Anatomy, Lymph Nodes – StatPearls

Introduction

The lymphatic system is composed of lymphatic vessels and lymphoid organs such as the thymus, tonsils, lymph nodes, and spleen. These assist in acquired and innate immunity, in filtering and draining the interstitial fluid, and recycling cells at the end of their life cycle. The fluid that leaks from end-stage capillaries returns to the vascular system via the superficial and deep lymphatic vessels, which in turn drain into the right lymphatic duct and the thoracic duct. The right lymphatic duct travels on the medial border of the scalenus anterior muscle and drains the lymph from the right upper quadrant of the body. The thoracic duct starts at the cisterna chyli and has highly variable anatomy. The right lymphatic duct and the thoracic duct drain into the right and left subclavian arteries, respectively, at the jugulovenous angle.[1]

Lymph nodes are found at the convergence of major blood vessels, and an adult will have approximately 800 nodes commonly sited in the neck, axilla, thorax, abdomen, and groin. These filter incoming lymph and play a role in infection as well as in malignancy. This paper will discuss the structure and function of lymph nodes, as well as the anatomical divisions of these.

Structure and Function

Lymph nodes are kidney-shaped and receive lymph via multiple afferent vessels, and filtered lymph then leaves via one or two efferent vessels. Nodes typically have an associated artery and vein, which terminates into a high endothelial venule (HEV). The HEV is the site of trans-endothelial migration of circulating lymphocytes due to T and B-cell endothelial surface receptors.[2]

Lymph nodes usually range in size from 1 to 2 cm and are enclosed in an adipose tissue capsule. Normal size depends upon location, as well as the axis which is being measured. The long axis should be 1 cm or less. They are considered pathological if they lose their oval shape, if there is a loss of the hilar fat, if there is an asymmetrical thickening of the cortex and if they are persistently enlarged. [3]

Lymph Node Structure
[4]

Capsule

The capsule of the lymph node is dense connective tissue stroma and collagenous fibers. The capsule sends trabeculae inside the lymph node, which pass inward, radiating towards the center.

Subscapular Sinus

The subcapsular sinus is the space between the capsule and the cortex, which allows the transportation of the lymphatic fluid.; this is also called the lymph path, the lymph sinus, or the marginal sinus.  The subcapsular sinus is present beneath the capsule and is traversed by both reticular fibers and cells. It receives the afferent vessels, continues with the trabecular sinuses, and joins the medullary sinus in the medulla of the lymph node. 

Cortex

The cortex of the lymph node is the layer beneath the subcapsular sinus. The cortex is formed of the outer cortex and the inner part known as the paracortex. The outer cortex layer is also named the B-cell layer, is rich in CXCR5 chemokines, and consists mainly of B-cells arranged into follicles. The immature B-cells develop into a germinal center when challenged with an antigen. Following this, resting B-cell and dendritic cells surround the germinal center to form a mantle zone. The paracortex layer, also called the T-cell layer, consists of T-cells that interact with the dendritic cells and is rich in CCR7 chemokines.[5]

Medulla

The medulla is the innermost layer of the lymph node and contains large blood vessels, sinuses, and medullary cords. The medullary cords contain antibody-secreting plasma cells, B-cells, and macrophages. The medullary sinuses (or sinusoids) are vessel-like spaces that separate the medullary cords. The medullary sinuses receive lymph from the trabecular sinuses and cortical sinuses and contain reticular cells and histocytes. The medullary sinus drains the lymph into the efferent lymphatic vessels.

Function of Lymph Node
[6]

The primary function of lymph nodes is filtering interstitial fluid collected from soft tissues and eventually returning it to the vascular system. Filtering this exudative fluid allows for exposure of T-cells and B-cells to a wide range of antigens. For antigen-specific B and T cells to activate, they must first suffer exposure to antigens with the aid of antigen-presenting cells, dendritic cells, and follicular dendritic cells. These form part of both the innate immune response and play a role in adaptive immunity.

Embryology

Lymph nodes begin their development in utero as mesenchymal condensation, which later bulges to form a lymph sac. At the 13th gestational week, the T-cell region begins to develop, and by the 17th gestation week, the interdigitating reticulum cells (a subtype of T-cells) are found in the paracortical lymph node region, surrounded by lymphoid cells. B-cell regions within lymph nodes start their development at the 14th gestation week at the marginal sinus with a population of dendritic reticulum cell precursors, lymphoblasts, immunoblasts, and plasmablasts. By the 20th gestation week, incipient primary follicles are observable in the outer cortex containing lymphocytes. During the 12th and 14th gestation weeks, lymph nodes undergo granulopoiesis and erythropoiesis to produce undifferentiated blast cells, monocytes, and macrophages temporarily.[7][8]

Blood Supply and Lymphatics

Lymph Nodes of the Head and Neck

The lymph nodes in the head and neck are paired and broadly split into superficial and deep nodes.

Superficial

Deep

In terms of anatomical dissection, these more easily split into levels of the neck.[9]

Level I

• Level Ia (submental nodes) – anteriorly, in the midline between the anterior bellies of the paired digastric muscles

• Level Ib (submandibular nodes) – in the submandibular triangle, as described above.

Level II

These nodes, also called the upper internal jugular nodes, are found in an anatomical area bounded by the base of the skull superiorly, the hyoid bone inferiorly, the submandibular gland anteriorly, the posterior border of the sternocleidomastoid muscle laterally, and the internal carotid artery medially. The spinal accessory nerve separates the level IIa and IIb nodes.

• Level IIa (jugulo-digastric nodes) – superficial or anterior to internal jugular vein

• Level IIb – deep or posterior to the internal jugular vein

Level III

These nodes are also names the middle internal jugular nodes and are bound superiorly by the hyoid bone, the cricoid cartilage inferiorly, the anterior edge of the sternocleidomastoid muscle anteriorly,  the posterior margin of the sternocleidomastoid muscle, and the common carotid artery medially.

Level IV

These nodes are also named the lower internal jugular nodes and include Virchow’s node. The anatomical area in which they are found is bound superiorly by the cricoid cartilage, the clavicle inferiorly, the sternocleidomastoid muscle anteriorly, and the common carotid artery medially.

Level V

These are also named the posterior triangle nodes and are bounded by the convergence of the sternocleidomastoid and trapezius muscles superiorly, the clavicle inferiorly, the sternocleidomastoid muscle anteriorly and medially, and the trapezius muscle posteriorly.

• Level Va – superior to the cricoid cartilage and include the spinal accessory nodes

• Level Vb – inferior to the cricoid cartilage and include the transverse cervical nodes and  the supraclavicular nodes

Level VI

This level is also named the anterior compartment and contains the anterior jugular, pre-tracheal, para-tracheal, pre-cricoid, pre-laryngeal, and thyroid nodes. It is bound superiorly by the hyoid bone, inferiorly by the suprasternal notch, by the platysma muscle anteriorly, and the common carotid artery laterally.

Lymph Nodes of the Upper Limb

The deep and superficial lymphatics in the upper limb eventually drain into the axillary nodes. However, there are supratrochlear and cubital lymph nodes at the level of the elbow, brachial lymph nodes, and deltopectoral lymph nodes. The drainage of the upper limbs is particular due to the presence of sentry or sentinel lymph nodes. These are usually larger than the rest of the lymph nodes and are the first to filter the incoming lymph. However, it is not uncommon for multiple smaller sentry lymph nodes to also be present.[10][11]

Axillary Nodes

• Lateral nodes (humeral) – These are found posterior to the axillary vein and are the primary draining nodes for the upper limb.

• Central nodes – These are found close to the 2nd part of the axillary artery and receive lymph from the anterior, posterior, and lateral nodes.

• Apical nodes – These are located near the 1st part of the axillary artery and vein and filter the lymph received from the central axillary nodes and the cephalic vein.

The apical nodes further form the subclavian lymphatic trunk, which then drains into the right lymphatic duct.

Lymph Nodes of the Lower Limb

The superficial and deep lymphatic vessels of the lower limb drain into the inguinal lymph nodes in the femoral triangle. This anatomical region, also named Scarpa’s triangle, is bounded by the inguinal ligament above, the medial border of the sartorius muscle laterally, and the medial border of the adductor longus muscle medially. [12][13]

Inguinal Nodes

The inguinal lymph nodes split at the level (where the great saphenous vein becomes the deep femoral vein) into sub-inguinal lymph nodes below and superficial inguinal nodes above.[3]

• Superficial inguinal nodes – These nodes are traditionally found immediately inferior to the inguinal ligament and drain the perineal area (penis, scrotum, perineum), the gluteal region, and part of the abdominal wall.

 Iliac Nodes:[14]

Clinical Significance

The lymphatic system is involved in infective, inflammatory, and malignant diseases, and as such, enlargement of lymph nodes can be attributed to multiple causes. In the case of lymphadenopathy of unclear origin, endoscopic ultrasound (EUS) with or without fine-needle aspiration (FNA) can aid in diagnosis.[15] This diagnostic technique has been shown to have high accuracy with up to 85% sensitivity and 100% specificity and is key in detecting and staging malignancy. [16] With lymph nodes that are out of the scope of fine-needle sampling, elastography plays an increasingly important role, similar to obtaining a virtual biopsy.[17] Functional and anatomical data can be acquired using more traditional diagnostic methods such as positron emission tomography (PET) combined with computed tomography. However, this is commonly a whole-body imaging technique and therefore involves high doses of ionizing radiation. Despite the recent advancements in imaging modalities, the diagnosis still heavily relies on clinical correlation with symptoms.

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Figure

Lymphatic System, Cervical lymph nodes, Lymphatics of the mammary gland, Cisterna chyli, Lumbar lymph nodes, Pelvic lymph nodes, Lymphatics of the lower limb, Thoracic duct, Thymus, Axillary lymph nodes, Spleen, Lymphatics of the upper limb, Inguinal (more…)

Figure

Deep Cervical Lymph nodes, Principal gland of tongue, Supraomohyoid gland, Central trunk, Interrupting nodule, Trunks from margin of tongue, Submental gland, Vessels from apex, Vessels from margin of tongue, Vessels from root of tongue. Contributed by (more…)

Figure

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

References

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Girard JP, Springer TA. High endothelial venules (HEVs): specialized endothelium for lymphocyte migration. Immunol Today. 1995 Sep;16(9):449-57. [PubMed: 7546210]

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Bontumasi N, Jacobson JA, Caoili E, Brandon C, Kim SM, Jamadar D. Inguinal lymph nodes: size, number, and other characteristics in asymptomatic patients by CT. Surg Radiol Anat. 2014 Dec;36(10):1051-5. [PubMed: 24435023]

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Elmore SA. Histopathology of the lymph nodes. Toxicol Pathol. 2006;34(5):425-54. [PMC free article: PMC1892634] [PubMed: 17067938]

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Baldazzi V, Paci P, Bernaschi M, Castiglione F. Modeling lymphocyte homing and encounters in lymph nodes. BMC Bioinformatics. 2009 Nov 25;10:387. [PMC free article: PMC2790470] [PubMed: 19939270]

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Liao S, von der Weid PY. Lymphatic system: an active pathway for immune protection. Semin Cell Dev Biol. 2015 Feb;38:83-9. [PMC free article: PMC4397130] [PubMed: 25534659]

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Markgraf R, von Gaudecker B, Müller-Hermelink HK. The development of the human lymph node. Cell Tissue Res. 1982;225(2):387-413. [PubMed: 6980711]

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Cupedo T. Human lymph node development: An inflammatory interaction. Immunol Lett. 2011 Jul;138(1):4-6. [PubMed: 21333686]

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Grégoire V, Ang K, Budach W, Grau C, Hamoir M, Langendijk JA, Lee A, Le QT, Maingon P, Nutting C, O’Sullivan B, Porceddu SV, Lengele B. Delineation of the neck node levels for head and neck tumors: a 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines. Radiother Oncol. 2014 Jan;110(1):172-81. [PubMed: 24183870]

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Suami H, Taylor GI, Pan WR. The lymphatic territories of the upper limb: anatomical study and clinical implications. Plast Reconstr Surg. 2007 May;119(6):1813-1822. [PubMed: 17440362]

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Cuadrado GA, de Andrade MFC, Akamatsu FE, Jacomo AL. Lymph drainage of the upper limb and mammary region to the axilla: anatomical study in stillborns. Breast Cancer Res Treat. 2018 Jun;169(2):251-256. [PubMed: 29380209]

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Pan WR, Wang DG, Levy SM, Chen Y. Superficial lymphatic drainage of the lower extremity: anatomical study and clinical implications. Plast Reconstr Surg. 2013 Sep;132(3):696-707. [PubMed: 23985641]

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Pan WR, Levy SM, Wang DG. Divergent lymphatic drainage routes from the heel to the inguinal region: anatomic study and clinical implications. Lymphat Res Biol. 2014 Sep;12(3):169-74. [PubMed: 25229435]

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Hsu MC, Itkin M. Lymphatic Anatomy. Tech Vasc Interv Radiol. 2016 Dec;19(4):247-254. [PubMed: 27993319]

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Eloubeidi MA, Chen VK, Eltoum IA, Jhala D, Chhieng DC, Jhala N, Vickers SM, Wilcox CM. Endoscopic ultrasound-guided fine needle aspiration biopsy of patients with suspected pancreatic cancer: diagnostic accuracy and acute and 30-day complications. Am J Gastroenterol. 2003 Dec;98(12):2663-8. [PubMed: 14687813]

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Disclosure: Iulia Bujoreanu declares no relevant financial relationships with ineligible companies.

Disclosure: Vikas Gupta declares no relevant financial relationships with ineligible companies.

Purpose, location, and disease warning signs

Lymph nodes are small, bean-shaped glands that play a crucial role in the immune system. They filter lymphatic fluid, which helps rid the body of germs and remove waste products. During an infection, a person may notice swollen lymph nodes, for instance, around the neck.

The body contains hundreds of lymph nodes. They form clusters around the body and are particularly prominent in areas such as the neck, armpit and groin and behind the ears.

The body’s cells and tissues dispose of waste products in lymphatic fluid, which lymph nodes then filter. During this process, they catch bacteria and viruses that could harm the rest of the body.

Lymph nodes are an essential part of the body’s immune system. Due to their function, they come into contact with toxins, which can cause them to swell. Although swollen lymph nodes are common, they may occasionally indicate lymph node cancer, or lymphoma.

Keep on reading to learn more about lymph nodes and their function within the immune system.

Lymph nodes are part of the lymphatic system, which is a complex network of nodes and vessels.

In certain areas of the body, such as the neck, armpit, and groin, lymph nodes sit close to the skin. This means a person may feel them swell when an infection develops.

Lymph nodes are also present in the stomach and between the lungs. However, there are no lymph nodes in the brain or spinal cord.

The name of a lymph node depends on its location in the body.

Lymph nodes form clusters throughout the body. Their main function is to filter out potentially harmful substances.

All tissues and cells in the body excrete lymphatic fluid, or lymph, in order to eliminate waste products. The lymph then travels through vessels in the lymphatic system and passes through lymph nodes for filtering.

Lymph nodes contain lymphocytes. These are a type of white blood cells that help destroy pathogens, such as bacteria, viruses, and fungi. When lymph nodes detect a pathogen in the lymph, they produce more lymphocytes, which causes them to swell.

Upon encountering bacteria or damaged cells, lymph nodes destroy them and turn them into a waste product.

When the lymph reenters the bloodstream, waste products travel to the kidneys and liver. The body then excretes waste products in the urine and feces.

Learn more about how the lymphatic system works here.

Swollen lymph nodes do not always indicate cancer. Below, we list some of many conditions that can cause lymph node swelling.

Lymphadenitis

Lymphadenitis occurs when bacteria, viruses, or fungi in the lymph infect lymph nodes. When this happens, lymph nodes swell and are painful to the touch.

If multiple clusters of nodes become infected, a person may feel pain and swelling in both their neck and groin.

The most common type of lymphadenitis is localized lymphadenitis. This means the condition only affects a few nodes. If the infection occurs in several node clusters, a doctor will likely diagnose generalized lymphadenitis.

The condition usually results from an infection elsewhere in the body.

Symptoms

Symptoms of lymphadenitis include:

• sore, swollen nodes
• soft or matted nodes
• skin streaking around the nodes
• abscesses around the nodes
• fluid seeping from the skin

Treatment

Lymphadenitis treatments include:

• antibiotics
• pain relief medication
• anti-inflammatories
• surgery

The type of treatment necessary will depend on a variety of factors, such as the severity of the disease and a person’s underlying conditions and allergies. A doctor will help a person choose the most suitable treatment based on these factors.

Learn more about swollen lymph nodes in the neck here.

Viral or bacterial throat infections

Swollen lymph nodes in the neck may be due to a viral or bacterial throat infection, such as strep throat.

Viral infections

Viral throat infections, such as colds, can present with swollen lymph nodes, a runny nose, and pinkeye.

These infections usually resolve on their own. However, a person can take over-the-counter pain relievers to alleviate pain they may experience when swallowing.

Strep throat

Strep throat is a bacterial infection that develops in the throat and tonsils due to group A streptococcus. People may contract strep throat if they come into contact with droplets containing the strep bacteria.

A person with strep throat may experience swollen lymph nodes on the neck, a sore throat, a fever, and red spots on the roof of the mouth.

Doctors treat strep throat with antibiotics.

Impetigo

Impetigo is an infection that develops due to group A streptococcus and may cause lymph nodes in the armpits and groin to swell.

A person can contract impetigo when the bacteria enter the body through a break in the skin. This can happen through sharing a towel, razor, or yoga mat.

Symptoms

Symptoms of impetigo include:

• itchy spots or sores around the nose or mouth that occur with change in skin color
• swollen lymph nodes
• painful sores
• blisters

Treatment

If a person has impetigo, they should seek medical attention to address their symptoms and prevent the condition from spreading to others.

Treatment will usually involve antibiotics.

Ringworm

Ringworm, or jock itch, is a fungal infection that can affect many areas of the body. If the fungus develops in the groin, a person may experience lymph node swelling in that area.

Typically, ringworm starts as a fungal lesion. The fungus often transmits when people share towels or razors.

Ringworm thrives in moist environments, and therefore a person should take care to dry thoroughly after a wash and try not to stay in damp clothes.

Symptoms

Common ringworm symptoms include:

• a patchy rash with a ring-like appearance and clear borders
• itchiness
• stinging
• flaky skin

Treatment

A doctor will prescribe an antifungal treatment to address ringworm.

The best way to prevent ringworm is to wear breathable fabrics, avoid sharing towels and razors, and dry thoroughly after bathing.

Learn more about swollen lymph nodes in the groin here.

Lymphoma is a type of cancer that affects the lymphatic system. The two main types of lymphoma are Hodgkin lymphoma and non-Hodgkin lymphoma.

Hodgkin lymphoma occurs when cancer cells spread from one cluster of lymph nodes to another. By contrast, in non-Hodgkin lymphoma, there is no order in how cancer cells spread throughout the lymphatic system.

Symptoms

Typical symptoms of lymphoma include:

• swollen lymph nodes
• fever
• night sweats
• fatigue
• unexplained weight loss

These are also common symptoms of viral infections, which can make lymphoma hard to diagnose. However, in people with lymphoma, symptoms tend to persist for longer periods of time.

It is of note that these symptoms do not clearly indicate cancer. If a person experiences any of these, they should contact a doctor to identify the cause of their symptoms.

Treatment

Treatment options for lymphoma include:

• CAR T cell therapy: This is a type of immunotherapy that uses a person’s own immune system to attack cancer cells.
• Chemotherapy: This therapy uses medication to destroy cancer cells.
• Radiation therapy: This treatment uses high energy beams to destroy cancer cells and shrink tumors.
• Stem cell transplant: A person receives stem cells from a donor. After they undergo high doses of chemotherapy, which destroys cancer cells and unhealthy blood cells, doctors implant stem cells, which start to produce new, healthy blood cells.

A person should contact a healthcare professional if they are experiencing persistent swelling of lymph nodes.

Swelling usually indicates an infection, and therefore a person should not immediately worry about lymphoma.

After reaching a diagnosis, a doctor will recommend the appropriate course of treatment.

Lymph nodes are a part of the lymphatic system. They filter lymph, which contains pathogens and damaged cells, and send the dead cells to the kidneys and liver.

Lymph node swelling usually results from an infection. In rare cases, however, it may be due to lymphoma.

If a person is concerned about swelling and other symptoms they have, they should contact a doctor.

where they are located, what functions they perform, in what diseases they increase

Inflammation and enlargement of the lymph nodes usually cause discomfort and pain. As a rule, this indicates that an inflammatory process is going on in the body.

What are lymph nodes

Lymph nodes are the most important organs that perform a barrier-filtration function ¹ . Their main function is the biological filter of lymph – a colorless liquid that washes all the tissues and cells of the body. It consists of plasma and formed elements. Interestingly, lymph plasma has an almost similar chemical structure to blood plasma, but contains fewer proteins ² .

Useful information about lymph nodes

Where are the lymph nodes

Lymph nodes are found almost everywhere. They are arranged in such a way as to become an obstacle in the way of various “garbage”: toxins, viruses, bacteria, parasites, fungi, cancer cells.

Most lymph nodes are located deep under the skin and even near internal organs where they cannot be felt. But some lymph nodes – under the jaw, in the armpits, in the groin – can be palpated even in a healthy, non-inflamed state.

Photo: Shutterstock

Functions of the lymph nodes

As mentioned earlier, the main function of the lymph nodes is barrier-protective function. In these organs of the lymphatic system, protective cells of the body are formed, such as lymphocytes, antibodies, phagocytes. Lymph nodes protect against the penetration of infections, and also prevent the reproduction of malignant tumor cells and play a role in the immune response to substances foreign to the body.

Lymph nodes also perform the following functions:

• hematopoietic – after the lymph nodes, lymph enriched with lymphocytes enters the blood;
• drainage – promote the outflow of excess fluid;
• depositing (reserve) – a lymph node is a temporary storage of lymphocytes and lymph. The latter lingers in the lymph node in order to ensure the unloading of the bloodstream in “emergency” situations, for example, during venous congestion;
• metabolic – lymph nodes are involved in the metabolism of fats, proteins, carbohydrates and other substances.

Causes of swollen lymph nodes

Lymph nodes have their own diseases, and most often their inflammation is a reaction to some other disease or condition. Completely different reasons can lead to an increase in lymph nodes (lymphadenopathy). Consider the most common of them.

Local infections

Infection is one of the most common causes of swollen lymph nodes.

— For example, it can be acute respiratory diseases, leading to an increase in regional lymph nodes associated with the area in which inflammation occurs, says general practitioner Oksana Khamitseva.

As a rule, the focus of the disease is located near enlarged lymph nodes. So, with infections of the upper respiratory tract, the lymph nodes in the neck become inflamed, with a sexual infection – in the groin.

Generalized viral and bacterial infections

If only one category of lymph nodes is affected, then they speak of local inflammation. If the nodes that are not adjacent to each other increase, then we are talking about a generalized inflammation of the lymph nodes.

This widespread inflammation can be caused by infections – bacterial, viral, fungal, which affect the entire body. It can be tuberculosis, some infectious skin diseases, rubella, chickenpox, cytomegalovirus, mononucleosis, HIV and others.

Autoimmune diseases

Autoimmune connective tissue diseases such as arthritis and systemic lupus erythematosus can also cause swollen lymph nodes. In such diseases, the body begins to attack its own cells. Due to the increasing load on the lymph nodes, their inflammation occurs.

Tumor processes

Swollen lymph nodes can also signal tumor processes in the body. As we wrote above, lymph nodes prevent the reproduction of cancer cells, but in some cases, tumor cells can get stuck in them and multiply. Tumor processes can lead to the development of leukemia, lymphogranulomatosis, lymphoma.

Hypersensitivity of the body

Allergic reactions can also provoke inflammation of the lymph nodes. In addition, their increase may be associated with hypersensitivity to certain drugs.

How lymph nodes are treated

The treatment of lymphadenopathy is varied and always depends on its cause. An increase in lymph nodes is a signal of inflammation, so you need to look for its focus.

Most often, inflammation of the lymph nodes occurs as a secondary process, that is, a reaction to another disease:

• if this is associated with acute respiratory infections, then it is necessary to treat the respiratory tract infection itself, be it a bacterium or a virus;
• if it is associated with a generalized infection (mononucleosis, HIV), then long-term specific therapy is selected here;
• cat-scratch disease (felinosis) is treated with special antibiotics;
• Sepsis is stopped only in the hospital by intravenous administration of various drugs, including antibiotics, and ionic solutions.
• autoimmune diseases (systemic lupus erythematosus, Kawasaki disease, etc.) are treated by a rheumatologist, prescribing hormones or cytostatics for long courses under constant supervision.

Lymphadenopathy can also be caused by cancer. Conventionally, they can be divided into 3 sections:

1. leukemia, when the primary malignant focus is in the bone marrow;
2. lymphomas, when the foci are located directly in the lymph nodes;
3. metastases, when the focus is located in the internal organ, and cancer cells affect the lymph nodes in the path of lymph outflow.

— In the case of leukemia, a bone marrow transplant is possible. With lymphoma, it is useless to do this, you can only use various options for radiation, chemotherapy, genetic engineering methods. And if lymphadenopathy is caused by metastases, then, as a rule, the tumor of the corresponding organ is removed, entering healthy tissues and capturing the “package” of the affected lymph nodes, says our expert Oksana Khamitseva.

How to maintain the health of the lymphatic system at home

According to physician Oksana Khamitseva, the health of the lymphatic system primarily depends on two components: good lymphatic drainage and normal functioning of the immune system. This is not difficult to achieve:

• regular physical activity;
• avoid tight, constricting clothing;
• smoking and alcohol cessation;
• courses of multivitamins 2 times a year;
• food high in protein and fiber in the diet;
• adequate fluid intake.

Popular questions and answers

General practitioner Oksana Khamitseva answers popular questions about lymph nodes.

Which lymph node is responsible for what?

– Each internal organ is supplied with lymph nodes, arteries and veins. If we talk about those lymph nodes that we can feel:

• Submandibular: increase with rhinitis, pharyngitis, tonsillitis, inflammation of the teeth and gums.
• Cervical: inflamed with acute respiratory infections, conjunctivitis, otitis media.
• Parotid: react to otitis media, acute respiratory infections.
• Occipital: increased with head and neck infections, acute tonsillitis, infectious mononucleosis.
• Axillary: may also be associated with mononucleosis, mastitis, breast cancer, HIV, cat scratch disease.
• Elbows: felinosis, HIV.
• Inguinal: mumps, generalized infections, inflammation of the urogenital organs.

What to do if the lymph nodes are inflamed?

– If you have lymphadenitis, you need to see a doctor, because you do not know what it can be connected with. If you notice an increase in lymph nodes in the head and neck, there are signs of acute respiratory infections (runny nose, sore throat, cough, fever), then you can independently start taking vitamins, antiviral drugs, NSAIDs, symptomatic treatments for colds.

If you notice an increase in lymph nodes, which is objectively not related to the infectious process, then doing something without a doctor’s recommendation can be dangerous. Even taking vitamins, if the process is autoimmune, will spur the immune system to even more aggressive inflammation.

Why is inflammation of the lymph nodes dangerous?

— Complications of lymphadenitis include:

• transfer of infection to nearby tissues: bones, subcutaneous fat, skin;
• blockage by blood clots of veins adjacent to inflamed lymph nodes;
• violation of lymphatic drainage, edema, “elephantiasis” of the limbs.

What can not be done with enlarged lymph nodes?

– If you notice an increase in lymph nodes, then it is strongly not recommended to ignore it, heat or apply ice, make lotions without the permission of a doctor. Also, do not smear with anti-inflammatory ointments (you will reduce one lymph node and decide that you are cured, and if it is an oncology?), squeeze and massage the lymph node.

The patient does not know in which direction the lymph flows from this or that lymph node, and if you make the wrong movements, stagnation can be provoked.

Which doctor treats lymph nodes?

— All roads lead to a therapist. After examination and examination, a specialist can identify what lymphadenitis is associated with, treat acute respiratory infections or refer to an ENT doctor, an infectious disease specialist if an infectious process is detected. If an autoimmune disease is detected, your doctor is a rheumatologist, and in case of suspicion of leukemia or lymphoma, an oncologist.

Sources:

1. Semioshko N.V. Lymph nodes adjacent to the celiac trunk // BBC 28.706 Ya431 V 38. – 2014. – P. 111. http://sno.grsmu.by/conference/mk47.pdf#page=111
2. Pogrelchuk O.E., Danko E.S. Blood and lymph. Hematopoiesis // In the world of scientific discoveries. – 2018. – S. 219-221. https://www.elibrary.ru/download/elibrary_36443065_39723184.pdf
3. Dvoretsky L.I. Differential diagnosis in lymphadenopathy // Handbook of a polyclinic doctor. – 2005. – no. 2. – S. 3-10. https://www.elibrary.ru/item.asp?id=18967212

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

Lymph nodes allow lymph to pass through, retaining and destroying bacteria, viruses and malignant cells. Sometimes they increase, which raises many questions.

Let’s figure out what lymph nodes are, how they are arranged and why, when they increase, you can not follow the advice from the Internet.

What are lymph nodes and why are they needed?

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

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

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

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

Classification of lymph nodes

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

Swollen lymph nodes: symptom or disease?

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

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

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

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

Why do lymph nodes enlarge?

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

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

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

Primary enlargement of lymph nodes

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

Secondary enlargement of lymph nodes

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

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

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

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

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

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

What not to do when the lymph nodes are “swollen”: we break the stereotypes compresses, etc. You can find a great many similar tips on the Internet.

Should I do it? No way.

Warming the Lymph Node Area

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

Taking antibiotics

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

Use of compresses, ointments/gels

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

Cabbage leaf application

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

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

M-EN-00005757 December 2021

Sources (Electronic resource). URL: https://diseases.medelement.