (FNAB).[30]

Other Issues

Below is the staging of carcinoma of the breast, primarily based on the axillary lymph nodes’ involvement.

• Stage O: No involvement of axillary lymph nodes. Few cancer cells are present in breast ductules or lobules.

• Stage 1A: No involvement of axillary lymph nodes. Tumor size in the breast is less than 2 cm.

• Stage 1B: Very few lymph nodes are involved, but their size is less than 2mm (micrometastases). The tumor might or might not be present in the breast. If present, it will be less than 2 cm in size. 

• Stage 2A: 1 to 3 axillary lymph nodes show cancer cells and are larger than 2mm with tumor size in breast less than 2cm. Or the size of the tumor in the breast is less than 5 cm without the involvement of lymph nodes. 

• Stage 2B: 1 to 3 axillary lymph nodes involved with a tumor less than 5 cm. Or the tumor is larger than 5 cm in size with no lymph node involvement.

• Stage 3A: 4 to 9 axillary lymph nodes are seen with a tumor less than 5 cm. Or 1 to 9 axillary lymph nodes are involved with the tumor being bigger than 5 cm.

• Stage 3B: Involvement of up to 9 axillary lymph nodes with tumor involving surrounding muscles and skin of the breast. 

• Stage 3C: Here ten or more axillary lymph nodes are involved with also the involvement of the surrounding lymph nodes (like infraclavicular, internal mammary, or supraclavicular lymph nodes)

• Stage 4: Involvement of almost all axillary lymph nodes with distant metastatic spread to organs like lungs, liver, bone, brain, etc.[31]

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Figure

Lymph nodes of the arm, Deltoid pectoral glands, Axillary glands, Supratrochlear gland. Contributed by Gray’s anatomy Plates

Figure

Axillary lymph nodes, Deltoideo Pectoral glands, lateral group, Subclavicular group, Central group, Subscapular group, Pectoral group, Cutaneous collecting trunk fro the thoracic wall, Cutaneous collecting trunks, Subareolar plexus, Pectoral group, Mammary (more. ..)

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Maiborodin IV, Kozyakov AE, Babayants EV, Krasil’nikov SE. Features of Blood Supply to Axillary Lymph Nodes in Breast Cancer Patients. Bull Exp Biol Med. 2017 May;163(1):82-86. [PubMed: 28580489]

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Lucci A, McCall LM, Beitsch PD, Whitworth PW, Reintgen DS, Blumencranz PW, Leitch AM, Saha S, Hunt KK, Giuliano AE., American College of Surgeons Oncology Group. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol. 2007 Aug 20;25(24):3657-63. [PubMed: 17485711]

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Rivadeneira DE, Simmons RM, Christos PJ, Hanna K, Daly JM, Osborne MP. Predictive factors associated with axillary lymph node metastases in T1a and T1b breast carcinomas: analysis in more than 900 patients. J Am Coll Surg. 2000 Jul;191(1):1-6; discussion 6-8. [PubMed: 10898177]

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Maxwell F, de Margerie Mellon C, Bricout M, Cauderlier E, Chapelier M, Albiter M, Bourrier P, Espié M, de Kerviler E, de Bazelaire C. Diagnostic strategy for the assessment of axillary lymph node status in breast cancer. Diagn Interv Imaging. 2015 Oct;96(10):1089-101. [PubMed: 26372221]

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Lernevall A. Imaging of axillary lymph nodes. Acta Oncol. 2000;39(3):277-81. [PubMed: 10987221]

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Disclosure: Harry Kyriacou declares no relevant financial relationships with ineligible companies.

Disclosure: Yusuf Khan declares no relevant financial relationships with ineligible companies.

What are lymph nodes and what to do if they are enlarged?

Lymph nodes allow lymph to pass through, retaining and destroying bacteria, viruses and malignant cells.

Sometimes they increase, which raises many questions.

Let’s figure out what lymph nodes are, how they are arranged and why it is impossible to follow the advice from the Internet when they increase.

What are lymph nodes and why are they needed?

Lymph node is a peripheral organ of the immune system, located on the path of lymphatic vessels from organs and tissues.

Lymph is the liquid part of the blood that is filtered into the intercellular space through the walls of the capillaries. It is rich in proteins, electrolytes and water. It is impossible to lose these valuable substances, and it is impossible to return them back to the blood vessels through the wall. The “filtrate” of the blood enters the lymphatic system, from where it enters the superior vena cava through a network of vessels, that is, it returns to the bloodstream.

Along the course of the lymphatic vessels there are lymph nodes – rounded formations the size of a pea. At its core, a lymph node is an accumulation of protective cells – lymphocytes and macrophages – on a “frame” of connective tissue. Lymph nodes allow the flow of lymph through them, and the protective cells that make up them delay and destroy foreign agents (bacteria, parasites, viruses, tumor cells) that have entered the human body.

That is why the lymph nodes are called biological filters, and they themselves resemble knight’s castles, located in the most important directions of medieval states and protecting them from enemy attacks.

Classification of lymph nodes

There are approximately 500 lymph nodes in the human body. They are located mainly in groups. Each group receives lymph from a specific area of ​​the body or part of an organ. There are many classifications of lymph nodes, the simplest of them is a classification based on localization. There are no lymph nodes in the brain and spinal cord, bones, and the area of ​​the hands and feet.

Swollen lymph nodes: symptom or disease?

Swollen lymph nodes, or lymphadenopathy, is a symptom of a large number of diseases. This is not an independent disease, but only one of its signs, such as headache or fever.

Doctors have many classifications of lymphadenopathy. In this article, we will give only a couple of the main ones that will help in understanding the stated problem.

Depending on the extent of the process, lymph node enlargement can be local and generalized ¹ . In the first case, the lymph nodes of 1-2 adjacent anatomical regions increase. For example, submandibular and cervical. In the second case, there is an increase in lymph nodes in two or more non-adjacent, located far from each other, zones. For example, in the inguinal and axillary regions.

Duration of lymph node enlargement can be short (less than 2 months) and protracted (more than 2 months) ¹ .

Why do lymph nodes enlarge?

Swollen lymph nodes can be a symptom of both a relatively harmless disease and a very serious disease. Therefore, you need not to self-medicate, but to look for the cause. And this is the prerogative of the doctor.

Here are just some of the possible causes of swollen lymph nodes:

• infectious diseases . The entry of an infectious agent (virus, bacteria) into the lymph node leads to increased blood flow, active division of lymphocytes and enlargement of the lymph node. That is, this process is of a reciprocal protective nature. An increase in lymph nodes is observed with infections of the upper respiratory tract (adenoviral, tonsillitis), infectious mononucleosis, childhood infections (measles, rubella, mumps, chickenpox), cytomegalovirus infection, etc. In acute infectious diseases, an increase in lymph nodes is temporary and is accompanied by other symptoms (fever, general weakness, malaise, cough, runny nose). Also, swollen lymph nodes can be one of the symptoms of HIV infection;
• autoimmune connective tissue diseases . With these diseases, the human immune system does not work quite adequately, which is why the body begins to attack its own cells. An increase in lymph nodes can be observed with rheumatoid arthritis, systemic lupus erythematosus;
• pyoinflammatory processes of the skin, underlying structures and internal organs. Even panaritium or a bad tooth can cause an increase in lymph nodes;
• vaccination . The introduction of a killed pathogen or its parts into the body leads to the development of an immune response. An increase in lymph nodes is not at all uncommon;
• allergic reactions . Taking many medications (antibiotics, anti-inflammatory and lowering blood pressure) may be accompanied by an increase in lymph nodes;
• neoplastic diseases . Enlarged lymph nodes are a common and sometimes the only sign of cancer. In oncological diseases, it can be primary and secondary.

Primary enlargement of lymph nodes

It is observed in tumors that directly affect the lymphatic system – lymphomas. Usually in these cases, the lymph nodes are more than 2 cm in diameter, painless, and their increase occurs against the background of apparent health, which is why the person does not immediately turn to the doctor.

Secondary enlargement of lymph nodes

It is observed in a malignant neoplasm of any localization. For example, with breast cancer, the only sign may be an increase in the lymph nodes in the armpit.

The fact is that as soon as malignant cells find themselves in the intercellular space, they quickly enter the lymphatic capillaries, and from there to the nearest lymph node. There, some of them are destroyed, and some settle and begin to divide, forming a secondary tumor focus.

The division of tumor cells and the increase in the number of protective cells over time leads to an increase in the size of the lymph node. This is a kind of “price” for curbing the growth of a tumor and the spread of tumor cells throughout the body, because if there were no lymph nodes, tumor cells would very quickly enter the bloodstream and give distant metastases.

With local lymphadenopathy, the tumor is detected in about half of the cases, and with generalized lymphadenopathy – in almost 90% of cases ¹ ! Therefore, it is so important to exclude the tumor origin of lymphadenopathy and understand its causes. You should not waste precious time on self-treatment, and if enlarged lymph nodes appear, you should consult a doctor as soon as possible.

What should I do if my lymph nodes are enlarged and which doctor should I visit?

The adult needs to see a general practitioner and the child/teenager needs to be taken to see a pediatrician. Usually, a clinical examination and simple studies (general and biochemical blood tests, if necessary, X-ray examination or ultrasound of a certain area of ​​the body) are enough for a specialist to make a preliminary diagnosis and prescribe treatment or refer the patient to a narrower specialist (oncologist, surgeon, rheumatologist, infectious disease specialist) for further examination.

What not to do when the lymph nodes are “swollen”: breaking the stereotypes

Having discovered enlarged lymph nodes, many people, instead of going to the doctor and understanding the causes of what is happening, begin to self-medicate: heat the area of ​​the enlarged lymph node, drink antibiotics, use compresses, etc. You can find a great many similar tips on the Internet.

Should I do it? No way.

Warming up the area of ​​the lymph nodes

Many people use pan-calcined salt or a freshly boiled egg to warm up the area of ​​the enlarged lymph node. This is usually done to reduce pain. But for most patients, this is absolutely impossible. In the presence of an inflammatory process, thermal exposure will lead to vasodilation and increased inflammation, and in the case of a tumor process, it can accelerate cell division. Both will make the situation worse.

Taking antibiotics

There are many people who uncontrollably “treat” any “suspicious” symptoms with antibiotics. Of course, this is wrong. Antibacterial drugs are prescribed only by a doctor and strictly according to indications. In most cases, with an increase in lymph nodes, taking antibiotics is simply not advisable and will not give a positive effect.

Use of compresses, ointments/gels

The result here is the same as when warming up – the situation only gets worse. In addition, there is the danger of chemical burns to the skin.

Cabbage leaf application

Cabbage, of course, contains many vitamins and microelements, but it is completely useless as an anti-inflammatory agent. But before the patient has time to be convinced of this, some time passes – and the delay in treatment can have an extremely adverse effect on the result, especially when it comes to malignant diseases such as lymphomas.

Do not waste time on self-treatment! In most cases, this leads to a loss of time and aggravates the situation. Swollen lymph nodes may be a symptom of a serious illness. Consult a doctor who will understand the causes of enlarged lymph nodes and determine further management tactics.

M-EN-00005757 December 2021

Sources (Electronic resource). URL: https://diseases.medelement.com/disease/%D0%B4%D0%B8%D0%B0%D0%B3%D0%BD%D0%BE%D1%81%D1%82%D0%B8 %D0%BA%D0%B0-%D0%BB%D0%B8%D0%BC%D1%84%D0%B0%D0%B4%D0%B5%D0%BD%D0%BE%D0%BF% D0%B0%D1%82%D0%B8%D0%B9-%D0%BA%D1%80-%D1%80%D1%84-2018/16754 (accessed 11/21/2021).

#Life with oncology#Cancer alertness#Useful information

symptoms, causes, classification, what to do with inflammation of the lymph nodes

This disease is treated by Therapist

The information provided on this page should not be used for self-treatment or self-diagnosis. If you suspect a disease, you should seek help from a qualified specialist. Only your doctor can diagnose and prescribe treatment.

Article content:

• What is the lymphatic system
• Lymph node functions
• What is lymphadenitis
• Causes
• Disease classification
• Symptoms
• Routes of infection
• Possible complications
• When to see a doctor
• Diagnostics
• Methods of treatment
• Disease prognosis and prevention

What is inflammation of the lymph nodes?

The lymphatic system ensures the normal functioning of the immune system, internal organs and tissues. One of the most common diseases of the lymphatic system is lymphadenitis of the lymph nodes. The disease has a different etiology, symptoms and degree of danger to health. In the article we will talk about how to recognize the pathology and what methods of treatment exist.

What is the lymphatic system

The lymphatic system is a network of lymph vessels and nodes. These vessels transport a special liquid – lymph. It is responsible for the transport of proteins, salts and metabolites into the blood.

Lymph nodes act as a filter. They purify the lymph from pathogenic microorganisms and foreign substances, due to which purified and safe lymphatic fluid enters the bloodstream. Source:
The role of lymph nodes in human life. Okunyaka O.M., Tumasyan T.I. Bulletin of science. 2019. №3. pp.60-62.

The lymphatic system performs three main functions:

1. Participates in immune defense. Together with the flow of lymph, pathogenic microorganisms enter the lymph nodes, where they are recognized and destroyed.
2. Maintains proper fluid levels in tissues. With an excessive amount of fluid, the lymphatic vessels “drain” organs and tissues.
3. Produces fat metabolism. Lymphatic vessels transport lipids, which are involved in almost all metabolic processes.

Functions of the lymph nodes

There are about 500 lymph nodes in the human body. They play the role of a barrier and pump, perform several important functions:

• Hematopoietic. Lymph nodes are involved in the development of white blood cells – lymphocytes. Lymphocytes are cells of the immune system responsible for fighting various infections and diseases.
• Drainage, or transport. Lymph nodes play an important role in the transport of lymph, which enters the lymphatic vessels from the intercellular spaces of tissues. Due to this, exudate and metabolic products are utilized from the tissues.
• Barrier. Lymph nodes serve as a barrier to infected cells and microorganisms, preventing them from spreading throughout the body. They can also form antibodies that help neutralize and destroy infectious agents.

What is lymphadenitis

Lymphadenitis is an inflammation of the lymph nodes. In most cases, this is not an independent disease, but a complication of the primary pathology. It is most often a sign of a bacterial, viral, fungal, or protozoal infection. Source:
Lymphadenopathy. Melikyan A.L., Egorova E.K., Kovrigina A.M. Clinical guidelines. 2018. p.5-30. Therefore, to find the cause of the inflammatory process, complex diagnostics are needed.

Depending on the etiology, one or more lymph nodes may become inflamed. With lymphadenitis, the following types of lymph nodes are usually affected:

• neck;
• elbow;
• submandibular;
• popliteal;
• inguinal;
• axillary.

In lymphadenitis, the lymph node becomes enlarged and painful. This is due to an increase in the number of lymphocytes and other cells of the immune system that collect inside it. If an infectious agent has entered the lymph node and caused the formation of an abscess or abscess, purulent inflammation may develop.

In the absence of timely treatment, lymphadenitis provokes the development of dangerous complications: the spread of infection to other tissues and organs, the formation of fistulas, sepsis. Therefore, it is important to consult a doctor at the first sign of illness.

Causes

Most common causes:

• Infections. In most cases, inflammation in the area of ​​the lymph node occurs precisely against the background of infection: tonsillitis, scarlet fever, stomatitis, SARS, influenza, tuberculosis, brucellosis, chicken pox, etc.
• Injuries and operations. Any injury, surgery and other damage to the lymph node can cause inflammation.
• Allergic reactions. Some allergens activate a cascade of inflammatory responses.
• Oncological diseases. Lymphadenitis sometimes becomes one of the signs of malignant tumors of the lymphatic system, especially lymphoma.
• Autoimmune diseases. Lymph node inflammation can accompany systemic lupus erythematosus and rheumatoid arthritis.

In some cases, it is not possible to determine the etiology of inflammation of the lymph node. Then a diagnosis of “lymphadenitis, unspecified” is established.

Clinical recommendations of the Ministry of Health of the Russian Federation offer several classifications of lymphadenitis.

Origin:

• Primary. Occurs when an infection or other cause of inflammation occurs directly in the lymph node. This most commonly occurs when bacteria or other pathogens enter the body through a skin wound, or when certain viruses, such as the Epstein-Barr virus, infect the lymphatic system.
• Secondary. Occurs when an infection or other cause of inflammation is localized not in the lymph node itself, but elsewhere in the body. In this case, the inflammatory process spreads from the primary focus to the lymph nodes through the lymphatic vessels. For example, secondary lymphadenitis can occur with an infection of the pharynx or teeth, as well as in the presence of cancer or blood diseases.

Intensity and duration of inflammation:

• Acute. It is characterized by an abrupt onset, rapid progression, and an acute inflammatory response. Usually acute lymphadenitis is accompanied by pain, swelling, redness of the skin, fever and other signs of inflammation. Source:
  Treatment of chronic tonsillitis and acute lymphadenitis. Pavlova K.V. Medicines and rational pharmacotherapy. 2022. No. 5-2. pp. 90-91.
• Chronic. It is characterized by a sluggish long course and a low intensity of the inflammatory process. Most often it develops against the background of untreated acute lymphadenitis. The chronic form is characterized by two periods: exacerbation and remission. In the first case, the clinical manifestations are pronounced, in the second – weakly or completely absent, an imaginary recovery occurs.
• Recurrent. It is characterized by periodic exacerbations of inflammation after a temporary improvement. Usually, relapses occur in the presence of a chronic infectious or inflammatory process in the body.

By the nature of inflammation:

• Purulent. It is characterized by the formation of pus inside the lymph node. It occurs as a result of an infection caused by bacteria, fungi, or other microorganisms. As a rule, purulent lymphadenitis is accompanied by severe pain, swelling, redness of the skin and fever.
• Serous. It differs in the formation of serous fluid inside the affected lymph node, and the inflammatory process does not go beyond its capsule. Often found in children.

Localization:

• submandibular – usually occurs against the background of diseases of the oral cavity, teeth or pharynx;
• axillary – associated with infectious or oncological diseases of the breast;
• inguinal – occurs against the background of skin infections and skin lesions;
• cervical – develops when the pharynx, mouth, nose or ears are affected. Source:
  Diagnosis and management of cervical lymphadenitis. Skorlyakov V.V., Babiev V.F., Keshchyan S.S., Stagnieva I.V., Boyko N.V. Young scientist. 2017. No. 16. pp. 75-78;
• parotid – caused by infectious diseases of the ear or mouth;
• occipital – occurs against the background of pathologies of the skin or upper respiratory tract.

Symptoms

Symptoms of lymphadenitis depend on its type, location and cause. The most common signs of inflammation of the lymph node:

• swelling and tenderness of the affected lymph node;
• redness of the skin in the affected area;
• general weakness, fatigue and fever;
• pain and discomfort when touching the affected lymph node;
• headache;
• sometimes – nausea, vomiting and loss of appetite;
• excessive sweating, especially at night;
• change in color and texture of the skin in the area of ​​an inflamed lymph node;
• appearance of spots on the skin or other rashes.

Ways of infection

Primary cause of secondary lymphadenitis can be:

• trophic ulcer;
• caries;
• otitis;
• influenza;
• tonsillitis;
• angina;
• herpes;
• tumor;
• tuberculosis and more.

Lymphadenitis is sometimes caused by a skin injury such as scratches, wounds, or insect bites, which can become entry points for bacteria.

Possible complications

Many people don’t even realize the danger of lymphadenitis. Without timely treatment, the disease leads to various, including dangerous consequences. Most often, the following complications develop:

• abscess – a limited accumulation of pus in the tissues, surrounded by a membrane;
• sepsis is a severe infectious disease in which the infection spreads throughout the body through the bloodstream;
• compression of surrounding tissues – enlarged lymph nodes cause discomfort and put pressure on neighboring tissues;
• thrombophlebitis – inflammation of the venous wall with the formation of blood clots that can clog the lumen of the vein;
• fistula – the formation of a pathological channel as a result of the accumulation of purulent fluid.

When to see a doctor

Lymphadenitis is diagnosed and treated by a vascular surgeon. It is necessary to consult a doctor at the first signs of the disease. The specialist will prescribe a diagnosis to identify the cause of inflammation and tell what to do to the patient. Timely access to a doctor prevents the development of dangerous complications.

Diagnosis

Diagnosis of lymphadenitis is aimed at finding the cause of the inflammatory process, assessing the current state of the lymph node and the body as a whole. For this, a comprehensive examination is used:

• Inspection. The doctor examines the skin at the site of the affected lymph node, evaluates its size, shape, texture, temperature and sensitivity of the skin.
• General and biochemical blood test. Analyzes confirm the inflammatory and infectious process.
• Biopsy. Taking a sample of a lymph node for histological examination allows you to determine the cellular composition of the tissue and differentiate the tumor. Source:
  Differential diagnosis of bacterial and viral lymphadenitis in children. Antonova S.S., Botvin’eva V.V., Sitnikov I.G. VSP. 2008. No. 3. pp.76-78.
• ultrasound. Ultrasound examination helps to determine the size and structure of the lymph node, as well as to identify the neoplasm.
• CT and MRI. The procedures are used for layer-by-layer study of the lymph node and surrounding soft tissues.
• Culture study. If lymphadenitis is caused by a bacterial infection, a bacterial culture is performed to determine the type of bacteria and select the most effective antibiotic.

Methods of treatment

The doctor chooses the method of treatment individually for each clinical case. It depends on the etiology of inflammation, the current state of the patient and associated complications. In most cases, conservative therapy is used, including medication, including:

• antibiotics if there is a bacterial infection;
• antiviral drugs – in the presence of a viral infection;
• antifungals – in the presence of a fungal infection;
• non-steroidal anti-inflammatory drugs – for the relief of inflammation and pain.

In addition, physiotherapy, compresses and massage are used. In the presence of abscesses, surgical intervention is indicated – removal of purulent contents and sanitation of the affected tissues.

Forecast and prevention of the disease

With timely visit to the doctor, lymphadenitis of the lymph node has a favorable prognosis. Early initiation of treatment allows you to achieve complete recovery, prevent the development of complications and the transition of the disease to a chronic form.

Due to the lack of a single etiology, there is no specific prevention of lymphadenitis. The following recommendations will help prevent infection:

• Maintain good personal hygiene. Wash your hands regularly with soap and water, especially after handling animals and visiting public places.
• Minimize contact with infected patients and visits to crowded places. If there is a sick person in the family, it is necessary to limit contact with him.
• Using only your own hygiene items. Do not use other people’s towels, razors, toothbrushes, etc.
• Strengthening immunity: giving up bad habits, maintaining physical activity, proper nutrition and regular walks in the fresh air.
• Timely treatment of diseases. When the first symptoms appear, you should immediately consult a doctor and do not self-medicate.
• Vaccination. Timely vaccination helps prevent infections that can cause lymphadenitis. You need to be vaccinated both in childhood and in adulthood.

• Differential diagnosis of bacterial and viral lymphadenitis in children. Antonova S.S., Botvin’eva V.V., Sitnikov I.G. VSP. 2008. No. 3. pp.76-78
• The role of lymph nodes in human life. Okunyaka O.M., Tumasyan T.I. Bulletin of science. 2019. №3. p.60-62
• Diagnosis and treatment of cervical lymphadenitis. Skorlyakov V.V., Babiev V.F., Keshchyan S.S., Stagnieva I.V., Boyko N.V. Young scientist. 2017. No. 16. p.75-78
• Treatment of chronic tonsillitis and acute lymphadenitis. Pavlova K.V. Medicines and rational pharmacotherapy. 2022. No. 5-2. p.90-91
• Lymphadenopathy. Melikyan A.L., Egorova E.K., Kovrigina A.M. Clinical guidelines. 2018. p.5-30

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SM-Clinic on Dybenko street

st. Dybenko, house 13, bldg. 4
(m. Dybenko Street, Nevsky district)

Opening hours:

Daily from 9.00 to 22.00

SM-Clinic on Udarnikov Avenue

Udarnikov Avenue, 19, building 1
(metro station Ladozhskaya, Krasnogvardeisky district)

Opening hours:

Daily from 9.00 to 22.00

SM-Clinic on Dunaysky Prospect

Dunaysky Prospekt, 47
(Dunayskaya metro station, Frunzensky district)

Opening hours:

Daily from 9.00 to 22.