What are the common causes of swollen popliteal lymph nodes. How can you recognize the symptoms of swollen popliteal lymph nodes. What diagnostic methods do doctors use to identify the underlying cause of swollen popliteal lymph nodes.

Understanding Popliteal Lymph Nodes: Location and Function

Popliteal lymph nodes are an essential component of the lymphatic system, located deep within the popliteal fossa – a diamond-shaped area behind the knee joint. These nodes play a crucial role in filtering bodily fluids and maintaining immune function. How many popliteal lymph nodes does a person typically have? The number can vary, with most individuals having between 2 to 9 nodes in each popliteal fossa.

The primary function of popliteal lymph nodes is to filter fluids from deep structures within the leg and foot. This filtering process involves removing harmful cells, molecules, and pathogens from the lymphatic fluid. By doing so, these nodes contribute to the body’s overall immune defense system and help manage fluid buildup between cells.

Anatomy of the Popliteal Fossa

To better understand the location of popliteal lymph nodes, it’s important to familiarize ourselves with the anatomy of the popliteal fossa. This region is situated behind the knee joint and forms a diamond-shaped depression. The popliteal fossa contains various important structures, including blood vessels, nerves, and lymph nodes. The strategic positioning of the popliteal lymph nodes in this area allows them to effectively filter lymph from the lower extremities.

Common Causes of Swollen Popliteal Lymph Nodes

Swollen popliteal lymph nodes, also known as popliteal lymphadenopathy, can occur due to various underlying conditions. Understanding these potential causes is crucial for proper diagnosis and treatment. What are the most common reasons for popliteal lymph node swelling? Let’s explore the primary factors:

Infections

Infections are among the most frequent causes of swollen popliteal lymph nodes. These can include:

• Bacterial infections
• Viral infections
• Fungal infections

When the body is fighting an infection, lymphocytes (a type of white blood cell) accumulate in the lymph nodes, leading to swelling. This response is part of the body’s natural defense mechanism against pathogens.

Autoimmune Conditions

Several autoimmune disorders can cause dysfunction in immune cells, potentially resulting in swollen popliteal lymph nodes. Some examples include:

• Sarcoidosis
• Amyloidosis
• Rheumatoid arthritis

In these conditions, the immune system may mistakenly attack healthy tissues, leading to inflammation and lymph node swelling.

Lymphoproliferative Conditions

Lymphoproliferative disorders are characterized by the excessive production of lymphocytes. One such condition that can cause popliteal lymphadenopathy is hemophagocytic lymphohistiocytosis. These disorders can lead to an accumulation of lymphocytes in the lymph nodes, resulting in swelling.

Cancer

While it’s important to note that cancer is a less common cause of swollen popliteal lymph nodes, it remains a possibility that should be considered. Lymphomas, which are cancers that originate in the lymph nodes, can cause lymphadenopathy. Additionally, other types of cancer may spread to the lymph nodes, including leukemia and various solid tumors.

However, it’s crucial to remember that according to the American Cancer Society, most cases of swollen lymph nodes are not due to cancer. Moreover, research indicates that it is relatively rare for cancer to spread specifically to the popliteal lymph nodes.

Recognizing Symptoms of Swollen Popliteal Lymph Nodes

Identifying the symptoms of swollen popliteal lymph nodes is essential for seeking timely medical attention. The presentation of symptoms can vary depending on the underlying cause. What are the typical signs of swollen popliteal lymph nodes?

Symptoms Indicative of Infection

When swollen popliteal lymph nodes are caused by an infection, you may experience:

• Pain, redness, and tenderness behind the knee
• A pea-sized lump that may swell to half an inch in diameter
• A lump that moves freely when pushed

These symptoms typically resolve within two weeks as the infection subsides.

Symptoms Requiring Medical Attention

Certain symptoms warrant a visit to the doctor. These include:

• Painless swelling behind the knee
• Swelling larger than half an inch in diameter
• A hard lump that does not move freely when pushed
• Swelling that persists for longer than two weeks

If you experience any of these symptoms, it’s important to consult a healthcare professional for proper evaluation and diagnosis.

Diagnostic Approaches for Swollen Popliteal Lymph Nodes

Diagnosing the underlying cause of swollen popliteal lymph nodes often requires a comprehensive approach. Doctors employ various methods to accurately identify the root cause of the swelling. What diagnostic techniques do medical professionals use to evaluate swollen popliteal lymph nodes?

Physical Examination

The initial step in diagnosis typically involves a thorough physical examination. During this process, the doctor will assess the swollen lymph node’s characteristics, including:

• Size
• Firmness
• Tenderness or pain
• Mobility

This examination provides valuable information that can help guide further diagnostic steps.

Blood Tests

Blood tests are often conducted to gather additional information about the patient’s overall health and potential underlying conditions. Common blood tests include:

• Complete blood count (CBC)
• Complete metabolic panel
• Fungal serologies

These tests can help identify infections, inflammatory conditions, or other systemic issues that may be causing the lymph node swelling.

Imaging Studies

Imaging techniques play a crucial role in visualizing the affected lymph nodes and surrounding structures. What imaging methods are commonly used for diagnosing swollen popliteal lymph nodes?

• Computed Tomography (CT) scans: These detailed images can reveal the extent of lymph node swelling and help identify any other affected nodes in the body. CT scans are also useful for planning lymph node biopsies if necessary.
• Ultrasound: This non-invasive imaging technique can provide real-time visualization of the lymph nodes and help distinguish between solid masses and fluid-filled cysts.
• Magnetic Resonance Imaging (MRI): In some cases, MRI may be used to obtain high-resolution images of the popliteal region and surrounding tissues.

Lymph Node Biopsy

In certain situations, a lymph node biopsy may be necessary to obtain a definitive diagnosis. This surgical procedure involves removing all or part of the swollen lymph node for laboratory analysis. When is a lymph node biopsy typically performed?

• When cancer is suspected
• To identify specific pathogens in cases of persistent infection
• To diagnose certain autoimmune or inflammatory conditions

While not always required, a lymph node biopsy can provide crucial information for accurate diagnosis and appropriate treatment planning.

Differential Diagnosis: Ruling Out Other Conditions

Given the variety of potential causes for swollen popliteal lymph nodes, healthcare providers must consider a range of possibilities during the diagnostic process. What other conditions might mimic the symptoms of swollen popliteal lymph nodes?

Baker’s Cyst

A Baker’s cyst, also known as a popliteal cyst, is a fluid-filled swelling that develops behind the knee. It can sometimes be mistaken for swollen popliteal lymph nodes. How can doctors differentiate between a Baker’s cyst and swollen lymph nodes?

• Ultrasound imaging can help visualize the cystic nature of a Baker’s cyst
• Baker’s cysts are typically larger and more diffuse than swollen lymph nodes
• The location and characteristics of the swelling may differ slightly from those of lymph nodes

Deep Vein Thrombosis (DVT)

Deep vein thrombosis, a blood clot in a deep vein of the leg, can sometimes cause swelling and discomfort in the popliteal region. What distinguishes DVT from swollen popliteal lymph nodes?

• DVT often causes more generalized swelling of the leg
• Patients with DVT may experience warmth and redness along the affected vein
• Doppler ultrasound can help identify blood clots in the veins

Popliteal Artery Aneurysm

An aneurysm of the popliteal artery can lead to a pulsatile mass behind the knee. How do doctors differentiate this condition from swollen lymph nodes?

• Popliteal artery aneurysms typically pulsate with the heartbeat
• Doppler ultrasound or angiography can confirm the presence of an aneurysm
• The mass is usually larger and more fixed than swollen lymph nodes

Treatment Approaches for Swollen Popliteal Lymph Nodes

The treatment of swollen popliteal lymph nodes depends on the underlying cause identified during the diagnostic process. What are the common treatment strategies for various causes of popliteal lymphadenopathy?

Treating Infections

When swollen popliteal lymph nodes are caused by infections, the primary focus is on addressing the underlying pathogen. Treatment may include:

• Antibiotics for bacterial infections
• Antiviral medications for certain viral infections
• Antifungal drugs for fungal infections

In many cases, the lymph node swelling will subside as the infection is brought under control.

Managing Autoimmune Conditions

For autoimmune disorders causing popliteal lymphadenopathy, treatment typically involves managing the underlying condition. This may include:

• Immunosuppressive medications
• Corticosteroids to reduce inflammation
• Disease-modifying antirheumatic drugs (DMARDs) for conditions like rheumatoid arthritis

Addressing Lymphoproliferative Disorders

Treatment for lymphoproliferative conditions often requires a multidisciplinary approach. Options may include:

• Chemotherapy
• Immunotherapy
• Stem cell transplantation in severe cases

Cancer Treatment

If cancer is identified as the cause of swollen popliteal lymph nodes, treatment will depend on the type and stage of cancer. Common approaches include:

• Surgery to remove affected lymph nodes
• Radiation therapy
• Chemotherapy
• Targeted therapy or immunotherapy for specific cancer types

The treatment plan will be tailored to the individual patient’s needs and the characteristics of the cancer.

Prognosis and Follow-up Care

The prognosis for patients with swollen popliteal lymph nodes varies greatly depending on the underlying cause. What factors influence the outlook for individuals with this condition?

Prognosis for Infectious Causes

In cases where swollen popliteal lymph nodes are due to infections, the prognosis is generally good. With appropriate treatment, most patients experience resolution of symptoms within a few weeks. However, follow-up care is important to ensure complete recovery and to address any potential complications.

Long-term Outlook for Autoimmune Conditions

For patients with autoimmune disorders causing popliteal lymphadenopathy, the prognosis depends on the specific condition and its management. While many autoimmune conditions are chronic, proper treatment can help control symptoms and prevent complications. Regular follow-up appointments with rheumatologists or immunologists are typically necessary for ongoing care.

Prognosis for Cancer-related Lymphadenopathy

When swollen popliteal lymph nodes are related to cancer, the prognosis varies based on several factors:

• Type and stage of cancer
• Response to treatment
• Overall health of the patient
• Presence of metastases

Close monitoring and follow-up care are crucial for cancer patients, often involving a team of oncologists, surgeons, and other specialists.

Importance of Regular Check-ups

Regardless of the underlying cause, patients who have experienced swollen popliteal lymph nodes should maintain regular check-ups with their healthcare providers. These follow-up appointments allow for:

• Monitoring of lymph node size and characteristics
• Early detection of any recurrence or new issues
• Adjustment of treatment plans as needed
• Addressing any ongoing symptoms or concerns

By staying vigilant and maintaining open communication with healthcare providers, patients can ensure the best possible outcomes and quality of life following a diagnosis of swollen popliteal lymph nodes.

Swollen popliteal lymph nodes: Causes, anatomy, and diagnosis

The popliteal lymph nodes lie in the tissues behind a person’s knee. Many conditions can cause them to swell, such as infections and autoimmune conditions. It is rare for cancer to affect the popliteal lymph nodes.

This article takes a detailed look at swollen popliteal lymph nodes. It discusses what can cause swelling, diagnostic tests, and what happens after diagnosis. It also explains the anatomy and function of popliteal lymph nodes.

Lymphadenopathy is swelling of the lymph nodes. It arises when too many lymphocytes accumulate within the lymph nodes. Lymphocytes are special types of white blood cells, a kind of immune system cell.

According to a 2022 review, many health conditions can cause lymphocytes to accumulate. Some possible causes of swollen popliteal lymph nodes include:

• Infections: Several types of infection can cause lymphadenopathy. These include bacterial, viral, and fungal infections.
• Autoimmune conditions: Some autoimmune conditions can cause dysfunctions with immune cells. These conditions include sarcoidosis, amyloidosis, and rheumatoid arthritis.
• Lymphoproliferative conditions: Lymphoproliferative conditions are when the immune system produces too many lymphocytes. For example, hemophagocytic lymphohistiocytosis can cause lymphadenopathy.

Swollen popliteal lymph nodes may also be due to cancer.

Learn more about lymph nodes here.

Could it be cancer?

Several cancers can cause lymphadenopathy. These include lymphomas, which are cancers that begin in the lymph nodes. However, other cancers can spread to the lymph nodes, from leukemia to neck cancer.

However, according to the American Cancer Society (ACS), most swollen lymph nodes are due to a condition that is not cancer. Moreover, an older study notes that it is rare for cancers to spread to the popliteal lymph nodes.

Learn about cancer in the lymph nodes here.

Swollen popliteal lymph nodes caused by infection may present the following symptoms:

• pain, redness, and tenderness behind the knee
• a pea-sized lump that may swell to half an inch in diameter
• a lump that moves freely when pushed

These symptoms indicate an infection and should disappear within 2 weeks once the infection subsides.

Swollen popliteal lymph nodes that present the following symptoms should be checked out by a doctor:

• painless swelling behind the knee
• a swelling larger than half an inch in diameter
• a hard lump that does not move freely when pushed
• swelling lasts longer than 2 weeks

Scientists describe popliteal lymph nodes as located deep within the popliteal fossa.

The popliteal fossa is a diamond-shaped part of the leg. It lies behind the knee joint. There are 2–9 lymph nodes within every popliteal fossa.

The picture below shows swollen popliteal lymph nodes in the popliteal fossa.

Share on PinterestAnatomy of the back of the knee showing the popliteal lymph nodes. Medical Illustration by Bailey Mariner

Lymph nodes are part of the lymphatic system. The lymphatic system serves many important functions. For instance, it moves immune cells around the body and manages fluid buildup between cells.

Within the lymphatic system, lymph nodes help to filter bodily fluids. Lymph nodes connect to lymphatic vessels, which feed these fluids into them. The filtering process involves removing harmful cells, molecules, or pathogens. Lymph nodes can do this because they contain several immune cells.

Lymph nodes receive fluids from different body parts. The popliteal lymph nodes filter fluids from deep structures within the leg and foot.

Learn about the anatomy of the lower leg here.

Doctors can diagnose swollen lymph nodes based on a physical exam. An individual with swollen popliteal lymph nodes may feel a lump in their popliteal fossa.

Swollen lymph nodes can show up in imaging studies, such as computed tomography (CT) scans.

Because so many different conditions cause lymphadenopathy, doctors can find it challenging to diagnose the cause. Doctors may recommend the following tests:

• Detailed physical exam: Doctors can gather useful information from a physical exam. This information includes a swollen lymph node’s size, firmness, and potential pain.
• Blood tests: Doctors may use a blood sample for testing in a laboratory. Tests include complete blood counts, complete metabolic panel, and fungal serologies.
• CT scans: Doctors may use a CT scan to check whether an individual has other swollen lymph nodes. These scans can also help with planning lymph node biopsies.
• Lymph node biopsy: In this surgical procedure, doctors remove all or part of a swollen lymph node. They will then send this sample for laboratory testing. Although lymph node biopsies are not always necessary, doctors must perform them to diagnose conditions such as cancer.

An individual may need to see several doctors before receiving a diagnosis. The process could take several weeks.

After diagnosis, doctors can recommend treatments. This varies greatly, depending on the underlying cause of swollen popliteal lymph nodes. Possible treatments include:

• For cancers: Surgery, radiation therapy, or chemotherapy can help. Sometimes, doctors recommend a combination of these.
• For autoimmune conditions: Treatment may include immune therapy and systemic glucocorticosteroids.
• For infectious conditions: Treatment might involve antibiotic, antifungal, or antiviral medications depending on the type of infection.

Some medications can cause swollen lymph nodes. When this occurs, doctors may recommend changing the medications or their dosages.

The popliteal fossa is an area of tissue behind a person’s knee joints. Deep within this structure lie 2–9 popliteal lymph nodes. As parts of the lymphatic system, these lymph nodes filter fluids from the leg and foot.

There are various causes of swollen popliteal lymph nodes, including infections, autoimmune conditions and conditions that increase lymphocyte production. Cancers can also cause swollen popliteal lymph nodes, although this is rare.

Doctors can diagnose swollen popliteal lymph nodes with a physical exam. To determine the cause, they may use imaging tests, laboratory tests, or biopsies.

Lymph Nodes

An IMBUS lymph node exam needs to be carefully performed and interpreted to avoid over- or under-reacting to these lumps.

Ultrasound is usually better than CT at finding and sizing lymph nodes in the neck, axilla, epitrochlear area, and groin.  A general lymph node survey, whether traditional or IMBUS, has not been shown beneficial as part of a periodic physical, but has anecdotally been useful in systemically ill patients who could have an infectious, inflammatory, or neoplastic disease because an abnormal node might be biopsied to make a diagnosis. A physician needs good technique and knowledge of lymph node anatomy to perform such a survey.

Most patients who need an IMBUS lymph node exam come to clinic after noticing a lump in the neck, armpit, or groin. If a lump is an abnormal node, a more general node survey might be done to determine if the lymphadenopathy is generalized. The differential diagnosis for generalized lymphadenopathy is different from that of localized lymphadenopathy.

The most frequent enlarged node in clinic is a neck node, the great majority of which are a reaction to head or neck infection. Yet, malignancy is the fear, which is why the size and character of nodes is evaluated carefully. In the primary care setting, initially unexplained lymphadenopathy has only about a 1% chance of malignancy, but failure of node regression over 4 weeks increases the chance of malignancy.

ANATOMY

The neck region is divided into Anterior and Posterior triangles, based on the sternocleidomastoid muscle, as shown in the next diagram. The small Subclavian triangle shown in the image is the location of supraclavicular nodes.

The next image shows the location of lymph node groups in the neck. There are nodes superficial and deep to the sternocleidomastoid. Some nodes are near the carotid artery and internal jugular vein. For a neck survey, the probe is moved in a transverse orientation up and down the neck from medial to lateral just like a systematic palpation exam would be performed.

The axillary region has nodes on the lateral chest, high in the axilla, and on the upper, inner arm, as in the following image. A systematic survey of axillary nodes would rarely be done with IMBUS, but when a patient has noticed a lump in this general area, it is important to know where to look for additional nodes in the region.

The epitrochlear region is small and many normal patients have only very small nodes in this location. However, an enlarged node indicates either generalized lymphadenopathy or an inflammatory condition in the lower arm, which should be obvious. The following image shows the location of potential epitrochlear (supratrochlear) nodes in the groove just medial to the biceps muscle. Notice the close proximity of the node group to the basilic vein near the medial epicondyle.

Groin nodes can be inguinal, which are located near the inguinal ligament and drain the lower retro-peritoneum, pelvis, and genitals, or they can be femoral, which are located anterior and medial to the common femoral and great saphenous veins. The femoral nodes drain the leg and occasionally the genitals. The following diagram shows the inguinal and femoral node groups.

TECHNIQUE

Lymph nodes are best evaluated with the linear probe and an exam type optimized for good detail and low Nyquist limits. All the peripheral node regions are best examined with the patient in the supine position. The view of each node should be optimized with depth and focus position so details of shape and texture can be observed. To be consistent amongst physicians and between follow up exams, the probe should be rotated to find the greatest dimension of the node, which is considered the “length”. The probe is then rotated 90 degrees to measure the “width” and “depth” of the node. These dimensions may have no relationship to the traditional parasagittal or transverse planes on the body. Color power Doppler should be applied to assess the vascularity.

NORMAL NODES

It is impossible to be certain that a node is normal or abnormal (or certainly reactive versus malignant) based on any single characteristic. However, the combination of findings, integrated with the rest of the clinical story, helps the care of the patient.

Normal nodes appear the same in any of the four regions that IMBUS can evaluate. They are less than 1.0 cm (often less than 0.5 cm) in length, oval/elliptical in shape, with a hyperechoic central hilum. Color/power Doppler shows only a little flow in the hilum. The periphery of the node has moderate to low echogenicity and the margins of the node should be clear and smooth. The following image is a normal neck node in an asymptomatic patient just anterior to the internal jugular vein. This node measured 0.9 cm in length.

ABNORMAL NODES

Increased size usually prompts a node exam but size alone does not distinguish reactive from malignant nodes. Every malignant node begins small.

A node that is ≥ 1 cm in maximum length is enlarged. In general, reactive nodes should maintain an oval/elliptical shape and should have a preserved hyperechoic hilum, but the periphery of the node may be more hypoechoic than normal. Color/power Doppler flow may be increased at the hilum of a reactive node but the margins of the node should still be sharp and smooth. The following image shows a modestly enlarged node that was proven to be reactive with careful follow up.

The next node was more worrisome to the physician because it was a little larger and rounder in shape. It was in the groin and had been present for over a month.

There was no obvious inflammatory focus in the leg or groin. The node seemed to have an irregular border. The periphery was definitely more hypoechoic than normal. Color/power Doppler flow was increased in the hilum. After seeing the surgeon several weeks later with persistence of the node, FNA was performed and no malignancy was found. Thus, differentiating reactive from malignant nodes is difficult and biopsy is sometimes needed.

Malignant nodes typically become rounded or irregularly shaped and are usually markedly hypoechoic, although a few types of tumors can create very hyperechoic nodes. Color/power Doppler flow can be increased in various places in the node. The next image is a neck node proven to be lymphoma. It was a 3 cm node, and while the margin was distinct and smooth, the hilum was obliterated and the node was very hypoechoic. There was also scattered color flow throughout the node.

The next clip is from a non-smoking clinic patient who noticed a lump in the neck. This hypoechoic node was 3.0 cm in length, modestly rounded, and had no hilar vessels. Biopsy revealed a squamous cell carcinoma related to HPV. This was the only lesion on PET/CT scanning.

The next composite image shows epitrochlear nodes ranging from normal to inflammatory and then malignant. Note that the reactive cat scratch disease node is difficult to differentiate from a malignant node. The rest of the clinical story and followup are usually necessary to separate reactive from malignant nodes.

The next case was a 72-year-old man who came to clinic with a URI. Several lumps were felt in the right supraclavicular region. The clip shows a round shape, texture that was more hypoechoic than normal, no hilum, and some increased Color. Biopsy showed follicular lymphoma.

An older woman noticed lumps in her inguinal region. Here is the color Doppler of the largest node in the group. The color Doppler flow is increased at the hilum and into the parenchyma of the node.

It is impossible to know if these are reactive or malignant nodes and given the overall appearance of the group and without an obvious leg, genital, or intra-abdominal inflammation, waiting a month for regression was probably not the right approach for this patient. So, an immediate CT of the abdomen and pelvis was obtained, but this showed no pathology to explain the nodes. Only longer-term follow-up will differentiate reactive from malignant and a biopsy may be needed.

IMBUS APPROACH TO NODES

1. Each enlarged node should be measured for length, width, and depth. The other characteristics of the node should be noted, including color/power Doppler flow, and the images/clips should be saved in case follow up comparison is needed.

2. A patient with a modestly enlarged node with other characteristics still appearing normal can be reassured by the extremely low likelihood that this node is malignant, particularly if the node is in the neck and the patient is younger. But, over the next month, each patient should note whether the node decreases or disappears (without vigorous palpation every day)! With a less reliable patient, a follow up visit should just be scheduled. If the node does not regress or even increases, the patient must return for re-imaging. Reactive nodes do not have to fully disappear in a month, but they should not grow, unless the inflammatory condition is continuing.  A clear reduction in size over a month strongly supports a reactive node.

3. Older patients, particularly smokers, with neck nodes and an absence of recent infections in the head/neck are more worrisome for cancer. A 4 week repeat exam might be appropriate, but with any other atypical characteristic beyond size, ENT consultation without a 4-week wait would be justified. It would usually be wise to call ENT and decide about a CT scan before the office consultation.

4. The larger and more abnormal a node appears, the greater the concern for malignancy. The integration of all the node findings with the rest of the clinical story will often prompt immediate ENT or surgical consultation (with CT imaging).

5. Multiple abnormal nodes in several locations (generalized lymphadenopathy) has a broad differential diagnosis of infectious, inflammatory, and neoplastic conditions. Integration with the rest of the clinical findings is essential, but a lymph node biopsy may contribute to the diagnosis and IMBUS can help identify the best node to biopsy.

Chapter 1

Go to the contents of the Bulletin of the RNTsRR MZ RF N5.

Current section: Abstracts and literature reviews.

Literature review from the dissertation for the scientific
degree of candidate of medical sciences.

The role of sonography
in the differential diagnosis of malignant and benign
lymphadenopathy.

Author : Elena Vasilievna Abassova.

Work
performed at the Federal State Institution Russian Scientific Center for Roentgen Radiology of Roszdrav
(Director – Academician of the Russian Academy of Medical Sciences, Professor V. P. Kharchenko).

Protection
dissertation took place on 27.06.05. on
meeting of the Dissertation Council
D.208.081.01 at the Federal State Institution of the Russian
scientific center of X-ray radiology
Roszdrav (117 997, Moscow,
st. Profsoyuznaya 86).

Address
Reference document: http://vestnik.rncrr.ru/vestnik/v5/papers/litabas_v5.htm 002 Table of contents:

5. Peripheral Ultrasound Technology
   LU.
6. Ultrasound anatomy of the lymph nodes.
7. Inflammatory, reactive lymphadenitis.
8. Changes in the lymph nodes in certain infections.
9. Lymph nodes affected by malignant
   tumors.
10. Malignant
    lymphomas.
11. References.

Based on the foregoing, it seemed relevant to us to conduct a study on
development of LU echosemiotics in the conditions of using new ultrasound
technologies for the differential diagnosis of LAP.

In children
the immune system, of which LNs are a part, is particularly vulnerable and sensitive to
unfavorable environmental factors, as it is in the stage
structural and functional maturation and has a greater functional
load. In this regard, in children in childhood it is often difficult
answer the question whether this LN hyperplasia is a manifestation
pathological process, or is it a constitutionally conditioned condition (I.
V. Davydovsky) [6].

2. Lymph node anatomy.

reference.

5. Technology
ultrasound examination of peripheral LUs.

Before
how to assess the state of the lymphatic collector of the head and neck area,
it is necessary to determine the main anatomical landmarks, namely, the common carotid
artery and internal jugular vein and their relationship with others
structures. Inspection begins with an assessment of the anterior neck during movement
sensor from the area of ​​the hyoid bone to the area of ​​the jugular notch in the transverse
planes. Then the head is turned to one side and a transverse and longitudinal
examination of the lateral sections of the neck from the angle of the lower jaw to the supraclavicular region
along the sternocleidomastoid muscle. Similarly, when examining the LU of the head and
necks are examined in the transverse and longitudinal planes of the periparotid region.

In his
In this study, we used the existing classification of head lymph nodes
and neck, according to which they are divided into the following groups [11]:

1)
deep cervical LU;

2)
lymph nodes of the posterior triangle;

3)
supraclavicular LU;

4)
chin LU;

5)
submandibular LU;

6)
periparotid LU.

Deep
extravisceral and retropharyngeal lymph nodes of the neck cannot be detected with
echography due to the unavailability of its location for this diagnostic
method. Most of the lymph nodes in the circumcervical region are drained by a chain of deep
jugular LU. Only from the occipital lymph node flows directly into
accessory spinal lymphatic collector.

According to
classification by H. Rouvierre (1932),
deep cervical lymph nodes are divided into anterior and lateral groups [cit. according to 11].

Front located
anterior to the internal jugular vein, mainly in the upper part of the neck between
digastric muscle and hyoid bone.

Lateral
internal jugular lymph nodes collect lymph both directly from organs and tissues,
and through the system of other LUs. This lymphatic collector drains the nasal
fossa, tonsils, tongue, hard palate, thyroid gland, ear, submandibular and
sublingual salivary glands.

Supraclavicular
the area is examined using a linear probe 6-10 MHz. To assess the state of the LU
of this regional zone, the ultrasound transducer is moved in the projection of the anterior supraclavicular
triangle. In the search for LU, the areas of location of such vessels, such as common
carotid arteries, brachiocephalic artery and vein. An important role is played by the identification
supraclavicular region of the lymph nodes located on the anterior fascia (superficial).
Supraclavicular LNs are considered second-order LNs for the upper quadrants
mammary gland. In the case when lymph nodes flow into the supraclavicular LU
vessels from the upper quadrants of the mammary glands, they are simultaneously
lymph nodes of the first and second order [11].

At
performing an ultrasound examination of the axillary region of the patient
is located on the back with the arm raised and at the same time laid aside.
Linear and convex transducers 5-10 MHz are used, taking into account the thickness of the subcutaneous
fiber. The reference point in the search for LU, as in other regions, was large
vascular trunks: axillary vein and external thoracic artery.

To these LUs
lymph flows from the outer quadrants of the mammary gland, anterior and lateral
sections of the chest wall and the upper section of the anterior abdominal wall.

For evaluation
condition of the subclavian LU linear or convex sensor 5.0-10 MHz (in
depending on the thickness of the soft tissues of the anterior chest wall and subcutaneous
fiber) is installed along an oblique line connecting the clavicle and axillary
region.

6. Ultrasound anatomy of the lymph nodes.

Available
a clear contradiction: on the one hand, data on a high diagnostic
the importance of C(E)DC in assessing information on the vascularization of parenchymal organs,
on the other hand, the inconsistency of the results obtained in a number of works
in relation to C(E)DK LU [1, 9, 12, 104, 106, 120, 115, 171].

With reduced immunity in response to an infectious process
reactive and hyperplastic changes in the LN are minimal, which does not allow
echography to distinguish them from normal lymph nodes.

8. Changes in the lymph nodes in certain infections.

9. Lymph nodes affected by malignant tumors.

Russian Scientific Center for Radiology of the Ministry of Health of Russia

Ultrasound of the lymph nodes (1 group)

Moscow. BS Clinic specialists have extensive experience and expert knowledge in the field of deciphering ultrasound indicators.

Ultrasound of the lymph nodes is a safe and informative diagnostic method that makes it possible to find out their number, evaluate all the necessary parameters, and the functional component. Ultrasound examination will reveal lymphadenopathy (an abnormal condition caused by inflammatory or autoimmune processes, pathology of the blood system, neoplasms).

More often, lymphadenopathy is observed against the background of any particular pathology, therefore, ultrasound of the lymph nodes is prescribed in combination with ultrasound of a diseased organ or tissue.

In total, there are about 150 groups of lymph nodes in the human body. They are located in various organs and tissues and are interconnected by a network of lymphatic vessels. The lymphatic system is part of the human immune system. The mission of the lymph nodes is to provide a barrier to the penetration of pathogenic microbes, toxic substances, and cancer cells into nearby organs. This is due to the formation and functioning of special cells – lymphocytes.

The value of the study lies in the ability to detect many dangerous changes at an early stage and prevent a severe course of the disease.

Ultrasound examination of the lymph nodes reveals: streptococci)

Indications for an appointment for an ultrasound of the lymph nodes

Ultrasound of the lymph nodes is necessary if the patient has the following symptoms:

• redness or fever of the skin (hot to the touch) in the area of ​​the lymph nodes;
• discomfort in movements in the area of ​​the lymph nodes (swallowing, walking, swinging arms)
• forced position of a part of the body due to pain in the area of ​​the lymph nodes (tilted head, hand pressed to the body)
• headache, general weakness for a long time
• sleep disorders (insomnia or drowsiness)
• persistent inflammatory processes in the body in a particular organ (otitis media, laryngitis, tonsillitis, adnexitis, thrombophlebitis, conjunctivitis, hepatitis)
• Suspicion of systemic diseases of the connective tissue or autoimmune processes (pain in the joints and muscles, rashes on the skin)
• deformity of the jaw bones
• Suspicion of tumors of various localization.

Also, ultrasound of the lymph nodes can be performed to assess the effectiveness of therapy and control the course of the disease.

Ultrasound of the lymph nodes helps to identify asymptomatic tumors. To exclude its malignancy, additional tests are carried out, but thanks to ultrasound, the neoplasm can be removed in time.

Methods of ultrasound diagnostics

When performing ultrasound of the lymph nodes, the doctor looks at the following indicators:

• location (solidity) relative to other organs
• anatomy
• size and volume of organs
• shape, structure and contours of organs
• echogenicity
• nature of blood flow

Ultrasound contraindications

This procedure has no contraindications, since the nature of the manipulation is safe, does not carry the risk of radiation exposure and does not involve surgical intervention. Even the presence of a pacemaker and an insulin pump is not an obstacle to the procedure.

How is the ultrasound of the lymph nodes

The patient lies on his back, the doctor applies an ultrasound gel to the area to be examined and moves the probe over it. Sometimes the doctor asks the patient to turn around, change the position of the body, bend the limb. Thus, he has the ability to obtain an image of the organs from different angles. The procedure lasts about 15 minutes.
Upon completion, all data are entered into the study protocol, which the doctor, along with the images, hands over to the patient.
It is possible to make an ultrasound scan of the lymph nodes in Moscow inexpensively and quickly by contacting the BS Clinic.

Benefits

The examination procedure is absolutely painless and quite informative. It allows you to quickly obtain reliable data on the state of the lymph nodes, thus at an early stage to identify a dangerous disease.

Preparation

Ultrasound of peripheral lymph nodes (cervical, axillary, knee, elbow, inguinal, etc.