Swollen lymph nodes in the neck

Introduction Lymph nodes are important immune organs in the body. They are the place where the immune response is stimulated by antigen, and there are filtration, proliferation and immunity. The normal human superficial lymph nodes are small, the diameter is less than 0.5cm, the surface is smooth, soft, no adhesion to the surrounding tissue, and no tenderness. When the body is attacked by pathogenic factors, the information is transmitted to the lymph nodes, which produce lymphokines and antibodies, effectively killing the causative agents. The result of the "struggle" between the two is the reactive hyperplasia of lymphocytes and histiocytes in the lymph nodes, causing the lymph nodes to enlarge.

Cause

Causes of cervical lymphadenopathy include three aspects, infection, tumor and other factors.

Infection factors: bacterial tooth, tonsil, facial or scalp bacterial infection, tuberculosis, syphilis, cat scratching, Lyme disease; viral-herpetic stomatitis, infectious mononucleosis, HIV infection (AIDS), Parasite-toxoplasmosis, skin mucosal lymph node syndrome (Kawasaki disease), subacute necrotic lymphadenitis ( Kikuchi disease).

Tumor factors: primary-Hodgkin's disease, non-Hodgkin's lymphoma, leukocytes, especially lymphocytic leukemia, secondary-cancer (oral, salivary gland, nasopharyngeal metastatic tumor), malignant melanoma, Juventus Sarcoma, other mesenchymal tumors.

Other factors: sarcoidosis, sinus histiocytosis, vascular follicular hyperplasia (including Castleman's disease, vascular lymphoid hyperplasia with eosinophils, that is, Mucun disease and related diseases).

an examination

Related inspection

Cervical MRI examination of carotid pulsation for jugular vein examination

(1) Inflammation: The acute ones have the characteristics of redness, pain, and heat. The onset is fast, local tenderness, and the mass disappears after anti-inflammatory. Chronic patients have a long course of disease, activity, no tenderness, and are often located in the submandibular area.

(2) Tuberculosis: can be primary or secondary. Abdominal tuberculosis lesions, long course, swollen lymph nodes in a string, medium quality, active, no tenderness, can adhere to each other into a group, if the cheese-like necrosis, collapse to form a fistula.

(3) metastatic malignant tumor: one of the causes of cervical lymphadenopathy, the primary lesion is mostly located in the head and neck, the mass gradually increases, the quality is hard, the activity is poor, no tenderness, often one side, also Can be affected on both sides. Nasopharyngeal carcinoma, tonsil cancer, laryngeal cancer metastasize to the supraclavicular lymph nodes, nasal, sinus, mouth, facial cancer often invade the submandibular lymph nodes, esophagus; cancer metastasis to the supraclavicular lymph nodes.

(4) Malignant lymphoma: a malignant tumor that occurs in lymphatic network. Non-Hodgkin's lymphoma is painless, progressive, hard, and poorly active. Hodgkin's lymphoma is mostly bilateral, with fever, hepatosplenomegaly, and weight loss.

(5) AIDS: caused by human immunodeficiency virus, long course of disease, lymph nodes gradually increase, often inguinal lymphadenopathy, fever, weight loss, fatigue and leukopenia.

Through detailed medical history, careful clinical examination, combined with imaging examination, and strive to find the primary lesion, when the primary lesion can be found, by puncture or removal biopsy, the nature and cause can be clarified, and then the corresponding anti-inflammatory and anti-inflammatory can be carried out. Hemorrhoids, surgery or radiotherapy.

Differential diagnosis

Symptoms of cervical lymphadenopathy need to be identified as follows.

First, tonsillitis

Acute tonsillitis has typical clinical manifestations and is not difficult to diagnose, but should be differentiated from pharyngeal diphtheria, Wensang's angina, leukemia and scarlet fever. Chronic tonsillitis has no satisfactory objective diagnosis method. It is mainly based on the history of repeated acute attacks. Combined with the examination, the tonsils and the tongue and the arch of the tongue are chronically congested. The tonsils have yellow-white embolism at the mouth of the tonsils. The substance is discharged from the small socket, and the tonsil is hypertrophied or the surface is scarred and adhered to the diagnosis. Bacterial culture, exfoliative cytology in the fossa and serum titanol hemolysin "O", anti-hyaluronidase and anti-streptokinase can be used as a reference for diagnosis.

Second, syphilis

Each stage of syphilis has special clinical symptoms and characteristics. If the lower jaw is accompanied by lymphadenopathy, the whole body is widely symmetrical, especially in the palm and ankle, there are rashes or papules without itching symptoms, or there is moist hyperplasia in the genital area. When a papule block (flat condyloma) is accompanied by systemic lymphadenopathy, the possibility of early syphilis should be considered. If the patient has a history of unclean sexual intercourse, syphilis is more likely. At this time, laboratory tests should be carried out. The laboratory tests include syphilis spirochete examination and syphilis serum reaction test. The commonly used spiral examination method in the clinic is the dark field reflection method. The spiral of the Treponema pallidum is tightly regular, the refractive is strong, the movement is lively, and it is easy to identify. It was found that Treponema pallidum is helpful for the diagnosis of primary syphilis, especially if sputum has appeared and the serum syphilis response has not been converted to positive.

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