Regional lymphadenopathy

Introduction Local lymphadenopathy is a phenomenon in which the lymph nodes are locally enlarged due to internal cell proliferation or tumor cell infiltration. Common clinical signs. Lymph node enlargement is very common, can occur in any age group, can be seen in a variety of diseases, benign, but also malignant, so it is very important to pay attention to the cause of lymphadenopathy, timely treatment, diagnosis, to avoid mistakes, missed diagnosis.

Cause

infection

1. Acute infection: bacterial virus, rickettsia, etc. caused by acute cellulitis, upper respiratory tract infection, infectious mononucleosis, tsutsugamushi disease, etc.

2. Chronic infection: Bacterial fungi, Helminthic chlamydia, Mycoplasma filariasis, Sickness, Lymph node granuloma, Syphilis, AIDS, etc.

Tumor

1. Malignant lymphoma: Hodgkin's disease and non-Hodgkin's lymphoma.

2. Leukemia: acute lymphocytic leukemia acute non-lymphocytic leukemia chronic lymphocytic leukemia chronic myelogenous leukemia plasma cell leukemia.

3. Plasma cell tumor: multiple myeloma primary macroglobulinemia.

4. Abdominal histiocytosis.

5. Tumor metastasis: gastric cancer, liver cancer, breast cancer, etc.

an examination

Related inspection

Tracheal softening test blood routine neuron specific enolase

Physical examination

When checking:

It is necessary to proceed in a certain order so that no omissions will occur. In order: lymphatic contact at the front of the ear, behind the ear, mastoid area, suboccipital region, submandibular, axillary lymph node, cervical lymph node group, supraclavicular fossa, armpit, trochlear, groin and axilla. At the time of diagnosis, attention should be paid to the location, number, size, texture, surface, tenderness, mobility, presence or absence of adhesion of the enlarged lymph nodes, and whether the local skin is red, swollen, or scarred. In acute non-specific lymphadenitis, swollen lymph nodes often have obvious tenderness, local redness, swelling, heat and other acute inflammation. In chronic infections, the generally swollen lymph nodes are mildly painful, medium in texture, and can adhere to each other. If the tissue necrosis occurs in the lymph node tuberculosis, fluctuations can be felt. The lymph nodes of malignant lymphoma are often swollen and the texture is as hard as cartilage. Lymph node metastasis has a rubbery texture around the texture and adheres to the surrounding tissue, making it difficult to push.

When the specimen is found to have enlarged lymph nodes, it should be combined with other positive signs to comprehensively analyze the cause. Neck and submandibular lymphadenopathy with pharyngeal congestion and tonsil enlargement should be considered as acute tonsillitis, lymphadenopathy with jaundice should consider jaundice hepatitis, malignant histiocytosis, leptospirosis, etc., lymphadenopathy with rash More common in some infectious diseases or allergic diseases, systemic lymphadenopathy with fever is seen in infectious mononucleosis, leukemia, lymphoma and so on.

Deep lymphadenopathy is difficult to reach, often due to its swelling and compression of adjacent organs to appear in the corresponding performance, such as mediastinal lymphadenopathy can compress the superior vena cava caused by upper vena cava blood flow obstruction manifested as head and upper extremity edema, jugular vein engorgement Such as the superior vena cava compression group; retroperitoneal lymphadenopathy can compress the ureter to cause hydronephrosis, compression of the solar plexus can cause severe and stubborn low back pain, relieve pain in the forward leaning position, pain in the supine position; Paralysis of the lymph nodes can cause paraplegia; the mediastinal lymph nodes caused by lung disease compress the recurrent laryngeal nerve can cause hoarseness, and compression of the esophagus can cause difficulty in swallowing.

Laboratory inspection

1. Blood: The total number and classification of peripheral blood leukocytes have certain reference value for judging the cause of lymphadenopathy. Lymph node enlargement with total white blood cell count and neutrophil increase is common in bacterial infection, but the number of white blood cells in some Gram-negative bacilli infections may not be high, but neutrophils often increase. Lymph node enlargement with normal or decreased white blood cell counts and lymphocytosis often consider viral infection, but patients with infectious mononucleosis caused by EB virus infection often have elevated white blood cells in the second week, and often in three weeks. Abnormal lymphocytes (1O%-20% or more) and eosinophilia were found, suggesting parasitic infection or eosinophilic granuloma. Lymph node enlargement with peripheral blood immature cells is mostly leukemia or cancer. In malignant histiocytosis (malignant group), in addition to fever, hepatosplenomegaly, the tumor often shows a decrease in whole blood cells.

2. Bone marrow examination: Morphological examination of bone marrow smear cells is decisive for the diagnosis of leukemia, plasmacytoma, malignant histiocytosis, high snow disease, and Niemann-Pick. Bone marrow pathology should be performed if necessary. Although it is difficult to identify the primary site for metastatic cancer, it is decisive for identifying metastatic cancer cells.

3, serological examination: suspected infectious mononucleosis can be done heterophilic agglutination test, the titer of clinical value above 1:80, >1:200 can be diagnosed as infectious mononucleosis. For patients with suspected leptospirosis, agglutination and dissolution tests can be performed, and the titer of more than 1:400 is positive. For patients with suspected sexually transmitted diseases, HlV antibodies and syphilis serological tests can be performed. When suspected SLE and other autoimmune diseases cause reactive lymphadenopathy, the corresponding serological examination should be done.

4, lymph node puncture needle smear examination: lymph node enlargement is more obvious and the position is shallow, you can use a thicker needle for lymph node puncture, with a large negative pressure to a small amount of content smear examination. This method is simple and easy.

5, lymph node pathology: lymph node enlargement is more obvious and the cause is unknown, if there is no surgical contraindications, it is generally necessary to routinely do lymph node biopsy pathological examination, at the same time can do lymph node printing, morphological examination of its diseased cells, than Pathological sections are seen more clearly.

Differential diagnosis

There are 3 common cases of lymphadenopathy:

1 benign enlargement. It includes swelling caused by various infections, connective tissue diseases and allergies. Clinically, it is often benign, and with the removal of the cause, it can be fully recovered within a certain period of time.

. 2 malignant swelling. It includes lymph node metastasis such as lung cancer, stomach cancer and breast cancer, which are primary lymph nodes, such as lymphoma, lymphocytic leukemia and malignant histiocytosis, and other malignant tumors. Clinically malignant, lymph nodes continue progressive enlargement, if not actively treated, often progressive deterioration.

3 between the benign and malignant swelling. Such as vascular primitive immune cell lymph node disease and vascular follicular lymph node hyperplasia. It is often benign at first, and can become malignant and deadly. Therefore, in the determination of lymphadenopathy, the key is to determine the cause and nature, local swelling with obvious pain often prompt infection; progressive painless hyperplasia often suggest malignant tumor disease. Bone marrow aspiration, especially lymph node biopsy, can help confirm the diagnosis. The treatment of lymphadenopathy is determined by disease. For example, streptomycin and remi-salt can be used for lymphatic tuberculosis. If it is a malignant lymphoma, it should be combined with chemotherapy. If the cancer is metastatic, the prognosis is extremely poor.

It can be found by touching the submandibular, neck, supraclavicular fossa, axilla, and groin, but swollen lymph nodes in the hilar, mediastinum, retroperitoneum, and mesentery can be found by X-ray, CT, and B-ultrasound. .

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