Lymph system Information | Mount Sinai

Lymphatic system

The lymph system is a network of organs, lymph nodes, lymph ducts, and lymph vessels that make and move lymph from tissues to the bloodstream. The lymph system is a major part of the body’s immune system.

The lymphatic system filters fluid from around cells. It is an important part of the immune system. When people refer to swollen glands in the neck, they are usually referring to swollen lymph nodes. Common areas where lymph nodes can be easily felt, especially if they are enlarged, are the groin, armpits (axilla), above the clavicle (supraclavicular), in the neck (cervical), and the back of the head just above hairline (occipital).

Lymph nodes produce immune cells to help fight infection. They also filter the lymph fluid and remove foreign material, such as bacteria and cancer cells. They can become swollen from inflammatory conditions, an abscess, cancer, and most commonly from infection. Common areas where lymph nodes can be felt include the groin, armpit, behind the ears, back of the head, sides of the neck and under the jaw and chin.

Information

Lymph is a clear-to-white fluid made of:

• White blood cells, especially lymphocytes, the cells that attack bacteria in the blood and body tissues
• Fluid from the intestines called chyle, which contains proteins and fats

Lymph nodes are soft, small, round- or bean-shaped structures. They usually cannot be seen or easily felt. They are located in clusters in various parts of the body, such as the:

• Neck
• Armpit
• Groin
• Inside the center of the chest and abdomen

Lymph nodes mainly store immune cells that help the body fight infection but are also places where these cells can be made. They also filter the lymph fluid and remove foreign material such as bacteria and cancer cells. When bacteria are recognized in the lymph fluid, the lymph nodes make more infection-fighting white blood cells. This causes the nodes to swell. The swollen nodes are sometimes felt in the neck, under the arms, and groin.

The lymph system includes the:

• Tonsils
• Adenoids
• Spleen
• Thymus

Ball JW, Dains JE, Flynn JA, Solomon BS, Stewart RW. Lymphatic system. In: Ball JW, Dains JE, Flynn JA, Solomon BS, Stewart RW, eds. Seidel’s Guide to Physical Examination. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 10.

Hall JE, Hall ME. The microcirculation and lymphatic system: capillary fluid exchange, interstitial fluid, and lymph flow. In: Hall JE, Hall ME, eds. Guyton and Hall Textbook of Medical Physiology. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 16.

Last reviewed on: 7/25/2022

Reviewed by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Mononucleosis Information | Mount Sinai

Mono; Kissing disease; Glandular fever

Mononucleosis, or mono, is a viral infection that causes fever, sore throat, and swollen lymph glands, most often in the neck.

This so-called Downy cell is typical of lymphocytes infected by EBV (Epstein Barr Virus) or CMV (Cytomegalovirus) in infectious mononucleosis. Downy cells may be classified as types I, II, or III. This is a type II Downy cell.

This is a lymphocyte that has been infected by the Epstein-Barr Virus (EBV) or Cytomegalovirus (CMV) in infectious mononucleosis and is referred to as a Downy cell. Downy cells may be classified as types I, II, or III. this is a type I Downy cell.

Infectious mononucleosis is caused by the Epstein-Barr virus. It is a viral infection causing high temperature, sore throat, and swollen lymph glands. Infectious mononucleosis can be contagious if the infected person comes in close or intimate contact with another person through saliva or sexual contact.

Acrodermatitis enteropathica is a skin condition peculiar to children that may be accompanied by mild symptoms of fever and malaise. It may also be associated with hepatitis B infection or other viral infections. The lesions appear as small coppery-red, flat-topped firm papules that appear in crops and sometime in long linear strings, often symmetric.

Splenomegaly is an enlargement of the spleen.

Swollen lymph nodes, sore throat, fatigue and headache are some of the symptoms of mononucleosis, which is caused by the Epstein-Barr virus. It is generally self-limiting and most patients can recover in 4 to 6 weeks without medicines.

This picture shows large, atypical lymphocytes (white blood cells). These cells are seen in viral infections, most commonly caused by the Epstein-Barr virus (infectious mononucleosis), cytomegalovirus diseases, and occasionally infectious hepatitis. This is an example of a type I Downy cell.

Gianotti-Crosti disease is also called acrodermatitis of childhood. These red, elevated lesions do not contain pus and can occur on the limbs, buttocks, face, and neck.

Infectious mononucleosis causes a sore throat, enlarged lymph nodes, and fatigue. The throat may appear red and the tonsils covered with a whitish material. Mononucleosis and severe streptococcal tonsillitis appear quite similar. Unless there are other findings to suggest mononucleosis, a throat culture and blood studies may be necessary to make an accurate diagnosis.

Infectious mononucleosis is caused by the Epstein-Barr virus. In teenagers and young adults, there is frequently a sore throat and red tonsils with whitish spots (exudate), as seen in this picture. Enlarged lymph nodes and fatigue are also common.

Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.

Causes

Mono is often spread by saliva and close contact. It is known as “the kissing disease.” Mono occurs most often in people ages 15 to 17, but the infection may develop at any age.

Mono is caused by the Epstein-Barr virus (EBV). Rarely, it is caused by other viruses, such as cytomegalovirus (CMV).

Symptoms

Mono may begin slowly with fatigue, a general ill feeling, headache, and sore throat. The sore throat slowly gets worse. Your tonsils become swollen and develop a whitish-yellow covering. Often, the lymph nodes in the neck are swollen and painful.

A pink, measles-like rash can occur, and is more likely if you take the medicine ampicillin or amoxicillin for a throat infection. (Antibiotics are typically not given without a test that shows you have a strep infection. )

Common symptoms of mono include:

• Drowsiness
• Fever
• General discomfort, uneasiness, or ill feeling
• Loss of appetite
• Muscle aches or stiffness
• Rash
• Sore throat
• Swollen lymph nodes, most often in the neck and armpit

Less common symptoms are:

• Chest pain
• Cough
• Fatigue
• Headache
• Hives
• Jaundice (yellow color to the skin and whites of the eyes)
• Neck stiffness
• Nosebleed
• Rapid heart rate
• Sensitivity to light
• Shortness of breath

Exams and Tests

Your health care provider will examine you. They may find:

• Swollen lymph nodes in the front and back of your neck
• Swollen tonsils with a whitish-yellow covering
• Swollen liver or spleen
• Skin rash

Blood tests will be done, including:

• White blood cell (WBC) count — will be higher than normal if you have mono
• Monospot test — will be positive for infectious mononucleosis
• Antibody titer — tells the difference between a current and past infection

Treatment

The goal of treatment is to relieve symptoms. Steroid medicine (prednisone) may be given if your symptoms are severe.

Antiviral drugs, such as acyclovir, have little or no benefit.

To relieve typical symptoms:

• Drink plenty of fluids.
• Gargle with warm salt water to ease a sore throat.
• Get plenty of rest.
• Take acetaminophen or ibuprofen for pain and fever.

Also avoid contact sports if your spleen is swollen (to prevent it from rupturing).

Outlook (Prognosis)

The fever usually drops in 10 days, and swollen lymph glands and spleen heal in 4 weeks. Tiredness usually goes away within a few weeks, but it may linger for 2 to 3 months. Nearly everyone recovers completely.

Possible Complications

Complications of mononucleosis may include:

• Anemia, which occurs when red blood cells in the blood die sooner than normal
• Hepatitis with jaundice (more common in people older than 35)
• Swollen or inflamed testicles
• Nervous system problems (rare), such as Guillain-Barré syndrome, meningitis, seizures, damage to the nerve that controls movement of the muscles in the face (Bell palsy), and uncoordinated movements
• Spleen rupture (rare, avoid pressure on the spleen)
• Skin rash (uncommon)

Death is possible in people who have a weakened immune system.

When to Contact a Medical Professional

The early symptoms of mono feel very much like any other illness caused by a virus. You do not need to contact a provider unless your symptoms last longer than 10 days or you develop:

• Abdominal pain
• Breathing difficulty
• Persistent high fevers (more than 101.5°F or 38.6°C)
• Severe headache
• Severe sore throat or swollen tonsils
• Weakness in your arms or legs
• Yellow color in your eyes or skin

Call 911 or the local emergency number or go to an emergency room if you develop:

• Sharp, sudden, severe abdominal pain
• Stiff neck or severe weakness
• Trouble swallowing or breathing

Prevention

People with mono may be contagious while they have symptoms and for up to a few months afterwards. How long someone with the disease is contagious varies. The virus can live for several hours outside the body. Avoid kissing or sharing utensils if you or someone close to you has mono.

Ebell MH, Call M, Shinholser J, Gardner J. Does this patient have infectious mononucleosis?: the rational clinical examination systematic review. JAMA. 2016;315(14):1502-1509. PMID: 27115266 pubmed.ncbi.nlm.nih.gov/27115266/.

Johannsen EC, Kaye KM. Epstein-Barr virus (infectious mononucleosis, Epstein-Barr virus-associated malignant diseases, and other diseases). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 138.

Weinberg JB. Epstein-Barr virus. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 281.

Winter JN. Approach to the patient with lymphadenopathy and splenomegaly. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 159.

Last reviewed on: 3/10/2022

Reviewed by: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Lymphadenopathy (swollen lymph nodes) – symptoms and treatment

What are lymph nodes

The lymphatic system is a part of the vascular system, similar to a second bloodstream. It consists of capillaries, vessels and ducts through which lymph flows – a transparent viscous liquid with a large number of immune cells.

The lymphatic system is connected with the circulatory system. The task of the lymph is to take excess proteins, salts, water, toxins, cellular debris, pathogens and metabolic products from the tissues, and then send them to the blood for further utilization by the organs of the excretory system.

The lymphatic system includes the lymphatic vessels, the spleen, and the lymph nodes, which are small collections of lymphoid tissue. They filter the lymph and fight pathogens.

The lymphatic system includes the lymphatic vessels, spleen and lymph nodes

Lymph nodes are peripheral and deep.

Peripheral lymph nodes:

• occipital,
• behind the ear,
• front ear,
• chin pads,
• back neck,
• front neck,
• submandibular,
• supraclavicular,
• jugular,
• axillary,
• cubital (elbow),
• inguinal,
• popliteal.

Peripheral lymph nodes are close to the surface of the skin and can be felt

Deep lymph nodes are located in the chest and abdominal cavities, as well as in the muscle tissue of the thigh.

There are about 500 lymph nodes in the human body.

Lymph nodes are needed to protect the body from the spread of pathogens. Each lymph node plays the role of a “customs” – it passes lymph through itself, but recognizes and retains bacteria, viruses, fungi, toxins, as well as damaged and mutated cells that migrate through the lymphatic vessels from various organs and tissues.

To neutralize pathogens, each lymph node contains clusters of lymphocytes and macrophages – immune cells that quickly destroy harmful atypical cells and microorganisms.

Also in the lymph nodes, the maturation and preparation of lymphocytes for the destruction of foreign proteins and cells occurs.

In the lymph node there are clusters of lymphocytes and macrophages that destroy atypical cells and microorganisms

If there are too many pathogens, the lymph nodes may not be able to cope with the load and increase in size. Physicians call this condition lymphadenopathy .

ICD-10 code for lymphadenopathy – R59 (“Swollen lymph nodes”).

Causes of lymphadenopathy

As a rule, lymphadenopathy is secondary. It does not arise by itself, but as a symptom and consequence of various pathologies.

Causes of lymphadenopathy can be infectious and non-infectious .

When infected, the lymphatic system reacts to the invasion and stimulates the production of protective immune cells – lymphocytes and macrophages, which are needed to destroy foreign microorganisms. Due to the growth in the number of immune cells, the lymph nodes increase in size.

Infection of the lymph node can also lead to lymphadenopathy. In this case, the lymph node not only enlarges, but also becomes inflamed – and lymphadenitis develops.

In non-infectious lymphadenopathy, the cause of enlarged lymph nodes may be the growth of tumor cells, as well as autoimmune diseases.

Lymphadenopathy in viral and bacterial infections

Most often, swollen lymph nodes are associated with infectious diseases.

The most common cause of enlargement of peripheral lymph nodes is acute respiratory diseases (ARI) viral and bacterial nature.

For example, lymph nodes often “swell” in acute tonsillitis, also called tonsillitis. Streptococci, staphylococci, pneumococci, adenoviruses, influenza virus and other infectious agents can provoke tonsillitis. Lymphadenopathy caused by acute respiratory infections, as a rule, affects only the posterior cervical or submandibular lymph nodes.

Most often, swollen lymph nodes are associated with infectious diseases.

Posterior cervical lymph nodes are most often enlarged in acute respiratory infections

Deep lymph nodes increase if the infection has penetrated into the internal organs. With intestinal infections, the mesenteric lymph nodes located in the abdominal cavity, next to the intestines, may increase, and with pneumonia, the lymph nodes of the chest cavity and mediastinum.

In some cases, for example, when infected with the Epstein-Barr virus, which leads to the development of infectious mononucleosis, both peripheral and deep lymph nodes, as well as the spleen (it is also part of the lymphatic system), are significantly enlarged.

With HIV infection, generalized lymphadenopathy is observed – almost all lymph nodes are enlarged at once.

Lymph nodes can also increase in size with diphtheria, chickenpox, tuberculosis, hepatitis, toxoplasmosis, venereal diseases and many other infections.

It is impossible to determine which pathogen has entered the body by the enlargement of the lymph nodes. However, the general complaints of the patient, as well as an examination of enlarged lymph nodes, will help the doctor narrow the area of ​​diagnosis, identify the source of infection and make a diagnosis.

Lymphadenopathy in autoimmune diseases

Lymphadenopathy often occurs in association with systemic autoimmune diseases, such as systemic lupus erythematosus, Still’s disease, or rheumatoid arthritis.

In autoimmune disorders, the immune system mistakenly perceives its own cells as pathogenic and begins to destroy them. Lymph nodes and the spleen are actively involved in this process and increase in size due to the heavy load.

Lymphadenopathy in malignant neoplasms

Lymphadenopathy occurs when cancer cells separated from the main tumor enter the lymphatic system and settle in the lymph node.

Accumulating, such cells begin to form metastases – distant secondary foci of a malignant tumor. With the development of a malignant process, the lymph nodes increase in size and become hard. Gradually, they cease to cope with cancer cells and begin to pass them further along the lymphatic system to the next lymph nodes.

All malignant tumors metastasize to lymph nodes.

In addition, there is a separate type of tumor that initially affects the lymphatic system – they are called lymphomas.

Types of lymphadenopathy

Lymphadenopathy is distinguished by the cause of occurrence, prevalence, duration and nature of the course.

By cause:

• infectious;
• non-infectious.

By involvement of the tumor process:

• tumor;
• non-tumor.

By prevalence:

• localized form – lymph nodes are enlarged only in one part of the body;
• common form – lymph nodes are enlarged in two or more parts of the body.

By duration:

• short – less than 2 months;
• long, or protracted – lasts more than 2 months.

Downstream:

• acute – short-lived, occurred together with any acute pathology;
• chronic – prolonged, persists due to chronic pathology or for no apparent reason;
• recurrent – exacerbates with a certain frequency against the background of a chronic disease or for no apparent reason.

Symptoms of lymphadenopathy

Lymphadenopathy is accompanied by an increase in lymph nodes. In classical lymphadenopathy, the nodes are soft in texture, sometimes slightly painful. In size, the affected lymph node may resemble a bean – it is about 2 cm.

In most cases, patients do not pay attention to enlarged lymph nodes, they are only concerned about the manifestations of the underlying disease. For example, with acute respiratory infections, it can be a sore throat, sore throat, cough, runny nose, fever, chills, a general feeling of malaise.

However, in some cases, an increase in lymph nodes is a symptom of a serious pathology.

An enlarged axillary lymph node in a woman may be a sign of breast cancer.

With the development of lymphoma or the spread of tumor cells (metastasis), the lymph nodes enlarge for no apparent reason and become dense, even hard.

In breast cancer, nearby lymph nodes are enlarged

The patient may not notice enlargement of internal lymph nodes at all. In this case, complaints will primarily indicate the symptoms of the underlying disease, and lymphadenopathy will be detected only after ultrasound, CT or MRI of the corresponding part of the body.

Diagnosis of lymphadenopathy

Most often, patients do not notice lymphadenopathy and do not complain about it. It serves as a secondary symptom of various diseases.

For example, with acute respiratory infections, patients first of all mention sore throat, nasal congestion, cough, chills and other symptoms, but not an increase in the submandibular lymph nodes – the general practitioner will pay attention to this during examination and palpation (palpation).

If a patient comes to a therapist complaining of a “cold”, the doctor will first feel the neck and the area under the lower jaw – he will check the lymph nodes.

In intestinal infections, such as salmonellosis, the main symptoms are abdominal pain, vomiting, diarrhea, high fever. An increase in the abdominal lymph nodes, if any, will reveal only a hardware study.

However, in some cases, the appearance of an unusual “bump” under the armpit or in the groin may be the main complaint. In this case, the doctor will ask in detail about the symptoms and, focusing on the location of the enlarged lymph node, will begin to look for the cause of lymphadenopathy.

To assess the general condition of the patient, detect inflammatory processes and narrow the search area for pathology, a specialist can prescribe a general blood test and biochemistry, a urinalysis, and, if necessary, a set of tests for HIV, syphilis and hepatitis.

Clinical blood test with leukocyte formula and ESR (with microscopy of a blood smear in case of pathological changes) (venous blood)

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If the consistency of the lymph node is not soft, but elastic and hard, the doctor may suggest the development of a lymphoma or metastasis of any tumor. For example, a hard lymph node under the arm of a woman can be a sign of breast cancer.

If a malignant process is suspected, the therapist will refer the patient to an oncologist for an extended examination, including for the appointment of a biopsy – an analysis of the tissues of the lymph node for the presence of pathological changes and cancer cells.

To confirm the diagnosis, the doctor may prescribe a histological examination of the lymph nodes, which will reveal a malignant process, as well as recommend studies for a specific type of cancer.

Histological examination of lymph nodes (1-5 lymph nodes)

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Treatment of lymphadenopathy

Lymphadenopathy is not considered an independent disease and does not require separate treatment. It occurs as a result of other diseases, and the main goal of therapy is to cure them, and in the case of autoimmune and some oncological diseases, to achieve a stable remission.

For a viral infection, the patient is prescribed antiviral drugs. If the causative agent of the infection is a bacterium, the doctor will give you a prescription for antibiotics.

Treatment of autoimmune diseases may be associated with the use of hormonal drugs and immunosuppressants – drugs that reduce the body’s immune response.

Oncological diseases are treated with the help of operations, chemical and radiation therapy.

If the cause of the enlarged lymph nodes is not established (idiopathic lymphadenopathy) and no diseases were found after the examination, the doctor may recommend a preventive visit every 3 months to observe and evaluate changes. Perhaps the disease proceeds in a latent form and it takes time to manifest itself.

Sequelae of lymphadenopathy

Lymphadenopathy is a clinical sign of many diseases and the body’s signal that something is wrong with health.

In advanced infectious diseases, the pathogen can enter the lymph node and lead to its inflammation – lymphadenitis . Pathology is manifested by severe pain in the lymph node, swelling, redness of the skin, and sometimes suppuration or tissue death (necrosis).

Tuberculous lymphadenitis.
Photo: Dr. J. S. Bhandari

Lymphadenitis can lead to blood poisoning – sepsis, as well as to the spread of infection throughout the body.

Moreover, an increase in lymph nodes can be oncogenic in nature – it can be a sign of the spread of secondary foci of a cancerous tumor. For example, lymph nodes increase with the development of a malignant neoplasm – lymphoma, as well as with the spread of cancer cells of other tumors (metastases) through the lymphatic system.

Suspicion of lymphadenopathy is a reason to consult a doctor.

Oncological diseases in the early stages in most cases respond well to treatment. But if their beginning is missed, the malignant process may spread to other organs, and in this case, the treatment may be less effective. For this reason, if you suspect an increase in lymph nodes and the appearance of uncharacteristic seals under the skin, you should immediately seek medical help.

Sources

1. National Clinical Guidelines for the Diagnosis of Lymphadenopathy / National Hematological Society. 2018.
2. Vorobyov A. I. Guide to hematology. Volume 2. M., 2005. S. 274.
3. Dvoretsky L.I. Differential diagnosis in lymphadenopathy. Reference book of the polyclinic doctor. Volume 3. M., 2005. S. 238.
4. Kazantsev A.P. Lymphadenopathy / Differential diagnosis of infectious diseases / ed. Zubik T. M. M., 1991. S. 115–129.

Enlargement of lymph nodes, lymphadenopathy – causes, examination and treatment in Astrakhan | Symptoms

Upper respiratory infection
Signs: Only the lymph nodes of the neck are affected, pain is negligible or absent. Sore throat, runny nose or cough.

Infection of dental tissue
Signs: Only the lymph nodes of the neck on one side are affected, a bad tooth.

Mononucleosis
Signs: Enlargement on both sides, usually in the neck, but sometimes under the armpits or in the groin. Fever, sore throat and excessive fatigue. Usually in teenagers or young adults.

Tuberculosis with lymph node involvement
Signs: Usually swelling of the lymph nodes in the neck or above the collarbone. Sometimes lymph nodes with inflammation or discharge. Often in a patient with HIV infection.

HIV (immediately after infection – primary infection)
Signs: Generalized lymphadenopathy. Usually fever, malaise, rash and joint pain. Often in a person with known HIV infection or risk factors for HIV (sticking with a needle used by another person or high-risk sexual activity).

Sexually transmitted diseases (herpes simplex virus, chlamydia and syphilis)
Signs: With the exception of secondary syphilis, only enlarged lymph nodes in the groin area. Often urinary tract symptoms (pain during urination) and discharge from the urethra or vagina. Sometimes ulcers on the genitals. For secondary syphilis, widespread mucosal ulcers and widespread lymphadenopathy are common.

Skin and soft tissue infections (phlegmon, abscess, cat-scratch disease)
Signs: Usually visible sore or skin infection near the enlarged lymph node.

Toxoplasmosis
Signs: Enlarged nodes on the neck and in the armpit on both sides. Sometimes flu-like symptoms and enlargement of the liver and spleen. Often a history of contact with cat feces.

Leukemias (chronic, acute lymphocytic leukemia)
Signs: Fatigue, fever and weight loss. In acute leukemia, there is often increased bleeding and/or bleeding.

Lymphomas
Signs: Painless lymphadenopathy (local or widespread). The knots are often elastic and sometimes fuse together. Often fever, night sweats, and weight loss.

Metastasizing malignancies (head and neck, thyroid, breast, or lung)
Signs: One or more painless lymph nodes in the neck. Lymph nodes are often dense, sometimes not amenable to displacement.

Systemic lupus erythematosus (SLE)
Signs: Widespread lymphadenopathy. Typically painful and sometimes swollen joints. Sometimes red rash on nose and cheeks and other skin ulcers.

Sarcoidosis
Signs: Painless lymphadenopathy, possibly widespread.