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Lymph gland in the neck: Swollen lymph nodes – Mayo Clinic


Strep Throat: Symptoms, Treatments


What is strep throat?

Strep throat is an infection in the throat and tonsils (glands in the back of the throat) that is caused by a bacterium known as Group A streptococcus. Strep throat spreads from person to person very easily, especially among family members. It is common in school-aged children but also occurs in adults.

Strep throat can very rarely cause more serious illnesses, such as rheumatic fever, a disease that can harm the heart valves. So, it’s important that strep throat is appropriately diagnosed and treated. With proper treatment, strep throat is usually cured within 10 days.

Symptoms and Causes

What are the symptoms of strep throat?

The symptoms of strep throat include:

How does strep throat spread?

Strep throat is spread by:

  • Close contact with an infected person
  • Sharing an infected person’s personal items

Diagnosis and Tests

How do I know if my child has strep throat?

Visit your healthcare provider if the symptoms suggest strep throat. Your child will be examined and may be given a strep test (throat culture). Viral illnesses can have the same symptoms as strep throat. This is why it’s important that a throat swab be done to confirm the presence of the Strep bacteria in the throat.

What is a strep test?

A strep test looks for Streptococcus bacteria in the throat. The test is painless and takes very little time. The tip of a cotton swab is used to wipe the back of the throat. The swab is then tested.

The rapid strep test takes approximately 20 minutes. If the test is positive (the Streptococcus bacteria is found), the patient has strep throat. If the test is negative (no signs of Streptococcus), the doctor may send the throat swab to a laboratory to double-check the results. Some doctors may not do a rapid strep test and instead just send the throat swab to the laboratory.

Management and Treatment

How is strep throat treated?

Strep throat is treated using antibiotics. An antibiotic is a type of medicine that kills the bacteria that cause the infection.

Antibiotics are often taken as pills or given as a shot. Penicillin and amoxicillin are common antibiotics used to treat strep throat. Other antibiotics are ordered for people who are allergic to penicillin.

Your healthcare provider may give your child a shot or prescribe an antibiotic in either pill or liquid form. The pills or liquid are usually taken for 10 days. Follow your healthcare provider’s instructions. Your child should take all of the medication, even if he or she feels better. The bacteria can still be alive even if your child feels okay.

What can be done to relieve the pain of strep throat?

Your child should:

  • Drink soothing liquids, such as warm tea.
  • Take a pain reliever, such as acetaminophen (Tylenol®).

Aspirin should not be given to children. Aspirin can cause Reye’s syndrome, a life-threatening illness, in children and adolescents who have fevers.

Other sore throats don’t need special medicine, so why does strep throat?

Most sore throats are caused by viruses, which cannot be cured with medicine; you can only relieve the aches and pains. Viruses heal on their own and cannot be cured with antibiotics or other medicines.

Strep throat is caused by a bacterium. Infections caused by bacteria can be treated with antibiotics. Strep throat can lead to more serious illnesses, so it’s important to get it treated.

Can I take antibiotics I already have in the house for strep throat?

You should never take medicines left over from an earlier illness or give a leftover medicine to your children. Leftover antibiotics can also make strep throat more difficult to treat and can cause serious side effects.

Outlook / Prognosis

How soon will the person who has strep throat feel better?

Your child should feel better within a day or two after treatment begins.

When can my child return to school after treatment for strep throat?

Your child can return to regular activities, including school attendance, 24 hours after receiving the shot or beginning the antibiotic, if his or her temperature is normal.

Living With

What if my child is not getting better after being treated for strep throat?

If your child is not getting better, let your healthcare provider know right away. Your child should not stop taking his or her medicine, unless your healthcare provider tells you to.

Call your healthcare provider if your child is not improving one to two days after starting the antibiotic. You should also call if your child has any of these symptoms:

  • Fever one or two days after feeling better
  • Nausea or vomiting
  • Earache
  • Headache
  • Skin rash
  • Cough
  • Swollen glands
  • Painful joints
  • Shortness of breath
  • Dark urine, rash, or chest pain (may occur three to four weeks later)

Swollen glands – NHS

Swollen glands are a sign the body is fighting an infection. They usually get better by themselves within 2 weeks.

Check if your glands are swollen

Swollen glands feel like tender, painful lumps:

  • on each side of the neck
  • under the chin
  • in the armpits
  • around the groin

Glands (known as lymph glands or lymph nodes) swell near an infection to help your body fight it.

Sometimes a gland on just one side of the body swells.

You might also have other symptoms, such as a sore throat, cough or high temperature.

Things you can do yourself

Swollen glands should go down within 2 weeks.

You can help to ease the symptoms by:

Non-urgent advice: See a GP if:

  • your swollen glands are getting bigger or they have not gone down within 2 weeks
  • they feel hard or do not move when you press them
  • you’re having night sweats or have a very high temperature (you feel hot and shivery) for more than 3 or 4 days
  • you have swollen glands and no other signs of illness or infection
  • you have swollen lymph glands just above or below your collar bone (the bone that runs from your breastbone to each of your shoulders)

Urgent advice: Get advice from 111 now if:

  • you have swollen glands and you’re finding it very difficult to swallow

111 will tell you what to do. They can arrange a phone call from a nurse or doctor if you need one.

Go to 111.nhs.uk or call 111.

Other ways to get help

Get an urgent GP appointment

A GP may be able to treat you.

Ask your GP surgery for an urgent appointment.

Causes of swollen glands

Do not self-diagnose – see a GP if you’re worried.

Swollen glands are:

  • often caused by common illnesses like colds, tonsillitis and ear or throat infections
  • sometimes caused by viral infections such as glandular fever
  • rarely caused by anything more serious, like cancer of the blood system (leukaemia) or lymph system (lymphoma)

A GP will be able to recommend treatment depending on the cause, which might include antibiotics (antibiotics do not work on viral infections).

Page last reviewed: 25 September 2020
Next review due: 25 September 2023

Swollen glands | NHS inform

Swollen lymph glands are usually a sign of infection and tend to go down when you recover.  However, they can sometimes have a more serious cause and may need to be seen by a doctor.

Lymph glands (also called lymph nodes) are pea-sized lumps of tissue that contain white blood cells. These help to fight bacteria, viruses and anything else that causes infection. They are an important part of the immune system and are found throughout the body.

The glands can swell to more than a few centimetres in response to infection or disease. Swollen glands, known medically as lymphadenopathy, may be felt under the chin or in the neck, armpits or groin, where they can be found in larger clumps.

Many different types of infection can cause swollen glands, such as a cold or glandular fever. Less commonly, swollen glands may be caused by a non-infectious condition, such as rheumatoid arthritis or even cancer.

When to see your GP

See your GP if you have swollen glands and:

  • they haven’t gone down within a few weeks or are getting bigger
  • they feel hard or don’t move when you press them
  • you also have a sore throat and find it difficult to swallow or breathe
  • you also have unexplained weight loss, night sweats or a persistent high temperature (fever)
  • you don’t have an obvious infection and don’t feel unwell

If necessary, your GP may request some tests to help identify the cause. These can include blood tests, an ultrasound scan or computerised tomography (CT) scan, and/or a biopsy (where a small sample of fluid is taken from the swelling and tested).

Common causes of swollen glands

Swollen glands are usually caused by a relatively minor viral or bacterial infection, including:

The glands in the affected area will often become suddenly tender or painful. You may also have additional symptoms, such as a sore throat, cough, or fever.

These infections usually clear up on their own, and the swollen glands will soon go down. You will normally just need to drink plenty of fluids, rest and relieve the symptoms at home using over-the-counter medicines such as paracetamol or ibuprofen.

See your GP if your symptoms don’t improve within a few weeks.

Less common causes of swollen glands

Less often, swollen glands may be the result of:

  • rubella – a viral infection that causes a red-pink skin rash made up of small spots
  • measles – a highly infectious viral illness that causes distinctive red or brown spots on the skin  
  • cytomegalovirus (CMV) – a common virus spread through bodily fluids, such as saliva and urine
  • tuberculosis (TB) – a bacterial infection spread that causes a persistent cough 
  • syphilis – a bacterial infection usually caught by having sex with someone who is infected
  • cat scratch disease – a bacterial infection caused by a scratch from an infected cat
  • HIV – a virus that attacks the immune system and weakens your ability to fight infections
  • lupus – where the immune system starts to attack the body’s joints, skin, blood cells and organs
  • rheumatoid arthritis – where the immune system starts to attack the tissue lining the joints
  • sarcoidosis – where small patches of red and swollen tissue, called granulomas, develop in the organs of the body

Click on the links above for more information on these conditions.

Could it be cancer?

Occasionally, swollen glands can be a sign of cancer that has started elsewhere in the body and spread to the lymph nodes, or a type of cancer affecting the white blood cells, such as non-Hodgkin lymphoma or chronic lymphocytic leukaemia.

Swollen glands are more likely to be caused by cancer if they:

  • don’t go away within a few weeks and slowly get bigger
  • are painless and firm or hard when you touch them
  • occur with other symptoms, such as night sweats and weight loss

See your GP if your glands have been swollen for more than a couple of weeks. The swelling is probably the result of a non-cancerous condition, but it’s best to be sure by getting a proper diagnosis.

Neck lymph node ultrasound and biopsy | Salivary gland cancer

This test is also sometimes called a fine needle aspiration or needle biopsy.

You might have this test to find out if your cancer has spread from the salivary glands to the lymph nodes in your neck. You might have this test if your doctor has seen changes in the lymph nodes in your neck on a CT scan.

What is a lymph node?

A lymph node is part of the lymphatic system. This is a network of thin tubes (vessels) and nodes that carry a clear fluid called lymph around the body. This is an important part of the immune system. It plays a role in fighting infection and destroying old or abnormal cells.

The nodes are bean shaped structures that filter the lymph fluid and trap bacteria and viruses, and cancer cells.

What happens

Your doctor uses an ultrasound scanner to help them take a small amount of lymph node tissue using a fine needle.

Ultrasound scans use high frequency sound waves to create a picture of a part of the body. The ultrasound scanner has a microphone that gives off sound waves. The sound waves bounce off the organs inside your body, and are picked up again by the microphone. The microphone links to a computer. This turns the sound waves into a picture.

You normally have this test as an outpatient procedure in the imaging department of the hospital.

Preparing for the test

Check your appointment letter for exactly how to prepare. You sign a consent form before the test. This is a good time to ask the doctor any questions that you have.

You should be able to eat and drink normally before the test.

Take your medicines as normal unless you’re told otherwise. If you’re taking medicines to thin your blood, your doctor might ask you to stop them beforehand.

Having the test

When you arrive at the department, a nurse might ask you to change into a gown. Then they show you to the test room.

You will have the test lying down on the couch. The doctor or a sonographer puts a cold lubricating gel on the skin by the lymph nodes. A sonographer is a trained professional who specialises in ultrasound scanning.

They put a handheld ultrasound probe on your skin. The gel helps the probe to move over your skin. You may feel a little pressure when they move the probe over your skin. Tell them if it is uncomfortable. It shouldn’t hurt.

This will be the end of your test if your lymph nodes look normal. Any changes on the ultrasound need looking into further.

If you need a biopsy, your doctor cleans your skin and may numb the area with local anaesthetic. They put a fine needle through your skin and using a syringe they pull up some cells and fluid. Or they take out some tissue through a needle. They send the samples to a laboratory to be looked at under a microscope.

The test takes about 15 to 20 minutes.

After your test

You should be able to go home the same day.

You have a small dressing over the site. Ask your doctor or nurse how to look after this for the next few days.

Getting your results

You should get your results within 1 or 2 weeks. Contact your doctor if you haven’t heard anything after this time.

Waiting for test results or for further tests can be very worrying. You might have contact details for a specialist nurse and you can contact them for information if you need to. It may help to talk to a close friend or relative about how you feel.

For support and information, you can also contact the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, from Monday to Friday.

Possible risks

A lymph node biopsy is a safe procedure but your doctor or nurse will tell you who to contact if you have any problems after your test. Your doctors make sure the benefits of having a lymph node biopsy outweigh any possible risks.


You might have some mild pain or discomfort around the site. Taking a painkiller such as paracetamol can help.


There is a small risk of bleeding. Your doctor can normally control this by pressing on the area. If there is a lot of blood from the biopsy site, let your doctor know straight away or go to your nearest accident and emergency department (A&E).


Contact your GP or the hospital if you have a high temperature or feel unwell. Or if there is redness, swelling or fluid (discharge) at the biopsy site.

Swollen lymph nodes | UF Health, University of Florida Health


Lymph nodes are present throughout your body. They are an important part of your immune system. Lymph nodes help your body recognize and fight germs, infections, and other foreign substances.

The term “swollen glands” refers to enlargement of one or more lymph nodes. The medical name for swollen lymph nodes is lymphadenopathy.

In a child, a node is considered enlarged if it is more than 1 centimeter (0.4 inch) wide.

Alternative Names

Swollen glands; Glands – swollen; Lymph nodes – swollen; Lymphadenopathy


Common areas where the lymph nodes can be felt (with the fingers) include:

  • Groin
  • Armpit
  • Neck (there is a chain of lymph nodes on either side of the front of the neck, both sides of the neck, and down each side of the back of the neck)
  • Under the jaw and chin
  • Behind the ears
  • On the back of the head


Infections are the most common cause of swollen lymph nodes. Infections that can cause them include:

Immune or autoimmune disorders that can cause swollen lymph nodes are:

Cancers that can cause swollen lymph nodes include:

Certain medicines can cause swollen lymph nodes, including:

Which lymph nodes are swollen depends on the cause and the body parts involved. Swollen lymph nodes that appear suddenly and are painful are usually due to injury or infection. Slow, painless swelling may be due to cancer or a tumor.

Home Care

Painful lymph nodes are generally a sign that your body is fighting an infection. The soreness usually goes away in a couple of days, without treatment. The lymph node may not return to its normal size for several weeks.

When to Contact a Medical Professional

Call your health care provider if:

  • Your lymph nodes do not get smaller after several weeks or they continue to get larger.
  • They are red and tender.
  • They feel hard, irregular, or fixed in place.
  • You have fever, night sweats, or unexplained weight loss.
  • Any node in a child is larger than 1 centimeter (a little less than half inch) in diameter.

What to Expect at Your Office Visit

Your provider will perform a physical examination and ask about your medical history and symptoms. Examples of questions that may be asked include:

  • When the swelling began
  • If the swelling came on suddenly
  • Whether any nodes are painful when pressed

The following tests may be done:

Treatment depends on the cause of the swollen nodes.



Armitage JO, Bierman PJ. Approach to the patient with lymphadenopathy and splenomegaly. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 168.

Tower RL, Camitta BM. Lymphadenopathy. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 490.

Swollen Lymph Nodes | PeaceHealth

Topic Overview

What are lymph nodes?

Lymph nodes are small, bean-shaped glands throughout the body. They are part of the lymph system, which carries fluid (lymph fluid), nutrients, and waste material between the body tissues and the bloodstream.

The lymph system is an important part of the immune system, the body’s defense system against disease. The lymph nodes filter lymph fluid as it flows through them, trapping bacteria, viruses, and other foreign substances, which are then destroyed by special white blood cells called lymphocytes.

Lymph nodes may be found singly or in groups. And they may be as small as the head of a pin or as large as an olive. Groups of lymph nodes can be felt in the neck, groin, and underarms. Lymph nodes generally are not tender or painful. Most lymph nodes in the body cannot be felt.

What causes swollen lymph nodes?

Lymph nodes often swell in one location when a problem such as an injury, infection, or tumor develops in or near the lymph node. Which lymph nodes are swollen can help identify the problem.

  • The glands on either side of the neck, under the jaw, or behind the ears commonly swell when you have a cold or sore throat. Glands can also swell following an injury, such as a cut or bite, near the gland or when a tumor or infection occurs in the mouth, head, or neck.
  • Glands in the armpit (axillary lymph nodes) may swell from an injury or infection to the arm or hand. A rare cause of axillary swelling may be breast cancer or lymphoma.
  • The lymph nodes in the groin (femoral or inguinal lymph nodes) may swell from an injury or infection in the foot, leg, groin, or genitals. In rare cases, testicular cancer, lymphoma, or melanoma may cause a lump in this area.
  • Glands above the collarbone (supraclavicular lymph nodes) may swell from an infection or tumor in the areas of the lungs, breasts, neck, or abdomen.

Common sites for swollen lymph nodes include the neck, groin, and underarms.

What does it mean when lymph nodes swell in two or more areas of the body?

When lymph nodes swell in two or more areas of the body, it is called generalized lymphadenopathy. This may be caused by:

  • A viral illness, such as measles, rubella, chickenpox (varicella), or mumps.
  • Mononucleosis(Epstein-Barr virus), which results in fever, sore throat, and fatigue, or cytomegalovirus (CMV), a viral infection that causes symptoms similar to those of mononucleosis.
  • A bacterial illness, such as strep throat (caused by the streptococcus bacterium) or Lyme disease (a bacterial infection spread by certain types of ticks).
  • Side effects of phenytoin (Dilantin), a medicine used to prevent seizures.
  • Side effects of measles-mumps-rubella (MMR) vaccination.
  • Cancer, such as leukemia, Hodgkin disease, and non-Hodgkin lymphoma.
  • Acquired immunodeficiency syndrome (AIDS), which develops after a person contracts HIV (human immunodeficiency virus). This virus attacks the immune system, making it difficult for the body to fight off infection and some disease.
  • Syphilis, a sexually transmitted infection.

How are swollen lymph nodes treated?

Treatment for swollen glands focuses on treating the cause. For example, a bacterial infection may be treated with antibiotics, while a viral infection often goes away on its own. If cancer is suspected, a biopsy may be done to confirm the diagnosis.

Any swollen lymph nodes that don’t go away or return to normal size within about a month should be checked by your doctor.

How long will lymph nodes remain swollen?

Lymph nodes may remain swollen or firm long after an initial infection is gone. This is especially true in children, whose glands may decrease in size while remaining firm and visible for many weeks.

Lymphoma Action | Symptoms of lymphoma

Common symptoms of lymphoma

Watch Dr Andrew Davies, Consultant in Medical Oncology, talk about the most common symptoms of lymphoma

There are over 60 types of lymphoma, broadly divided into Hodgkin lymphoma and non-Hodgkin lymphoma. These lymphomas can start almost anywhere in the body and can have many different symptoms. The exact symptoms they cause depend on the type of lymphoma and where it is in the body.

Most of the symptoms of lymphoma can also be symptoms of many other illnesses. These are often mild illnesses such as infections but they can sometimes be more serious conditions.

Because the symptoms of lymphoma are very general, it can sometimes be difficult to diagnose.

The most common symptoms of lymphoma are:

Swollen lymph nodes

The most common sign of lymphoma is a lump or lumps, usually in the neck, armpit or groin. They are usually painless. These lumps are swollen lymph nodes. Lots of things that aren’t lymphoma can cause lumps – and not all lymphomas cause obvious lumps.




Fatigue means being exhausted for no obvious reason or feeling washed out after doing very little. It is not the same as normal tiredness; fatigue is overwhelming and doesn’t usually feel better after sleep or rest. Fatigue can be caused by many different things. Lymphoma is just one of them.


Unexplained weight loss

Unexplained weight loss means losing a lot of weight quite quickly when you’re not trying to. It can be a symptom of lymphoma – but it can be caused by other things, too.




Lymphoma can cause night sweats that make your nightclothes and bed sheets soaking wet. The night sweats are often described as ‘drenching’. They can happen with any type of lymphoma and can also happen during the day. Night sweats can also have causes other than lymphoma.




Itching (‘pruritus’) without a rash can be a symptom of lymphoma but it can have many other causes. It can be very troublesome, particularly in hot weather.



Lymphoma affects everybody differently. For example:

  • You might have lots of symptoms, only a few symptoms, or no symptoms at all. (Sometimes lymphoma is discovered during tests for something else.)
  • You might have symptoms in one area (local symptoms) or symptoms that affect your whole body (systemic symptoms).
  • You might feel well or you might become very unwell quickly.

Local symptoms and systemic symptoms

Some symptoms of lymphoma affect the area in and around the lymphoma itself. These are called ‘local symptoms’. The most common local symptom is a swollen lymph node or nodes. Other local symptoms are caused by swollen nodes pressing on nearby tissues. The symptoms you experience depend on where the swollen lymph nodes are. You might have:

Some symptoms of lymphoma affect your whole body. These are called ‘systemic symptoms’. They are caused by the chemicals produced by the lymphoma itself and your body’s reaction to the lymphoma. Systemic symptoms include:

Around 1 in 4 people with Hodgkin lymphoma and 1 in 3 people with high-grade non-Hodgkin lymphoma may have systemic symptoms. Systemic symptoms are less common in people with low-grade non-Hodgkin lymphoma. 

What should I do if I have symptoms of lymphoma?

Most of the symptoms of lymphoma can occur in other, more common illnesses as well. Having one or more of these symptoms doesn’t necessarily mean you have lymphoma.

If you think you might have lymphoma, or you are worried about any aspect of your health, visit your GP.

You can also find helpful information and advice about your health on NHS Choices or Patient.Info.

If you have a diagnosis of lymphoma and you’re finding it difficult to manage your symptoms, we have some general guidance for coping with some of the common symptoms of lymphoma. Speak to your doctor for advice about managing your individual symptoms.

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B symptoms

You may hear the term ‘B symptoms’, especially when your lymphoma is being staged. Staging is the process of working out how many different parts of your body are affected by lymphoma. The following symptoms are referred to as B symptoms:

Doctors will take into account whether you have any B symptoms when they plan your treatment.

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Swollen lymph nodes

Lymph nodes help to fight infection. They can become swollen for lots of reasons, even when they’re working as they should.

A swollen lymph node or nodes is the most common symptom of lymphoma – but lymphoma is not the most common cause of swollen lymph nodes. Most people who have swollen lymph nodes do not have lymphoma. More common causes of swollen lymph nodes include:

  • infections, such as coughs, colds, ear and throat infections
  • illnesses that affect the immune system, such as rheumatoid arthritis
  • severe skin diseases such as eczema or psoriasis
  • some medicines.

Swollen lymph nodes caused by infections are usually sensitive or painful to the touch. The swelling normally goes down within 2 or 3 weeks.

Swollen lymph nodes caused by lymphoma:

  • are most commonly found in the neck, armpit or groin
  • are usually smooth and round
  • tend to be mobile (they move out of the way when you press on them)
  • have a ‘rubbery’ texture
  • are usually painless – although they can sometimes ache or cause pain in nearby areas (for example, if they’re pressing on a nerve)
  • rarely, can become painful a few minutes after drinking alcohol (this affects up to 5 in 100 people with Hodgkin lymphoma and is probably due to blood vessels in the lymph node widening in response to alcohol).

Having swollen lymph nodes does not necessarily mean you have lymphoma. If you notice a lump that doesn’t go away within 2 to 3 weeks, or you find that a lump is getting bigger, see your doctor.

Lymph nodes in the neck, armpit or groin are close to the surface of the skin and are easy to see and feel. Others, such as those deep inside the abdomen (stomach) or the chest, can’t be felt from the outside. If these swell, they might cause pain if they press on internal tissues, or they might only be found on a scan.

Around 2 in 3 people with lymphoma have swollen lymph nodes that they can feel. It might be the only sign that anything is wrong.

You might have swollen lymph nodes:

  • in just one area of your body, which can happen with any type of lymphoma
  • spread throughout your body (known as ‘generalised lymphadenopathy’), which is more common in non-Hodgkin lymphoma than Hodgkin lymphoma.

Swollen lymph nodes in lymphoma are caused by a build-up of cancerous cells in the lymph nodes. Sometimes the disease is active, making lots of cancerous cells, while at other times it quietens down and some of the cells die. This means the swollen lymph nodes can sometimes grow and shrink, especially in people with low-grade non-Hodgkin lymphoma. 

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Fatigue is overwhelming physical, emotional or mental exhaustion for no obvious reason. It isn’t relieved by sleep or rest. People describe it as feeling drained of energy, or being so tired you can’t do your normal activities. Sometimes even simple daily tasks, such as getting dressed, can feel too much.

Many conditions can make you feel fatigued, including anaemia (low red blood cell count), underactive thyroid, depression and anxiety, chronic fatigue syndrome and glandular fever. If you feel fatigued, it does not necessarily mean that you have lymphoma.

Exactly why lymphoma causes fatigue is not known. It is likely that there are several reasons for it.

If you are experiencing fatigue, speak to your doctor. We also have some suggestions that may help you cope with fatigue.

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Unexplained weight loss

‘Unexplained’ weight loss means losing weight over a short period of time without trying to. The NHS advises that you see your GP if you lose more than 5% of your normal body weight over 6 to 12 months. For an average person, this means losing around half a stone (7lbs) or more. People with lymphoma might lose more than this: over 10% of their body weight within 6 months. For example, a person who usually weighs 11 stone (70kg) might lose 15lbs (7kg) or more.

Weight loss can happen in people with lymphoma because cancerous cells use up your energy resources. In addition, your body uses energy trying to get rid of the cancerous cells. Weight loss is more common with lymphomas that grow very quickly and put a sudden demand on your body.

As with many other symptoms, weight loss can happen for a lot of other reasons, such as stress, depression, diseases of the digestive tract, or overactive thyroid. Lymphoma is just one of the possible causes of unexplained weight loss.

Contact your doctor if you lose more than 5% of your body weight over 6 to 12 months without trying to.

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Night sweats

If you have night sweats, it does not necessarily mean you have lymphoma. Night sweats can also be caused by other conditions, such as a viral infection, anxiety, menopause or some medicines.

Doctors don’t know exactly why lymphoma causes night sweats. One possible reason is that they are your body’s natural reaction to your temperature rising above a normal level (fever). Night sweats may also be a response to some of the chemicals produced by the lymphoma cells.

Lymphoma can cause night sweats that are severe enough to make your nightclothes and bed linen soaking wet. They are often described as ‘drenching’. They can happen with any type of lymphoma. Although they are usually called night sweats, they can also sometimes happen during the day.

There are things you can do that might help you to cope with night sweats, but do also speak to your medical team for advice.

Contact your doctor if you have night sweats that regularly wake you up or if you also have other symptoms, such as fever or unexplained weight loss.

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Itching (also known as ‘pruritus’) can be caused by many different conditions, including allergies, skin conditions such as eczema, skin infections or menopause. It is not usually serious. Although itching is common in people with lymphoma, having itchy skin does not necessarily mean you have lymphoma.

Itching affects around 1 in 3 people with Hodgkin lymphoma and 1 in 10 people with non-Hodgkin lymphoma. It can affect:

  • areas of skin near lymph nodes that are affected by lymphoma
  • patches of skin lymphoma
  • the lower legs
  • the whole body.

Itching in lymphoma is thought to be due to chemicals released by your immune system, as part of its reaction against the lymphoma cells. These chemicals irritate the nerves in your skin and make it itch.

Itching due to lymphoma can be severe. It may also cause a burning sensation. It is not usually associated with an obvious rash unless you have skin lymphoma.

Itching can be very difficult to tolerate, especially in hot weather. It is usually worse at night in bed. If you have a diagnosis of lymphoma and you are struggling to cope with itching, there are some things you could try that might help. Also speak to your medical team for advice.

Contact your GP if you have itching that affects your whole body or lasts for more than 2 weeks.

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Fever is a rise in your body temperature above the normal level. It is almost always caused by an infection, but there are a few other much less common causes, including lymphoma.

Lymphoma causes fevers because the lymphoma cells produce chemicals that raise your body temperature. Lymphoma usually causes mild fevers – a body temperature over 38°C or 100.4°F. These are described as ‘low-grade’ fevers. They usually come and go.

Contact your doctor if you have a fever without an obvious infection that lasts for 2 weeks or more.

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Difficulty getting over infections

Having lymphoma can mean that your immune system doesn’t work as well as it should.

Normally, white blood cells fight infections. If you have lymphoma, cancerous white blood cells (that make up the lymphoma) are produced instead of the healthy, ‘good’ white blood cells. This can make you pick up infections more easily. The infections could be more severe or last for longer than they would normally.

Infections often cause a high temperature and make you feel hot and shivery. Other symptoms depend on where in your body you have the infection – for example, you might have an earache, a cough, a sore throat, pain when you have a wee, or sickness and diarrhoea.

See your GP if you’re worried that you’re not getting better after a minor infection.

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Chest symptoms

Any type of lymphoma can cause swollen lymph nodes in the chest but they are especially common in Hodgkin lymphoma and some types of high-grade non-Hodgkin lymphoma (where the cells appear to be dividing quickly). Around 1 in 2 people with Hodgkin lymphoma have swollen lymph nodes in their chest.

Swollen lymph nodes in the chest can press on your airways, lungs, or blood vessels. They can also make fluid collect around your lungs. This can cause:

  • a dry cough
  • shortness of breath
  • noisy breathing
  • pain behind the breastbone
  • a feeling of pressure in the chest.

These symptoms may be worse when you lie down.

It is important to remember that all these symptoms can happen with many other illnesses, especially lung diseases. Having these symptoms doesn’t necessarily mean you have lymphoma.

Visit your GP if you’ve had a cough lasting more than 3 weeks or shortness of breath lasting more than 4 weeks.

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Abdominal (tummy) symptoms

Lymphoma can develop in lymph nodes in the abdomen (tummy) or lymphatic tissue in your liver or spleen. It can also develop outside your lymphatic system (‘extranodal’ lymphoma). The gut is the most common place for extranodal lymphoma to develop.

Symptoms of lymphoma in the tummy depend on what part of the tummy is involved. For example:

  • If your spleen is very swollen, you might have pain behind your ribs on the left side, or you might feel bloated or full after eating only small amounts of food. You or your doctor might be able to feel the swollen spleen as a lump in the top left hand side of your tummy.
  • If you have lymphoma affecting your liver, your tummy might become swollen, the whites of your eyes and your skin might develop a yellow tinge (jaundice), or you might notice a build-up of fluid in your abdomen. This can make you feel bloated.
  • Lymphoma in the stomach can cause inflammation of the stomach lining (gastritis), which may cause pain, nausea (feeling sick) and vomiting.
  • Lymphoma in the bowel can cause abdominal pain, diarrhoea or constipation.

See your GP if you have blood in your poo, diarrhoea for more than 7 days, green or yellow vomit, vomiting lasting more than 2 days, or if you are dehydrated and you are unable to keep liquids down.

See your GP urgently if your skin or the whites of your eyes look yellow. 

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Swollen lymph nodes themselves are not usually painful but lymphoma can press on the tissues around the nodes and cause pain. Where you feel the pain depends on where the lymphoma is.

Lymphoma in the bone itself is rare but when it does happen, it can cause pain in the affected bone. It is more common to have lymphoma in the bone marrow (the spongy part in the middle of some of our larger bones), but this doesn’t usually cause pain.

If you are worried about any aspect of your health, visit your GP.

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Skin symptoms

If you have skin lymphoma, you might get symptoms on your skin such as:

  • flat red patches
  • raised plaques with a scaly surface
  • lumps.

Lymphoma in the skin can look a lot like other skin conditions, such as eczema or psoriasis. Skin lymphomas are usually low-grade lymphomas. Sometimes other parts of the body are also affected but for most people with skin lymphoma, it stays in the skin.

If you have a diagnosis of skin lymphoma and you are finding it hard to cope with your symptoms, there are some things you could try that might help. Also speak to your medical team for advice.

Contact your GP urgently if you have a rash that starts suddenly and spreads quickly, a rash that is all over your body, or a rash with other symptoms such as pain, fever or breathlessness.

Visit your GP if you have a rash that doesn’t go away within a few days or that is interfering with your normal life.

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Brain and nerve symptoms

Lymphoma that starts in or spreads to the brain or nervous system is very uncommon but can cause symptoms such as headaches, fits (seizures), memory problems, dizziness, sight problems, numbness, tingling or weakness in a limb. Many other conditions can also cause these symptoms, such as epilepsy, migraine or stroke.

Contact your GP if you have any of these symptoms.

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Swelling in the arms or legs

Swollen lymph nodes can sometimes block the lymphatic vessels that run through the body. This stops fluid called lymph draining properly from the body’s tissues. This fluid can build up, causing swelling and feelings of tightness, heaviness or soreness. This is called ‘lymphoedema’. It usually affects an arm or a leg, although other areas of the body can be affected depending on where your lymphoma is. Other conditions, such as infection, injury, or some types of surgery, can also cause lymphoedema.

It is important to know that lymphoedema is very uncommon and usually gets better once treatment is started. If you are finding it hard to cope with, there are some things you can do that might help.

See your GP if you have any symptoms of lymphoedema.

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Around 1 in 3 people with lymphoma have anaemia (low number of red blood cells). This can make you feel tired and breathless because your body has to work harder than usual to get enough oxygen. You might look pale and you may have heart palpitations.

Anaemia may be caused by lymphoma in the bone marrow or by bleeding due to lymphoma in the gut. If you have a swollen spleen, anaemia can also be caused by red blood cells collecting in the spleen or being destroyed in the spleen. Lots of other, less serious, conditions can also cause anaemia, such as heavy periods, pregnancy or stomach ulcers.

Contact your GP if you think you might be anaemic.

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Seeing your GP

You might find it helpful to keep a note of your symptoms and how they’re affecting you. You could have this with you when you speak to your GP so that you remember everything you want to discuss.

If your GP suspects lymphoma, you might be referred for tests and scans. If, at any time you feel a second opinion would be helpful, you are entitled to ask for one. 

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Prophylactic central neck dissection in papillary thyroid carcinomas (literature review and own research)

Prophylactic central neck dissection in papillary thyroid carcinomas (literature review and own research)

Kovalenko A.E., Bolgov M.Yu., Zinych P.P., Suprun I.S.

The issue of performing preventive central neck dissection in papillary thyroid carcinoma is one of the most controversial in the world of endocrine surgery.Randomized studies have confirmed that in cases of detection of metastatic lesions of the lymph nodes of the neck, carrying out a radical dissection of the appropriate length significantly reduces the risk of developing locoregional recurrence and improves survival [1, 2, 3, 4]. To date, it has not been proven whether prophylactic central neck dissection will improve the rates of recurrence and survival, allowing the detection of micrometastases that cannot be diagnosed before surgery.

The question of the difficulties of preoperative ultrasound assessment of the lymph nodes of the VI level of the neck due to their hidden location behind and below the thyroid gland, in contrast to the lymph nodes of the II, III, IV, V levels, is discussed.Preoperative confirmation of the presence of metastases by ultrasound, cytological and radiological methods is possible only in 1/3 of patients with papillary carcinomas. It is assumed that among the remaining 2/3 of patients without obvious preoperative metastatic lesions, postoperative morphological examination of dissected nodes will reveal metastases in 30-80% of cases [1]. The frequency of morphological detection of micrometastases of papillary thyroid carcinomas with negative preoperative examination reaches 50% and 30% in small carcinomas up to 7 mm in diameter [2,3].

In this regard, a large number of studies have appeared confirming that the implementation of preventive central cervical dissection in papillary thyroid carcinoma reduces the risk of developing local recurrence, but at the same time leads to an increase in the frequency of transient hypocalcemia [1, 5, 6, 7].

Ambiguous results were obtained when assessing postoperative thyroglobulin levels depending on the performed central dissection of the neck.A group of authors (Sywak M. 2006) noted a significantly low level of thyroglobulin in patients during central dissection compared with patients without intervention on the lymphatic collectors [8]. This opinion is not confirmed by all authors. It has been suggested that the effective decrease in thyroglobulin may depend on many factors: the completeness of thyroidectomy, depending on the surgeon, the nature of radioiodine ablation, and the volume of cervical dissection [9, 10].

Analysis of studies in recent years has shown a decrease in the frequency of relapses and better survival rates in patients who underwent thyroidectomy with bilateral level VI lymph node dissection.Barczynski M. confirmed a 10-year disease-free survival rate of 98% among patients with neck dissection versus 92.5% in the group without dissection [11].

Terminology of surgical anatomy

Central cervical dissection (CCND). This is the removal or dissection of lymph nodes and fatty tissue contained in the central part of the neck, while preserving the great vessels, nerves and visceral structures located inside and along the edge of the anatomical space.The dissection involves the central level VI of the neck and may extend to the central level VII of the neck. It can be unilateral or bilateral, with preservation or removal of the thymus. Dissection can be performed for prophylactic or therapeutic purposes.

Central section of the VI level of the neck. Contains the thyroid gland and adjacent pre-laryngeal, pretracheal and paratracheal lymph nodes. From above, the compartment is bounded by the hyoid bone, from below – by the jugular notch of the sternum, laterally on both sides – by the membranes of the carotid artery.

Central section of the VII level of the neck. Contains the upper mediastinal lymph nodes from the jugular notch of the sternum from above to the brachiocephalic trunk from top to bottom. The section is bounded laterally by the sheath of the carotid and unnamed artery on the right side and the sheath of the left carotid artery on the left. Ventrally, calving is limited by the sternum and dorsally by the trachea.

Unilateral central cervical dissection. Central cervical dissection of pre-laryngeal, pretracheal and one (ipsilateral) paratracheal lymph node groups.

Bilateral central cervical dissection. Central cervical dissection of prelaryngeal, pretracheal and both paratracheal groups of lymph nodes.

Prophylactic Central Neck Dissection (pCCND). Central cervical dissection is performed when lymph node metastases are not detected by preoperative imaging or intraoperative visual revision (Clinical N 0 ).

Therapeutic central cervical dissection (tCCND).Central cervical dissection to remove clinically or radiologically visible metastatic or suspected metastatic lymph nodes in the central region.

Surgical anatomy of the central part of the neck and its implications for prognosis

Performing an oncological operation requires knowledge of the critical points of the surgical anatomy, which affect both postoperative complications and the radicality of treatment.

Role and Predictive Significance of Delphic Lymph Nodes

Most authors note the importance of the lesion of the precricoid laryngeal nodes in the midline of the neck (Delphic lymph nodes) in the staging and prognosis of the disease, due to the fact that the intrathyroid lymph circulation is largely drained through the upper poles of the thyroid gland.The frequency of damage to the Delphic lymph nodes in thyroid carcinoma is high and reaches 25% [12,13]. The presence of metastases in the Delphic nodes, even of small sizes of 3-4 mm, has a high prognostic value in assessing further metastasis in the central section (N 1 ) – three times more often [13] and in the lateral section (N 1b ) – nine times more often [14]. Delphic lymph nodes are included in all CCND types and should be removed in all thyroid carcinoma surgeries along with any residual pyramidal tissue, thereby minimizing the risk of local recurrence.

Paratracheal lymph nodes

Surgical anatomy involves the division of the paratracheal lymph nodes in the central compartment of the neck into left and right.

Left paratracheal lymph nodes with fiber levels VI and VII are located anterior to the recurrent laryngeal nerve and esophagus, cranial from the thymus, lateral to the trachea and medial to the common carotid artery [15,16].

The right paratracheal lymph nodes with fiber levels VI and VII are located anterior and posterior to the recurrent laryngeal nerve, often occupying the entire para-esophageal region.In order to complete the dissection on the right, it is necessary to remember about the removal of the right paratracheal lymph nodes located not only in front of the nerve, but also behind it [15]. When removing both the anterior and posterior groups of the right paratracheal lymph nodes, isolation and transposition of the right recurrent laryngeal nerve are provided throughout. The paratracheal lymph nodes of the posterior region are mobilized anteriorly and move under the nerve in the direction of the anterior lymph nodes and tissue from the level of the trunk a.thyroidea inferior and below [17].

Right-sided paratracheal lymph nodes, especially the posterior group, are the most frequent site of residual and recurrent metastasis, which forces them to be dissected at almost every thyroidectomy. In addition, as a rule, it is not possible to assess their lesion without excision and morphological examination, which once again confirms the validity of the concept of preventive central dissection of lymph nodes [18, 19].

Thymus and pretracheal lymph nodes

The cervical sections of the upper thymus poles lie within the central compartment of the neck and provide a good guideline for the surgeon to determine the localization of the lower parathyroid glands in the thyrothymic tract zone. It is advisable to preserve the thymus during prophylactic central dissection of the neck, using its upper poles for anatomical reference [20,16]. The lower parathyroid gland, especially on the side of the tumor lesion, it is desirable to isolate and preserve on the vascular pedicle, with the remnant of the upper thymus, and retracted downward, controlling the nature of ischemic lesions in it [15].

Postoperative complications of prophylactic central cervical dissection

Most researchers did not find significant differences in the rates of temporary or permanent damage to the recurrent laryngeal nerve in patients who underwent preventive central neck dissection with thyroidectomy for papillary thyroid carcinoma, compared with patients who underwent thyroidectomy alone. Comparison of unilateral and bilateral prophylactic central neck dissection showed a higher incidence of laryngeal injury with bilateral dissection, but without reaching the level of statistical significance [21,22].

In contrast, it has been shown that performing prophylactic central dissection significantly increased the incidence of transient hypoparathyroidism [23-26]. However, the rate of persistent hypoparathyroidism was not significantly higher among patients undergoing prophylactic central dissection.

It should be emphasized that these results were presented by highly specialized endocrine surgery departments, and there is no doubt that the complication rate will be significantly higher when the operation is performed by general surgeons.It makes sense to analyze the incidence of hypoparathyroidism during operations with the preservation of the thymus and vascularized parathyroid glands.

Effect of prophylactic central neck dissection on the incidence of regional metastasis

The development of relapse in the lymphatic collectors of the neck is influenced by such factors as differences in risk groups, different conditions for radioactive iodine therapy, the combined inclusion of all regional relapses, which requires long-term prospective multi-cohort studies.Nevertheless, among patients who underwent prophylactic central neck dissection with thyroidectomy, the risk of regional recurrence is two times lower compared to the group of patients who underwent only thyroidectomy [25].

Effect of prophylactic central neck dissection on postoperative thyroglobulin levels

Data on the effect of prophylactic central neck dissection on thyroglobulin levels are conflicting. Sywak’s studies confirmed that postoperative pre-ablative thyroglobulin levels and the proportion of athyroglobulinemic patients were directly proportional to the performance of central dissection [27].

It should be noted, however, that in most cases an effective reduction in thyroglobulin levels can be achieved by the ablative effect of radioiodine and that differences between patients with or without prophylactic central neck dissection disappear 6 months after ablation [9]. It should also be noted that some studies have not confirmed a decrease in thyroglobulin levels or a decrease in the absorption of radioactive iodine during thyroidectomy with level VI lymph node dissection [10].

Discussion issues of performing prophylactic central dissection of the neck

The most important positive side of performing prophylactic dissection of the central part of the neck is the possibility of detecting micrometastases in the lymph nodes of levels VI and VII, followed by a more adequate selection of the dose of radioiodine. Bonnet et al. Calculated that the confirmation of the absence of metastatic lesions of the removed lymph nodes in the central compartment can reduce the need for radioiodine treatment by up to 30%, while maintaining the radicality of treatment [28,29,30].

Prophylactic removal of level VI lymph nodes that do not appear to be affected can be performed either as open surgery or with minimal complications using a video approach [31].

The lack of a large evidence base does not allow to fully determine strict indications for performing prophylactic central neck dissection in papillary thyroid carcinoma. The American Thyroid Association guidelines indicate that “routine central dissection can be performed” [32, 33].The question of whether a central dissection should be performed in bilateral or multifocal thyroid carcinomas remains controversial [34].

The issue of the length of preventive central dissection from unilateral level VI dissection on the side of tumor lesion to bilateral central cervical dissection with addition of thymectomy and dissection of level VII lymph nodes is discussed [8]. An opinion was expressed about the necessity and possibility of performing unilateral central level VI dissection in the presence of papillary microcarcinomas (tumors less than 1 cm) [35].

Care should be taken when extending the dissection volume beyond the recommended level to avoid increasing complications. It should be noted that performing prophylactic dissection of the central section carries a high risk of complications and should not be performed routinely during re-intervention, in cases of final thyroidectomy, as the final stage of treatment.

Undoubtedly, in the case of more common primary thyroid tumors of high risk (T 3 and T 4 ), central prophylactic dissection is always justified [36].

It should be noted that sentinel lymph node biopsy, which is often used in breast cancer surgery, unfortunately does not always show a reliable picture of the metastatic spread of thyroid carcinomas, which limits its use.

The Department of Endocrine Gland Surgery of the V.P. Komissarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine has experience in treating 5261 patients with papillary thyroid carcinomas since 1990, when the first observations of papillary thyroid carcinomas were noted in children from regions affected by due to the Chernobyl disaster.

Papillary thyroid carcinomas that developed in the affected population of Ukraine in the early post-accident period (1990-1997) were characterized by an aggressive course. Common tumors of category T 3 and T 4 were quite common in 52.9% of cases, regional lymphogenous metastasis N 1 a
and N 1 b
was confirmed in 53.9% of patients.

The high biological potential of the malignancy of these tumors forced the surgeons to switch to a more radical therapeutic program, performing thyroidectomy with cervical lymphadenectomy, depending on the extent of the process.There were 4436 (84.3%) thyroidectomies, 825 (15.6%) organ-preserving surgeries with undetermined cytological diagnosis, 2853 (54.2%) neck dissections of various lengths.

With the passage of time, the improvement in the quality of ultrasound and cytological diagnostics made it possible to increase the number of operations performed at the early stages of carcinoma development. If in 1990-1997. the number of small carcinomas of category T 1 was 23%, then in 1998-2005.their number increased to 41.8%, and in 2006-2013. reached 62.6%. Naturally, the proportion of patients with common forms of carcinomas of the category T 3 and T 4 decreased (1990-1997 – 52.9% of observations; 1998-2005 – 41.6% of observations; 2006-2013 years – 22.5% of observations).

Despite improved early diagnosis of papillary thyroid carcinomas, even small tumors in young patients showed more aggressive biological behavior.For three years (2010-2012), among 313 patients (age group under 18 at the time of the Chernobyl accident) with papillary thyroid carcinoma, category pT 1 , intrathyroid dissemination was noted in 26.8% of cases, regional metastasis in 21, 7% of patients.

It is noteworthy that improved diagnostics did not affect the incidence of recurrent and residual metastases, which began to acquire an iodine-resistant nature. Reoperations for metastases were performed in 8.3% of cases.

Since 2008, in our department, the performance of thyroidectomy for papillary carcinoma has become more often complemented by prophylactic dissection of the lymphatic collectors of the central part of the neck. These were observations of cytologically confirmed carcinomas without preoperative evidence of metastasis by ultrasound and macroscopic intraoperative visual assessment. It was noted that systematic central lymph node dissection has significantly increased the frequency of detection of metastases in level VI lymph nodes.Among 221 patients of “Chernobyl age” during preventive dissection of the central part of the neck, micrometastasis was morphologically detected in 59.2% of cases. Improving the surgical technique of performing surgery did not increase the level of laryngeal and parathyroid complications (persistent laryngeal paresis – 2.1%, persistent hypoparathyroidism – 0.8%).

Results and recommendations

In discussing the rationality of preventive central neck dissection in papillary thyroid cancer, the classic thesis about the radical nature of the expansion of the volume of surgical intervention and the risk of developing specific complications of thyroid operations – laryngeal disorders and parathyroid insufficiency – comes first.

When determining the indications for prophylactic removal of lymph nodes in the central compartment of the neck, it should be remembered that:

  • subclinical micrometastasis of papillary thyroid carcinomas to level VI lymph nodes is quite common;

  • performing prophylactic central dissection reduces the frequent need for reoperation for central recurrence and increases long-term survival;

  • preoperative ultrasound assessment of the nature of metastatic lesions of the central part of the neck in the presence of a thyroid gland is unreliable;

  • intraoperative visual and palpation assessment of lymphogenous micrometastasis is also unreliable;

  • performing prophylactic central dissection improves tumor staging and stratification of ablation with radioiodine, can reduce postoperative pre-ablative thyroglobulin levels, which is important for reducing the effect of radiation exposure.

The European Society of Endocrine Surgeons proposes to stratify the performance of prophylactic central dissection of the VI and VII levels of the neck by risk. Risk stratification allows you to determine the nature and predict the outcome of the disease. Therefore, when choosing the volume of surgical intervention, one should remember the thesis of Ashok R. Shaha that “relapses in the low-risk group requiring repeated central lymph node dissection are quite rare, and in the high-risk group, they are obviously inevitable”.

In general, prophylactic dissection of the central part of the neck is justified for large carcinomas of the T category 3
and T 4 , in patients over the age of 45 or under 15 years, in male patients, with bilateral or multifocal thyroid tumors, in cases of preoperatively confirmed lesions of the lateral lymph nodes of the neck.

It is possible to refrain from prophylactic central dissection in patients with very low risk carcinomas, in women under 45 years of age with unilateral monofocal tumors T 1a .

It should be noted that to date, the cohort of the radiation-affected population of Ukraine remains at high risk of developing papillary thyroid carcinomas, which are quite aggressive in their behavior, which requires thyroidectomy with preventive central neck dissection in this group of patients.

In any case, prophylactic central dissection should only be performed by surgeons who have the appropriate knowledge, experience and are able to carefully evaluate their results during this operation.

Lymphadenopathy in children | Children’s Clinical Diagnostic Center in Domodedovo


Bolshakov Igor Viktorovich, orthopedic surgeon

Surgical aspects of lymphadenopathy in children

Lymphadenopathy is an enlargement of lymph nodes, both single and several groups with various diseases. Usually, parents come to the pediatric surgeon with complaints that the child has some “bumps” on the back of the head, in the submandibular region, cervical, axillary, inguinal and other areas.These formations periodically increase, which causes fair concern for the mother. At the first examination by the doctor, it turns out that these are lymph nodes of different localization. The main task of the pediatrician and pediatric surgeon is to explain that the child’s lymph nodes are organs of the immune system, where, along with other organs (spleen, thymus, palatine tonsils), immune cells – lymphocytes are produced. The purpose of the latter is to protect the body from pathogens of various infections, allergens.

When examining healthy children, individual groups of lymph nodes can be palpated, which are usually located in the submandibular, cervical, axillary and inguinal regions. Their sizes vary from 0.3 – 0.5 cm during the neonatal period to 1.5 cm at an older age. Normally, the lymph nodes are of soft elastic consistency, mobile, painless.

The enlargement of the lymph nodes occurs due to the activation of lymphocytes in the node in response to an external factor that leads to lymphadenopathy.Among the causes of lymphadenopathy, local and widespread infections, connective tissue diseases and an oncological component can be distinguished. Usually, lymphadenopathies are observed against the background of staphylococcal and streptococcal infections (bacterial component) in diseases such as tonsillitis, tonsillitis, rhinosinitis, otitis media. There is lymphadenopathy of tuberculous etiology. An increase in lymph nodes against the background of a viral infection is observed in ARVI, chickenpox, rubella, cat scratch disease, infectious mononucleosis.In diseases of the connective tissue (arthritis, systemic lupus erythematosus), lymph node reactions are not uncommon. Oncological diseases (lymphogranulomatosis, lymphoma), which are much less common in children than in adults, also cause lymphadenopathy.

To identify the cause of lymphadenopathy by a pediatrician and a surgeon, a thorough history taking is necessary (identification of diseases of the ENT organs, oral cavity, skin, contacts with patients, as well as contacts with insects, pets).

Along with a general examination, it is necessary to pay attention to the condition of the peripheral lymph nodes, their size, localization, consistency, mobility, soreness, skin color over the lymph node, the presence of fluctuations. In addition, patients with lymphadenopathy are recommended to carry out laboratory research methods: a detailed general blood test, a general urine test, a biochemical blood test, serological tests for CMV, toxoplasmosis, HIV. Skin tests for tuberculosis, nasal and pharyngeal culture for flora and antibiotic sensitivity, abdominal X-ray, ultrasound or CT of the abdominal organs to detect spleno-hepatomegaly, lymph node puncture or biopsy.

The examination described above is not required for all children with lymphadenopathy. In 90 – 95% of cases, the latter is the result of a nonspecific process (against the background of a banal bacterial or viral component). Competent treatment (elimination of the cause of lymphadenopathy) leads to the normalization of the lymph nodes within 1.5 – 2 months. A long course of lymphadenopathy, especially after sanitation of foci of infection, is an indication for the use of an extended examination.

Pediatric surgeons have to deal with lymphadenopathies in the presence of an acute purulent process that occurs in one or more lymph nodes. The presence of manifestations of intoxication of the child’s body, local signs in the form of pain, edema, hyperemia, fluctuation is an indication for surgical intervention. The purulent lymph node is opened and drained for sanitation, followed by the appointment of antibiotics, desensitizing and immunostimulating agents, which leads to the child’s recovery.In the presence of a chronic process and if a lymphoproliferative process is suspected, the interested lymph node is removed for biopsy.

As a result, we can conclude that in most cases, lymphadenopathies are caused by nonspecific (benign) processes. Timely identification of the causes of lymphadenopathy at all levels of diagnosis will help to identify a risk group of sick children who need the help of an oncologist.

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90,000 ultrasound of lymph nodes in Mytishchi | “Andreevskie hospitals

Ultrasound of lymph nodes is a modern method of non-invasive ultrasound examination that allows you to detect the location, shape and structure of lymph nodes, measure the linear dimensions, and identify pathology or lesions of individual areas.The lymph node is an organ of the immune system that plays the role of a protective barrier (filter) that traps bacteria, viruses, tumor cells and toxins circulating in the blood. When a disease occurs, the reaction of the lymph nodes occurs long before the first symptoms of the disease appear.

Study types

Usually, an ultrasound of the lymph nodes examines two areas of the location of the lymph nodes, such as the abdomen and the neck. The lymph nodes of the abdomen are examined while holding the breath during a deep breath.Often enlarged lymph nodes indicate pathologies in the gastrointestinal tract, pancreas and liver, as well as in the ovaries and uterus.

The cervical lymph nodes are examined when the patient is at rest. A change in the size of the cervical lymph nodes directly indicates a pathology in the tonsils or ears, in the salivary glands or in the thyroid gland.

To determine the exact dimensions, it is necessary to examine the node in cross section.When this parameter is more than 8 mm, then it signals about tumor metastases, when it is less than 8 mm, but more than normal, it usually means an inflammatory process. When the lymph nodes are normal, then during examination they are not noticeable, because their echo structure does not differ from the surrounding tissues.


Indications for ultrasound of lymph nodes:

  • when lymph nodes enlarged during an infectious disease, but their size did not change for two weeks after recovery;
  • when an external examination revealed an increase in all lymph nodes;
  • if the size of the nodes of the lymphatic system has increased not due to an infectious or catarrhal disease;
  • if enlarged lymph nodes are combined with high fever, impaired swallowing or breathing, sore throat;
  • when there is only one lymph node enlarged in the neck region or its size is much larger than others;
  • when, on palpation, the chin and thoracic nodes, ulnar or popliteal and supraclavicular or subclavian nodes are felt.


To obtain adequate information about the state of the lymph nodes in the abdominal cavity, retroperitoneal space and small pelvis, it is recommended to limit food intake in the evening before the study, water – on the day of the study.


The study has no contraindications, cannot irradiate the body, has no side effects and does not cause any harm to the human body.

Neck cellulitis – symptoms and treatment

By Evgeny Basin,

maxillofacial surgeon, d.M.Sc.

Phlegmon of the neck is an acute or chronic inflammation that develops and proceeds in the neck region: from the edge of the lower jaw to the level of the collarbones and jugular notch. Due to the anatomical structure of this area and the highly developed lymphatic system, purulent and inflammatory changes spread in it extremely quickly.

Cellulitis of the neck is characterized by a rapid spread and is a life-threatening condition, and if not treated and diagnosed in a timely manner, it can be fatal.

Causes of the development of phlegmon of the neck

Most often, neck phlegmon develop due to a long-standing focus of infection, the symptoms of which are often ignored.

Other reasons:

  • unsatisfactory filling of the root canals of the teeth and the development of peri-maxillary abscesses and phlegmon with extension to the neck,
  • Difficulty erupting wisdom teeth (third molars),
  • dental diseases (caries, pulpitis, periodontitis)
  • sialoadenitis – inflammation of the submandibular salivary gland or the formation of calculus (stone),
  • diseases of the lymph nodes – lymphadenitis, which can proceed as a “hot” or “cold” abscess, as well as a manifestation of systemic diseases: metastases in malignant neoplasms of the head and neck, specific diseases: syphilis, tuberculosis, actinomycosis,
  • skin diseases: carbuncles, boils, wounds and abrasions contribute to the development of superficial abscesses and phlegmon of the neck,
  • consequences of trauma – untimely treatment of fractures or pathological fractures of the jaws (with bisphosphonate, antiresorptive, desomorphine, radiation osteonecrosis of the jaws),
  • neck cysts (lateral and median) are often diagnosed only when they are inflamed, which requires anti-inflammatory therapy and their subsequent removal in a planned manner,
  • periopharyngeal or paratosillar abscesses contribute to the spread of a purulent-inflammatory process to the neck,
  • foreign bodies,
  • thyroid disease,
  • neck injury

Symptoms of neck phlegmon

With phlegmon of the neck, the condition worsens rapidly.The body temperature rises to 38 °, edema grows in the neck area, the skin becomes hypertensive, swallowing is impaired, and general intoxication develops. Other characteristic symptoms also appear:

  • Presence of swelling, “ball”, lymph node in the neck, previous pain in the tooth, jaw or ENT organs, which “subsided”, but swelling appeared on the neck
  • Skin redness
  • Feeling of fullness in the neck
  • Voice change
  • Respiratory distress
  • Putrid or bad breath
  • Inability to open mouth and chew food
  • Impaired speech
  • Impaired swallowing

Diagnosis of phlegmon of the neck

For timely diagnosis and treatment due to the threat to life and the high probability of surgical treatment, an immediate examination by a maxillofacial surgeon or an ENT doctor is recommended.

  • During the initial examination, the doctor specifies the anamnesis, which makes it possible to recognize the “entrance gate” of the infection.

  • Next, he palpates the maxillofacial region to determine the primary boundaries of the inflammatory process in the neck.

  • Based on the results of examination and palpation, the doctor prescribes blood tests to determine the general condition of the patient.

  • Ultrasound of the neck tissues is the primary element in the diagnosis of cystic and common inflammatory diseases.

  • If there is a suspicion of metastases or specific damage to the neck tissues, a puncture is performed under ultrasound control.

  • To assess the state of the oral cavity, it is necessary to conduct a cone-beam computed tomography.

  • Computed tomography and MRI studies with contrast enhancement can determine the boundaries and spread of the inflammatory process or neoplasm.

What not to do if neck phlegmon is suspected

Self-administration and administration of antibacterial drugs contributes to the aggravation of the condition, the slow spread of inflammation and complicates postoperative treatment due to the development of antibiotic-resistant strains of microorganisms.

Warming up or, conversely, applying a cold compress promotes the spread of the process or its transition into a “cold” abscess.


Effective treatment is possible only with urgent medical attention at the first symptoms of the disease!

Complex treatment is prescribed individually depending on the reasons for the development of neck phlegmon. Hospitalization is required with surgical treatment – opening of a purulent-inflammatory process, antibiotics to determine the sensitivity of microflora, in some cases a biopsy is performed to determine the boundaries and nature of the neck disease.


  • secondary mediastinitis (mediastinal lesion)
  • sepsis
  • deep vein thrombosis of the lower extremities
  • damage to the respiratory system (pneumonia, pneumothorax), pericarditis
  • disseminated intravascular coagulation syndrome


The best prevention of purulent-inflammatory neck diseases is oral cavity sanitation and orthopantomogram or cone-beam computed tomography once a year.We recommend that you regularly visit a dental hygienist for professional oral hygiene twice a year to identify possible problems and, if necessary, dental treatment.

IDC – Irkutsk Diagnostic Center

Contraindications :
intolerance (hypersensitivity) to iodine and iodine-containing drugs, renal
insufficiency (plasma creatinine: women more than 106.00 μmol / l, men
more than 115.00 μmol / l), pheochromacytoma, hyperthyroidism, myeloma / paraproteinemia, myasthenia gravis,
inability by the patient to take a supine position, pregnancy, extremely difficult
condition, body weight over 180 kg.

examination is compulsory
: blood test for creatinine content no later than 10 days

Preparation :
1. On the day and the next day of MSCT, the amount of fluid should be sufficient
large (for an adult at least 1-1.5 liters per day).

2. Patients,
taking non-steroidal anti-inflammatory drugs (aspirin, voltaren, etc.)
5-7 days before the study, stop taking (in agreement with the attending physician).

3. Patients
with diabetes mellitus taking biguanides – metformin, avandamet, bagomet, glucophage,
Metfogamma, Siofor, etc. should be discontinued 2 days before MSCT and resumed
2 days after MSCT examination.

4. Patients,
taking interleukin-2 requires consultation with an oncologist.

5. If on the day of the
MSCT coincides with the delivery of blood and urine tests, then first – to pass the tests.

On the day of the study
last meal 3-4 hours before the study.With you, you should have data on the previous examination, the conclusion of specialists. Before research:
remove jewelry (earrings, chains, beads, piercings, etc.), remove the watch,
telephone, magnetic cards. Clothes should not have metal items (buttons,
buckles, buckles, belt buckle).

The contrast agent will be administered intravenously
through the catheter, the installation of the catheter into the vein is carried out in the hospital in the office No. 218 (second floor without queue), for the branch
Bratsk – office # 150.

Appearance for the study 15 minutes before the appointed

the service “Burn to disc”.

Primorsky district, Krasnoselsky district, Kirovsky district


The network of clinics “Medicenter” uses a high-precision Japanese scanner Mindray DC-8, which allows ultrasound of the lymph nodes of the neck, armpits, abdominal cavity, as well as the groin and peripheral lymph nodes.Qualified specialists of our clinic will conduct an examination and make an accurate diagnosis. The procedure will take about 15-20 minutes, after which you will receive the printed ultrasound results on your hands.

Medical specialists

Doctor-cardiologist, Doctor of ultrasound diagnostics

Ultrasound Diagnostic Doctor, Obstetrician-Gynecologist

Doctor of ultrasound diagnostics

Obstetrician-gynecologist, Doctor of ultrasound diagnostics

Doctor of ultrasound diagnostics

Currently, work is underway on the site to change the price list, check the current information by phone: 640-55-25 or leave a request, the operator will contact you.

Prices for services

  • Ultrasound examination (ultrasound) of the lymph nodes (one anatomical zone)

  • Ultrasound examination (ultrasound) of lymph nodes, paired

The information and prices presented on the site are for reference only and are not a public offer.

Our clinics in St. Petersburg

Medical Center South-West

Marshal Zhukov Ave. 28k2
Kirovsky district

  • Avtovo
  • Veterans Avenue
  • Leninsky Prospect

You can get detailed information and make an appointment by calling
+7 (812) 640-55-25

Attention! It is possible to simultaneously conduct other surveys on shares with the same specialist.

Ultrasound examination of lymph nodes is absolutely safe, while it provides relevant information about the state of the body.

What an ultrasound scan of the lymph nodes can reveal

It is important to regularly pay attention to the state of the lymphatic system, which forms the immunity of your body. Lymph nodes function as biological filters, purifying lymph from pathogens, in addition, they participate in the formation of lymphocytes and antibodies that neutralize various microorganisms, protecting a person.

A common symptom of inflammation of the lymph nodes is their enlargement, which can be noticed even when palpating. Inflammation occurs when pathogens enter the lymph. But the reason for the increase in the size of the lymph nodes can be not only inflammation, but also autoimmune diseases. Therefore, it is necessary to periodically diagnose the condition of the lymphatic system.

Indications for ultrasound of lymph nodes

  • pain in the region of the lymph nodes;
  • severe headache;
  • persistent chills for several days;
  • revealed an increase in lymph nodes in size;
  • the presence of a malignant or benign tumor.

Ultrasound of the lymph nodes of the neck is also performed if the following diseases are suspected:

  • neoplasms in the area of ​​the salivary glands;
  • damage to the thyroid gland;
  • tuberculosis;
  • syphilis;
  • Sesari’s disease;
  • actinomycosis;
  • a number of autoimmune pathologies;
  • oncological diseases – lymphoma, sarcoma, cancer.

Ultrasound of the lymph nodes of the neck

Ultrasound of the lymph nodes of the neck makes it possible to detect rubella, measles, as well as tonsillitis, pharyngitis and laryngitis in time.

Ultrasound of the groin lymph nodes

Research reveals a number of pathologies of inflammatory diseases. It is carried out when seals in the groin area, pain in the groin, swelling of the legs and a consistently high temperature are detected.

Ultrasound of peripheral lymph nodes

A study is prescribed for the detection of enlarged lymph nodes, as well as for various oncological diseases. The procedure involves examining the lymph nodes in the head, clavicular region and other areas.

Ultrasound of the lymph nodes of the armpits

It is advisable to conduct a study in case of pain arising in the armpits of a patient with sudden movements or palpation, when seals are found, persistent elevated temperature and migraine.

Preparation for ultrasound of lymph nodes

When examining most groups of nodes, for example, ultrasound of the lymph nodes of the neck, any preparation for the procedure is not required. The only requirement is the absence of thick hair at the point of contact of the sensor with the skin, as well as the absence of significant damage to the skin.

An exception is ultrasound of the lymph nodes of the retroperitoneal space or abdominal cavity. In this case, you will need a little preparation for the procedure. The patient may be required to follow a diet for 2–3 days prior to the study. You should refrain from eating for several hours before the study. You can get more detailed advice from your doctor.


Utkina Evgeniya Igorevna



I want to say thank you to the Medical Center. Unfortunately, my husband and I also faced a covid. However, it turned out that the doctors from our clinic did not go home, in principle the call center does not work there, 25 telephones and NONE of them answered us. And the clinic Medicenter works with patients on VHI and compulsory medical insurance !!! Despite all the workload with covid patients in our area, this center will always answer and send a doctor! And the doctor MUST come! Once again, thank you for such a center in our area, otherwise I can’t even imagine how we would have escaped here in such a difficult situation.

Hello. Thank you for the well-coordinated work of the staff of the Medical Center. Has applied with signs of acute respiratory infections. 1. At the reception, they described in sufficient detail the rules of attachment and conditions of admission in the absence of attachment under the OMS policy. 2. Excellent work of the treatment room, as well as m / brother, who carries out the collection of smears at home. 3. My therapists: Polovodova E.A. and Artyukh L.Yu. Thank you for everything!
4. Excellent work of the call-center and personal account is just SUPER!

I would very much like the review to be found by everyone who is mentioned.Thank you!

Lokotosh Sergey Vladimirovich



I would like to express my gratitude to your clinic and Dr. Gerasimenok Grigory Alexandrovich. I signed up for your clinic for the first time and did not regret my choice. The doctor was appointed to me by Gerasimenok G.A – listened, examined carefully, quickly established a diagnosis, prescribed the correct treatment. And the staff of the clinic inquired about the state of health by phone (this is the first time I meet such an attitude towards patients). Many thanks to the staff of the clinic and especially to Dr. Gerasimenok Grigory Alexandrovich.


I express my gratitude to all the staff of the medical center and personally to Anastasia Mikhailovna Poddubnaya for their work in such a difficult time, good and effective recommendations for treatment.I have been ill with COVID, thanks to you I am on the mend!

Was on 06/21/2020 with Regina Gumerovna Gareeva. I want to thank her for her professionalism, good attitude towards patients and for sound reasoning! She explained everything in detail, did not frighten and did not make hasty conclusions, like some, but, on the contrary, encouraged. and calm. I advise everyone ????????

Fastest service ever. 20 minutes ecg + x-ray. Minimum of securities. Maximum result.For busy people – optimal

90,000 diagrams, description, causes and symptoms of diseases

The location of the lymph nodes on the neck, so as to cleanse the lymph, preventing the infection of nearby organs with infection, bacteria. The nodes of the neck serve their purpose by cleansing the lymph.

Lymph nodes in the neck are one of the many nodes (glands) that make up the lymphatic system. Lymph, a transparent liquid, flows through the capillaries, vessels, trunks throughout the body, capturing foreign substances, nuclides and similar formations from the blood and tissues.On the way, there may be inflamed parts of the body, purulent wounds and many other organs infected with infection or bacteria, which will also be captured by the lymph.

Intended use

Lymph begins its path in the lymphatic system when a person walks. From the feet, when walking, a clear fluid called lymph rises to the head. The system does not have its own engine. Therefore, the lymph by gravity returns to the feet, making a full circle through the body of people. Lymph nodes are located near vital organs in humans, including lymph nodes in the neck, which are part of the lymphatic system.In the lymph nodes, the lymph is cleared of bacteria and infections in order to prevent infection of the areas around the glands, including in the neck.

Places of groupings

There are 300 cervical lymph nodes. The location diagram makes it possible to see where the lymph nodes are located in the neck. The diagrams show that the location of the lymph nodes on the neck in people in the region of the cervical vertebrae. According to the classification, they are divided into groups:

The anatomy of the location of the glands in the neck can be seen in the diagrams.


The anterior cervical lymph nodes, which allow the head to tilt and rotate, are located above and below the sternocleidomastoid muscle in front of the internal jugular vein. These are superficial jugular nodes. They are small, but there are many of them. The anterior cervicals cleanse the lymph flowing into the pharynx, throat, tonsils and thyroid gland.

In turn, if you look at the figure, it is clear that among the anterior glands there are groups of prelaryngeal, thyroid, paratracheal and pretracheal.These are deep knots.

Feeling of the cervical ganglion is difficult, it is impossible to find them, as they are small. In an adult, they are less than in children.

The lymph node on the left or right of the neck is inflamed. We need to find out what happened:

  • The tonsils are inflamed.
  • An infection has got into the oral cavity.
  • Bacteria have entered the respiratory tract.

The reason could be:

  • decreased immunity;
  • lack of vitamins;
  • freezing of the body;
  • stressful situations of a prolonged nature;
  • insect bites;
  • inflammation in the ears.

A bump has appeared on the front of the neck. It is often not painful. The anatomy of the appearance of a lump is as follows: depending on the infectious lymph node that first seizes the infection, the lump can be in front, on the side or under the chin.

The submandibular glands are the first to fight infections of the pharynx, mouth and throat. Change usually takes place at the micro level. The neck remains unchanged. When an infection or viruses enter the gland, the node swells.

The neck can be seen with a bump under the chin.If the lump is on the neck when the glands have entered a normal state, then the doctor can answer whether lymphadenitis has developed into a chronic stage.

Glands in the back of the neck

Inflammation of the lymph nodes in the back of the neck is a sign of some kind of disease: an organ or infection in the body. The posterior cervical lymph nodes, located between the collarbone and the mastoid region of the temporal bone, protect the airways from infection. When the glands in the back of the head are swollen, the lymph nodes in the back of the neck can become inflamed.

Lymph nodes in the neck, which are located behind, can be seen if you consider the diagram.


Lymph in this area flows from the chin to the submandibular glands. The chin glands are located below the chin, cleaning the lower lip, tip of the tongue, central incisors.


Submandibular or submandibular cervical lymph nodes are located under the jaw bone on the sides.

Lymphatic flow goes from the lower oral cavity through the pharynx to the tonsils.In addition, lymph flows from the lower teeth, excluding the central incisors, to the maxillary molars, including the anterior teeth.

The outflowing lymphatic vessels of the skin go to the submandibular and anterior nodes of the neck from the middle of the face. Through the submandibular pass and from the lower part of the face.

The figure is a left side view showing the diverting lymph from the tongue.


If you look at the sectional drawing, we will see the supraclavicular nodes and the subclavian trunk.The supraclavicular glands are located in fossae near the junction of the clavicle with the sternum. They control the flow of lymph from the abdominal and thoracic regions.

The nodes that are responsible for the flow of lymph from the abdominal region are known as Vikhrov’s nodes and are considered the main ones. Since these nodes transport the incoming lymph back into the venous circulation through the left subclavian vein, they are susceptible to the creation of painful neoplasms such as an infection in the arm, lymphadenitis, and breast cancer.


Are there ear glands? The side view in the figure answers this question. To the left of the group of parotid nodes, there are several ear glands at the base of the neck. With otitis media, the lymph nodes on the front of the neck are inflamed and on the left side, inflammation of the nodes on the anterior surface of the neck and submandibular may occur. The pain will be felt in the neck and given to the ear.


The occipital nodes are located on the back of the neck. If in children under 5 years of age, the occipital nodes slightly increased in size, but the tumor quickly subsides, there are no symptoms of the disease.You do not need to see a doctor. This works the lymph nodes in the back of the head, successfully coping with the infection. Such a process is considered the norm, since at this time the child is developing immunity.


There are also lateral (lateral) cervical nodes: superficial and deep. The deep ones are more numerous and deserve special attention. The location of the lymph nodes in the neck is responsible for the movement of lymph. Deep cervical glands propel lymph along the neck through the carotid vagina, pharynx, esophagus, and trachea.

Deep cervical lymph nodes are divided into two groups: primary and secondary:

  • Primary ones ensure the movement of lymph flow along the path – the head, occipital part of the neck, thyroid gland, pharynx, esophagus, trachea, nose, palate and tongue. At the same time, lymph is taken from deep primary nodes in the neck, neck muscles.
  • The second group is responsible for lymph flow from the chest, parts of the arms and the surface of the liver. It takes lymph from the deep primary glands in the neck and neck muscles.

There is also a group of deep cervical nodes: lateral jugular, anterior jugular; jugular: jugular-digastric and jugular-scapular-hyoid. The jugular-digastric is the deepest. It can be felt only with inflammation of the tongue, tonsils, pharynx. The jugular-scapular-hyoid is located between the internal jugular vein and the scapular-hyoid muscle.

The figure clearly shows how each location of the gland groups is located.

What is a tonsillar lymph node?

These are glands located in the corners of the jaw.There are several tonsillar nodes, they protect the body from diseases, especially infectious, bacterial ones. Inflammation occurs with respiratory diseases such as tonsillitis, tracheitis, and similar infectious diseases.

1) Tonsilar (jugulodigastric) lymph nodes are located in the jugular region of the neck

In chronic tonsillitis, the condition is often similar to the condition during the listed diseases.

Jugular fossa (suprasternal fossa)

Hollow in the lower part of the neck.V-shaped depression, bounded laterally by the sternocleidomastoid muscles. The outflow of blood from the head and neck to the heart is carried out by several veins located in the jugular fossa.


This is a zone in the jugular fossa associated with the mucous membrane in the lower part of the larynx, pharynx and thymus gland, which regulates the human immune system. The impact on the zone increases the body’s resistance to infectious diseases by improving blood circulation in the thymus (thymus gland).


There is no definite solution to this issue. The textbooks indicate the size of 1 cm. Medical workers, based on practice, consider 1 cm to be the norm. However, there are opinions of oncologists who believe that the lymph node should be smaller. So, for the elbows, this size will be normal less than 0.5 cm; for inguinal – 1.5 cm. In healthy children, axillary, cervical and inguinal – 1.6 cm.

Causes of inflammation

Causes of inflammation of the lymph nodes may be different depending on which nodes are inflamed.

The enlargement of the submandibular lymph nodes is most often the result of diseases such as:

  • tuberculosis;
  • bacterial infection;
  • herpes;
  • Epstein-Barr virus;
  • lymphadenitis.

Inflammation of the occipital nodes, if the infection penetrates directly into the lymph nodes, mainly arises from the following diseases:

  • syphilis;
  • HIV;
  • AIDS;
  • tuberculosis;
  • measles.

When the infection did not affect the node itself, but the organs located near it, the causes may be diseases such as tonsillitis, pharyngitis and other infectious diseases affecting the area of ​​the eyes and mouth.

An advanced form of caries can lead to inflammation of the lymph node in the neck on the right or left side under the jaw. Untreated caries penetrates into the root and causes inflammation. In addition, inflammation of the node under the jaw can cause infection of the following diseases:

  • tonsillitis, sinusitis, mumps;
  • atheroma – a swelling in the throat;
  • cancer.

Causes of inflammation in children on the back of the head:

  • measles;
  • rubella;
  • toxoplasmosis;
  • infectious mononucleosis.

These are usually chronic diseases. Diseases of the ENT organs are not chronic.

The causes of inflammation of the cervical lymph nodes are many, of which the following are most common:

  • mesotympanitis;
  • boil;
  • epimesotympanitis;
  • otitis media and otitis externa.

Ear disease can be provoked by such diseases as:

  • acute leukemia;
  • oral cavity disease;
  • Hodgkin’s lymphoma.

One of the reasons for the formation of a lump on the neck can be:

  • lipomas;
  • cutaneous cysts;
  • atheroma;
  • folliculitis;
  • follicles (inflammation of the hair follicles).

Symptoms of inflammation

First of all, swelling, an increase in the size of the nodes indicate the onset of inflammation.There are two types of inflammation of the nodes:

Without the formation of pus (catarrhal):

  • The glands increase in size. This may be accompanied by redness of the surrounding skin surface.
  • Feeling painful.
  • Swelling of the subcutaneous tissue, skin.
  • Fever, weakness, poor appetite, slight chills are possible.
  • A painful, red bump on the neck.


  • Indispensable increase in temperature.
  • Weakness, fatigue.
  • Feeling unwell.
  • People suffer from headaches.
  • Chills.
  • The glands are dense, do not move under the arms.

The progression of the inflammatory process may lead to a more serious stage of the disease, lymphadenitis. Nausea, vomiting – symptoms of intoxication with lymphadenitis. In case of inflammation of the lymph nodes in the neck due to sore throat, the symptom will be an unpleasant smell of their throat.


For the treatment of lymph nodes, you need to see a doctor and follow his recommendations.To eliminate the viruses that caused the disease, doctors prescribe antiviral drugs. In case of infection, the patient is prescribed antibiotics:

  • Ampicillin – for adults and children.
  • Clindimycin.

And also used:

  • Antibacterial drugs.
  • Anti-inflammatory.
  • Painkillers.
  • Immunomodulators.

A painful place in the area of ​​an inflamed gland must not be heated, the consequence may be life-threatening sepsis.You can not rub a sore spot. Better to put on a cooling compress.

Skin cysts that cause lumps on the neck are removed surgically.

Lymph nodes are part of the immune system and the lymphatic system, which is a natural filter that delays the penetration of infections and bacteria into the body. The fight against infection, bacteria, elimination of toxins, restoration of injured tissues occurs due to cell formations and anatomically intelligent structure of the body.

The lymphatic system cleanses the body only when a person moves.