Iliac lymph nodes: features, reasons for visiting a doctor, diagnosis and treatment. Causes of enlarged lymph nodes in the abdominal cavity: symptoms, diagnosis, treatment Reactive enlargement of the lymph node after PDT

Reactive lymphadenitis is one of the components of a general chain of pathological changes that are practically asymptomatic. Reactive disorder in the lymph nodes is considered initial manifestation of a particular disease, the first symptom of the body’s fight against the infectious process.

For example, with latent hidden form tuberculosis pathogen can remain in an inactive stage for quite long time. It can be neutralized by its own protective forces without causing any harm to the person.

However, due to a number of negative influences, a latent infection can suddenly become active. Then, with a high probability, the lymph nodes are the first to take the blow as part of the immune system.

Reasons for the development of this pathology

The following factors can provoke the occurrence of reactive lymphadenitis:

• Chronic inflammatory process.
• Decreased immunity.
• Frequent colds.
• Hypothermia.
• Prolonged stay in a poorly ventilated area.
• Lack of sunlight.
• Chronic emotional tension, severe stress.
• Poor nutrition, mono-diet.
• Excessive fatigue.
• Sedentary lifestyle.
• Avitaminosis.
• Bad habits (smoking, alcohol abuse).

Often reactive lymphadenitis develops in children under five years of age due to immature immunity, as a reaction to any inflammatory focus in the child’s body, which can be rhinitis, otitis media and respiratory viral pathologies.

Clinical manifestations of the disease

Reactive inflammation of the lymph nodes is accompanying symptom this or that pathological process. Its occurrence is provoked by the following pathogenic agents:

Often the localization of inflammation indicates a specific pathological process in the same area, that is, they are located near the inflammatory focus.

Signs and symptoms of this pathological condition

First initial sign the development of reactive lymphadenitis is which can be manifested by an increase in a varying number of lymph nodes and their slight soreness. Left unattended, such a pathological process begins to be aggravated by lymphadenitis, and it can be recognized by the following clinical signs:

• their increase in size;
• soreness of the lymph glands with pressure and palpation;
• swelling and redness of the skin over the affected lymph nodes;
• the nodes are not connected to the skin or to each other; they feel hard and dense to the touch.

Depending on the factors that provoked the development of nonspecific reactive lymphadenitis, it may be accompanied by the following manifestations:

• excessive weakness;
• low-grade fever or elevated temperature;
• cephalgia;
• sleep disturbance;
• rhinitis;
• cough.

When a strong pain syndrome in the area of ​​one lymph node or a group of them, hyperthermia of more than 38.5 ° C, rapid heartbeat and breathing (symptoms of purulent lymphadenitis), it is necessary to urgently consult a specialist.

With reactive lymphadenopathy after treatment of the underlying disease, the condition of the lymph nodes always normalizes on its own. However, if the primary cause of the development of the pathological phenomenon remains without appropriate treatment, the process may be complicated by inflammation of the lymph glands themselves. In this case, proliferation may occur with the appearance of reactive hyperplasia in the nodes and pronounced violation their functionality, which can provoke their suppuration or the spread of infection to neighboring tissues and the entire body.

Diseases that may be accompanied by inflammation of the lymph nodes:

• tuberculosis;
• angina;
• caries, stomatitis;
• mastitis;
• AIDS;
• enterocolitis;
• syphilis;
• pathology genitourinary system;
• flu;
• sinusitis;
• otitis;
• adenoiditis in a child;
• bubonic plague;
• teething in babies.

Varieties of this pathology

According to the duration and severity of the course, acute and chronic types of the disease are distinguished. The first develops as a reaction to any infection entering the body. The chronic form of lymphadenitis occurs most often in the case of chronic pathologies. In this case, the lymph nodes are only slightly enlarged, and their pain may be absent.

Depending on the cause that provoked the development of the inflammatory process in the lymph nodes, reactive lymphadenitis (according to ICD-10, this disease is coded R59 until an accurate diagnosis is established) can be nonspecific and specific. The latter is the most dangerous and much more difficult to treat, since it is caused by serious infectious agents (tuberculosis, syphilis, plague). Nonspecific occurs most often with colds and acute respiratory viral infections and is easily treated with the elimination of the underlying pathology.

Depending on cellular structure inflamed lymph node purulent, serous and simple lymphadenitis is distinguished. Serous develops with a viral course of the disease or with cancer, purulent - with a bacterial nature of the development of inflammation. Purulent form lymphadenitis is especially dangerous, since an abscess or phlegmon can develop.

Depending on the localization, the reactive cervical lymphadenitis, axillary, inguinal and other types of pathology.

Lymphadenitis in children

Reactive lymphadenitis in a child is a disease in which inflammatory damage to the lymph nodes occurs, regardless of their location. This pathology always appears in the form of a secondary disease, which is the response of the immune system to other pathological processes occurring in it.

In children, this type of disease develops much more often than in adults. This is due to the fact that the child’s immunity is not yet developed enough to actively fight certain diseases. And often the lymph nodes react even to a common cold. The most common location of reactive lymphadenitis in children is the neck, armpits, back of the head and groin.

Cervical lymphadenitis

Clinical manifestations of inflammation in the body may vary depending on the factors that provoked it. As a rule, the inflammatory process develops due to the penetration of pathological bacteria into the body. In most cases, cervical lymphadenitis is caused by the proliferation of streptococcus and staphylococcus. Enlargement and tenderness of the lymph nodes of the neck are observed with the following diseases:

• ARVI, influenza;
• tonsillitis, tonsillitis, glossitis;
• advanced caries, periodontitis with the addition of pulpitis.

Axillary lymphadenitis

This localization of lymphadenitis is observed during infection with streptococcus, Escherichia coli or Pseudomonas aeruginosa, pneumococcus or diplococcus. In this case, there are several routes of transmission of infection: hematogenous, lymphogenous and contact.

Diseases that contribute to the development of axillary reactive lymphadenitis:

• tuberculosis;
• brucellosis;
• syphilis;
• tularemia;
• actinomycosis;
• inflammatory diseases of the mucous membranes and skin;
• furunculosis, eczema;
• blood diseases;
• oncological pathologies;
• HIV infection, AIDS.

Diagnostic measures for the development of this pathology

If the lymph nodes are enlarged and painful, it is recommended to consult a physician. This doctor can refer the patient to more specialized specialists: a urologist, gynecologist, dentist, gastroenterologist, infectious disease specialist, mammologist or surgeon.

In case of reactive lymphadenitis, the following laboratory tests are necessary to determine the cause of the disease:

• general urine and blood tests;
• blood test for syphilis, viral hepatitis, HIV;
• bacteriological examination of urine and blood;
• tumor markers;
• blood for hormones;
• blood biochemistry;
• cytological analysis of discharge from the urethra and vagina;
• puncture of the lymph node with cytological examination.

To the list of methods instrumental diagnostics includes:

• X-ray;
• computed tomogram;
• gastroduodenoscopy;
• bronchoscopy;
• sigmoidoscopy.

Treatment of the disease in children and adults

How to treat reactive lymphadenitis? This frequently asked question. Let's look at it in more detail.

Reactive inflammation of the lymph nodes is the initial sign of many diseases. Accordingly, therapy will have to be based on eliminating the underlying pathology and source of infection.

A qualified specialist should select a treatment regimen.

If the infectious agent of the inflammatory process is bacterial flora, antibiotic therapy is used. Fungal infections also treated with appropriate antimycotic drugs, for example, Fluconazole, Orungal, etc.

Lymph is a fluid that collects foreign substances throughout the body and carries them to the lymph nodes. The lymph nodes themselves are the body's natural filters, which contain a huge number of immune system cells - lymphocytes. The purpose of lymphocytes is to get rid of foreign substances and microorganisms (viruses, bacteria) that are transported to the lymph nodes along with the lymph.

Lymphadenopathy is a condition in which the lymph nodes increase in size. Such pathological changes indicate a serious illness that is progressing in the body (often of an oncological nature). To make an accurate diagnosis, several laboratory and instrumental analyzes. Lymphadenopathy can form in any part of the body and even affects internal organs.

Lymphadenopathy syndrome may indicate the presence of serious diseases in the patient, so this condition should be given special attention when diagnosing the patient.

Normally, lymph flows freely through the lymph nodes, but sometimes it begins to accumulate in them, along with the growing number of immune system cells. As a result, the lymph node swells, sometimes increasing many times in size.

Enlarged lymph nodes can be caused by a number of reasons, including:

In addition to pathological changes in the lymph nodes, one can observe additional symptoms. The nature of their manifestation depends on what caused the development of such pathology. In general, the following symptoms can be distinguished: skin rashes;

• elevated temperature;
• increased sweating (especially at night);
• attacks of fever;
• increased splenomegaly and hepatomegaly;
• sudden weight loss for no apparent reason.

In most cases, enlarged lymph nodes are a marker of other complex diseases.

Classification

Depending on the nature of the manifestation and localization of the disease, the following forms of lymphadenopathy are distinguished:

Local form

Occurs in 70% of cases and is usually associated with limited infection or trauma.

Generalized lymphadenopathy

Generalized lymphadenopathy is considered the most complex form of the disease. Unlike local lymphadenopathy, which affects only one group of lymph nodes, generalized lymphadenopathy can affect any area of ​​the human body. Generalized lymphadenopathy has the following etiology:

• allergic disease;
• autoimmune processes;
• acute inflammatory and infectious diseases.

If enlarged lymph nodes are observed during a chronic infectious disease, then persistent generalized lymphadenopathy is implied. Most often, the pathological process affects nodes in non-overlapping areas - in the anterior and posterior cervical chain, in the axillary and retroperitoneal region. In some cases, enlarged lymph nodes are possible in the groin and supraclavicular areas. The most common diagnosis is neck lymphadenopathy. Cervical lymphadenopathy may indicate illnesses caused by insufficient or excessive production of hormones or cancer.

Reactive lymphadenopathy

Reactive lymphadenopathy is the body's response to infectious diseases. Any number of lymph nodes can be affected. The symptoms are not expressed, there is no painful sensation.

Stages of disease development

According to the statute of limitations, lymphadenopathy can be divided into the following groups:

In addition, any form of lymphadenopathy can take both tumor and non-tumor forms. However, any of them is dangerous to human life.

Characteristic localization of lesions

There are more than 600 lymph nodes in the human body, so the pathological process can develop in almost any system of the human body. But most often lesions are diagnosed in the following places:

• abdominal cavity;
• mammary glands;
• mediastinal area;
• groin area;
• lungs;
• submandibular region;
• armpit area;

Each of these types of pathology indicates an underlying disease. Often this is an oncological disease. It is possible to establish the exact causes of the formation of such a pathological process only after a complete diagnosis.

Abdominal lymphadenopathy

Increasing nodes in abdominal cavity indicates an infectious or inflammatory disease. Less often, such a pathological process acts as a marker of an oncological or immunological disease. The symptoms, in this case, correspond to the points described above. In a child, the list can be added with the following symptoms:

• increased temperature at night;
• weakness and malaise;
• nausea.

Diagnosis, if damage to the abdominal cavity is suspected, begins with laboratory tests:

• biochemical and general blood test;
• general urinalysis.

When diagnosing, special attention is paid to the patient’s medical history and age, since some ailments are unique to children. Lymphatic vessels and nodes of the abdominal cavity

Lymphadenopathy of the breast

Enlarged breast lymph nodes may indicate a dangerous oncological disease, including cancer. Therefore, if you have such symptoms, you should immediately consult a doctor. In this case, it is worth noting the nature of the tumor manifestation. If an increase in nodes is observed in the upper part of the mammary gland, then it can be assumed benign education. However, almost any benign process may degenerate into malignant tumor. Enlarged nodes in the lower area of ​​the mammary gland may indicate the formation of a malignant process. You should consult a doctor immediately. Enlarged lymph nodes in the area of ​​the mammary glands can be easily noticed visually. As a rule, the formation is noticed by the woman herself. Painful sensations not observed. Any extraneous formation in the area of ​​the mammary glands of both women and men requires immediate examination by a specialized doctor to clarify the diagnosis and correct, timely treatment. The earlier the disease is detected, the greater the chance of a positive result. Especially with regard to intrathoracic pathological changes.

Mediastinal lymphadenopathy

Mediastinal lymphadenopathy, according to statistics, is diagnosed in 45% of patients. To understand what pathology is, it is necessary to clarify what the mediastinum is. Lymphatic vessels and mediastinal nodes

The mediastinum is an anatomical space that forms in the cavity chest. The mediastinum is closed in front by the chest, and in the back by the spine. On both sides of this formation there are pleural cavities. Pathological enlargement of nodes in this area is divided into the following groups:

• primary enlarged lymph nodes;
• malignant tumors;
• damage to organs located in the mediastinum;
• pseudotumor formations.

The latter may be due to defects in the development of large vessels, severe viral and infectious diseases.

Mediastinal lymphadenopathy has a well-defined clinical picture. During the development of such a pathological process, the following symptoms are observed:

• sharp, intense pain in the chest area that radiates to the neck and shoulder;
• dilated pupils or sunken eyeball;
• hoarseness (more often observed during the chronic stage of development);
• headaches, noise in the head;
• heavy passage of food.

In some cases, bluishness of the face and swelling of the veins in the neck may be observed. If the disease has a chronic stage of development, then the clinical picture is more detailed:

• elevated temperature;
• weakness;
• swelling of the limbs;
• heart rhythm disturbance.

The child may experience shortness of breath and increased sweating, especially at night. If such symptoms appear, the child must be hospitalized immediately.

Pulmonary lymphadenopathy

Enlarged lymph nodes of the lungs signal a current underlying disease. In this case, the formation of metastases (lung cancer) cannot be excluded. But under no circumstances should you make such a diagnosis yourself, based on primary signs alone. Simultaneously with the enlargement of the lymph nodes of the lungs, the same pathological process may form in the neck and mediastinum. Clinical picture is this:

• cough;
• pain when swallowing;
• difficulty breathing;
• increased temperature, especially at night;
• pain in the chest area.

Lung damage can be caused by severe infectious diseases - tuberculosis, sarcoidosis and previous injuries. Smoking and excessive alcohol intake should also not be excluded.

Submandibular pathology

Submandibular lymphadenopathy is most often diagnosed in children preschool age and teenagers. As shown medical practice, in most cases, such changes are temporary and do not pose a threat to the child’s life. But this does not mean that such symptoms should not be paid attention to. The cause of enlarged lymph nodes may be a dangerous oncological formation. Therefore, you should not postpone a visit to the therapist.

Axillary lymphadenopathy

The axillary type of pathology (axillary lymphadenopathy) can even develop due to a hand injury or an infectious disease. But inflammation of the axillary lymph nodes may indicate inflammation of the mammary gland. Therefore, you should not postpone a visit to the therapist. As statistics show, it is the enlargement of lymph nodes in the axillary region and in the mammary glands that is the first sign of the appearance of metastases in the body of the mammary gland. If the disease is detected in a timely manner, then the chances of complete cure from breast cancer increase significantly.

Diagnostics

Diagnostic methods depend on the location of the pathology. To prescribe the correct course of treatment, it is necessary not only to make an accurate diagnosis, but also to identify the cause of the progression of the pathological process. The standard procedure includes:

Since PAP is a kind of marker of another disease, the cause of the development of the disease should first be diagnosed.

Treatment

It is necessary to treat the disease that caused lymphadenopathy. If this is a tumor metastasis or a primary oncological process, then chemotherapy is prescribed as prescribed by the oncologist, radiation therapy, surgery or a combination thereof.

In inflammatory processes, as a rule, the following is carried out:

• a course of antibiotic therapy in tablets or injections (if there is a bacterial infection);
• antifungal treatment (if the cause of inflammation is a fungus);
• antiviral effect in case of viral infection;
• anti-inflammatory, analgesic therapy (drugs of the NSAID group - ketorol, analgin, ortofen, diclofenac, butadione, nurofen);
• local use of antiseptics (gargling, rinsing the sinuses);
• physiotherapy (it is contraindicated in oncology) – UHF on the area of ​​enlarged lymph nodes;
• strengthening immunity;
• When a lymph node suppurates, it is sometimes opened and the abscess is removed.

Removal of tonsils is carried out only when all conservative treatment measures have been exhausted and do not bring any benefit. positive result. It has been proven that, in addition to the barrier function against microbes, the tonsils play a significant role in the maturation of the ovaries in girls. Their early removal can lead to delayed puberty. Later, in adulthood, such women may have problems bearing a child.

For allergic conditions that cause lymphadenopathy, it is prescribed antihistamines, carry out elimination (removal) of the allergen.

At HIV infection evaluate immune status patient (carried out by determining the level of CD4 cells), if necessary (decrease in the level of CD4 cells below a certain level) antiretroviral therapy, aimed at suppressing the human immunodeficiency virus.

At mechanical injuries that caused lymphadenopathy, painkillers and rest are prescribed, and surgery is performed if necessary.

Prevention

Since lymphadenitis in the majority develops during colds, their prevention is associated with hardening the body, strengthening the immune system, and preventing colds.

Complications

With untimely or delayed treatment, the following consequences may develop:

• purulent melting of an enlarged node, formation of fistulas, abscesses;
• bleeding due to germination of the vessel wall;
• thrombophlebitis of the veins of the affected area;
• impaired lymph outflow leading to lymphostasis;
• sepsis.

With timely identification of the cause of lymphadenopathy and adequate treatment of this pathology, it is possible to defeat the disease and avoid undesirable consequences.

Lymphadenopathy

Lymphadenopathy is pathological condition, characterized by enlarged lymph nodes and is one of the leading symptoms of many diseases.

Approximately 1% of patients with persistent lymphadenopathy during medical examination detect malignant neoplasms.

Lymph nodes are peripheral organs lymphatic system. They play the role of a kind of biological filter that cleanses the lymph entering them from the limbs and internal organs. There are about 600 lymph nodes in the human body. However, only the inguinal, axillary and submandibular lymph nodes, i.e. those that are located superficially, can be palpated.

Reasons

Infectious diseases lead to the development of lymphadenopathy:

Treatment with certain drugs may lead to the development of lymphadenopathy. medicines, including cephalosporins, gold preparations, sulfonamides, Captopril, Atenolol, Allopurinol, Carbamazepine, Phenytoin, Penicillin, Hydralazine, Quinidine, Pyrimethamine.

The most common lymphadenopathy is observed against the background of the following diseases:

• lymphadenitis;
• infectious mononucleosis;
• rubella;
• streptoderma;
• tuberculosis of the lymph nodes;
• non-Hodgkin's lymphomas;
• lymphogranulomatosis (Hodgkin's disease);
• Gaucher disease;
• viral hepatitis;
• Still's disease;
• sarcoidosis;
• Waldenström's macroglobulinemia;
• Niemann–Pick disease;
• Lyme disease;
• tularemia;
• HIV infection;
• benign lymphoreticulosis.

Enlarged lymph nodes in the right supraclavicular region are often associated with a malignant process in the esophagus, lungs, and mediastinum.

Oropharyngeal infections often lead to cervical lymphadenopathy. Typically, this condition develops in children and adolescents against the background of childhood infectious diseases and is associated with the functional immaturity of the immune system, which does not always adequately respond to infectious stimuli. The risk of developing cervical lymphadenopathy is highest in children who have not received timely vaccination against diphtheria, mumps, measles, and rubella.

The occurrence of axillary lymphadenopathy is caused by:

• purulent-inflammatory processes localized in the arms, shoulders or chest;
• some types of skin pathology (neurodermatitis, psoriasis);
• immunodeficiency states;
• diseases of the mammary glands (mastitis, mastopathy, cancer);
• autoimmune systemic diseases (systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, systemic scleroderma).

Depending on the number of lymph nodes involved in the pathological process, they are divided into the following types lymphadenopathy:

• localized – enlargement of one lymph node;
• regional - enlargement of several lymph nodes located in one or two adjacent anatomical areas, for example, axillary lymphadenopathy;
• generalized - enlarged lymph nodes are localized in several non-contiguous anatomical areas, for example, inguinal and cervical adenopathy.

Localized lymphadenopathy occurs much more often (in 75% of cases) than regional or generalized ones. Approximately 1% of patients with persistent lymphadenopathy are diagnosed with malignancy during medical examination.

Depending on etiological factor lymphadenopathy occurs:

• primary – caused by primary tumor lesions of the lymph nodes;
• secondary – infectious, drug-induced, metastatic (secondary tumor process).

In turn, infectious lymphadenopathy is divided into specific (caused by tuberculosis, syphilis and other specific infections) and not specific.

Inguinal lymphadenopathy is usually caused by sexually transmitted infections, and cat scratch disease is accompanied by axillary or cervical lymphadenopathy.

By duration clinical course lymphadenopathy is divided into acute and chronic.

Signs of lymphadenopathy

With cervical, inguinal or axillary lymphadenopathy in the corresponding area, an increase in lymph nodes is observed, from slight to noticeable to the naked eye (from a small pea to a goose egg). Their palpation may be painful. In some cases, redness of the skin is observed above the enlarged lymph nodes.

It is impossible to detect lymphadenopathy of the visceral nodes (mesenteric, peribronchial, hepatic portal lymph nodes) visually or by palpation; it is determined only during an instrumental examination of the patient.

In addition to enlarged lymph nodes, there are a number of other signs that may accompany the development of lymphadenopathy:

• unexplained loss of body weight;
• increased body temperature;
• increased sweating, especially at night;
• enlarged liver and spleen;
• recurrent infections of the upper respiratory tract(tonsillitis, pharyngitis).

Diagnostics

Since lymphadenopathy is not an independent pathology, but only a symptom of intoxication in many diseases, its diagnosis is aimed at identifying the causes that led to the enlargement of the lymph nodes. The examination begins with a thorough history taking, which in many cases makes it possible to make a preliminary diagnosis:

• eating raw meat– toxoplasmosis;
• contact with cats – toxoplasmosis, cat scratch disease;
• recent blood transfusions – hepatitis B, cytomegalovirus;
• contact with tuberculosis patients – tuberculous lymphadenitis;
• intravenous drug administration – hepatitis B, endocarditis, HIV infection;
• casual sexual intercourse – hepatitis B, cytomegalovirus, herpes, syphilis, HIV infection;
• work in a slaughterhouse or livestock farm - erysipeloid;
• fishing, hunting – tularemia.

For localized or regional lymphadenopathy, the area from which lymph flows through the affected lymph nodes is examined for the presence of tumors, skin lesions, inflammatory diseases. Other groups of lymph nodes are also examined to identify possible generalized lymphadenopathy.

There are about 600 lymph nodes in the human body. However, only the inguinal, axillary and submandibular lymph nodes can be palpated.

With localized lymphadenopathy, the anatomical location of enlarged lymph nodes can significantly narrow the number of suspected pathologies. For example, sexually transmitted infections usually lead to the development of inguinal lymphadenopathy, and cat scratch disease is accompanied by axillary or cervical lymphadenopathy.

Enlarged lymph nodes in the right supraclavicular region are often associated with a malignant process in the esophagus, lungs, and mediastinum. Left supraclavicular lymphadenopathy signals possible damage to the gallbladder, stomach, prostate, pancreas, kidneys, ovaries, and seminal vesicles. A pathological process in the abdominal or pelvic cavity can lead to enlargement of the paraumbilical lymph nodes.

Clinical evaluation of patients with generalized lymphadenopathy should be aimed at searching for systemic disease. Valuable diagnostic findings are the detection of inflammation of the joints, mucous membranes, splenomegaly, hepatomegaly, and various types of rashes.

In order to identify the cause that led to lymphadenopathy, according to indications, different types laboratory and instrumental studies. A standard examination usually includes:

• general and biochemical analysis blood;
• general urinalysis;
• chest x-ray;
• Ultrasound of the abdominal and pelvic cavity;
• computed and magnetic resonance imaging.

If necessary, a biopsy of an enlarged lymph node can be performed, followed by histological and cytological examination of the resulting tissue samples.

The risk of developing cervical lymphadenopathy is highest in children who have not received timely vaccination against diphtheria, mumps, measles, and rubella.

Treatment of lymphadenopathy

Treatment of lymphadenopathy consists of eliminating the underlying disease. Thus, if enlarged lymph nodes are associated with a bacterial infection, a course of antibacterial therapy is indicated; treatment of lymphadenopathy of tuberculous etiology is carried out according to a special DOTS+ regimen; treatment of lymphadenopathy caused by cancer consists of antitumor therapy.

Prevention

Prevention of lymphadenopathy is aimed at preventing diseases and intoxications that can provoke enlarged lymph nodes.

Video from YouTube on the topic of the article:

Education: graduated from Tashkent State medical school majoring in general medicine in 1991. Repeatedly took advanced training courses.

Work experience: anesthesiologist-resuscitator at a city maternity complex, resuscitator at the hemodialysis department.

The information is generalized and is provided for informational purposes. At the first signs of illness, consult a doctor. Self-medication is dangerous to health!

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Retroperitoneal lymphadenopathy: what is it and how to treat?

Retroperitoneal lymphadenopathy is a pathological enlargement of the lymph nodes and the subsequent development of the inflammatory process in them. This condition is one of the symptoms of many diseases of various origins, but not an independent pathology.

With a prolonged course, lymphadenopathy becomes an independent pathology and can lead to severe complications. In this article we will understand what retroperitoneal lymphadenopathy is and how to treat it.

Difference from lymphadenitis

Even a slight increase in lymph nodes is a clear signal about an obvious or hidden pathological process in the body. Lymph nodes act as a natural filter associated with circulatory system. Their main role is to cleanse the blood of potentially dangerous microorganisms.

If infection enters the lymph nodes, it may develop inflammatory reaction, involving one of them, several lymph nodes or several groups.

The reaction of the lymph nodes to pathological processes in the body can develop as an independent inflammatory disease or as a concomitant symptom of another pathology. Inflammation of the lymph nodes is called lymphadenitis, reactive enlargement of the lymph node is called lymphadenopathy.

Lymphadenitis occurs acutely, with symptoms characteristic of an acute process. The affected lymph node increases in size and becomes painful. The skin over the superficial lymph nodes turns red, and a local increase in temperature is observed.

Watch a video about the causes of inflammation of the lymph nodes:

Superficial lymph nodes become very hard; when the lesion is localized in the retroperitoneal space, diagnosis is very difficult due to the lack of characteristic symptoms and the impossibility of external inspection. Over time, an enlarged lymph node may become inflamed.

Causes of the disease

Retroperitoneal lymphadenopathy develops due to entry into the lymph node significant amount biological or other materials that provoke inflammation. These could be:

• Pathogenic microorganisms and their metabolic products;
• Fragments of dead cells;
• Foreign solids;
• Some products of tissue breakdown.

Most often, the introduction of a provoking agent occurs against the background of local inflammatory processes, acute, subacute or chronic, sometimes for general infectious diseases. Penetration of the pathogen is possible through direct contact, through lymph or blood.

Against the background of the pathological process, pathogens enter the lymph nodes in large quantities. In response, the number of lymphocytes increases and the size of the lymph node increases. The degree of enlargement of the lymph node is related to the activity of the process.

As the underlying disease progresses, inflammation may develop in the affected lymph nodes, turning into a purulent process.

The rate of progression of lymphadenopathy varies depending on the intensity and duration of exposure to pathogenic factors, as well as their quantity.

The direct cause of the development of retroperitoneal lymphadenopathy can be:

• Giardia, toxoplasma and other protozoa;
• Helminths;
• Fungal infections;
• Pathogenic bacteria;
• Viruses.

Enlargement of the retroperitoneal lymph nodes may occur as one of the complications of mesadenitis or part of a symptom complex oncological diseases. In children, such complications can accompany the course of viral mumps, rubella and other childhood diseases. The clinical picture may resemble acute appendicitis.

Abdominal lymphadenopathy (enlarged lymph nodes located in the abdominal cavity) can develop against the background of mesenteric adenitis or lymphoma.

Inguinal localization of the lesion occurs against the background of local infections, in particular, it is a symptom of a number of sexually transmitted diseases.

Classification

According to the duration and characteristics of the flow, they are distinguished:

Additionally, classification of the pathological process according to the severity of lymph node hyperplasia can be used. This criterion is used relatively rarely, since the normal sizes of lymph nodes from different groups are very different.

Based on the number of lymph nodes involved in the pathological process, local, regional and generalized forms of pathology are distinguished.

Local damage is indicated when one lymph node is enlarged. When several lymph nodes located in adjacent groups are affected.

The most severe form of pathology is generalized, in which pathological changes affect three or more groups of lymph nodes located in different areas.

About 70% of cases of lymphadenopathy are local, developing against the background of trauma and limited infectious lesions. The generalized form of the pathology indicates serious dysfunction of the immune system.

Find out more about immune system and lymph here.

Symptoms

The main sign of developing lymphadenopathy is enlarged lymph nodes. Increase inguinal lymph nodes can be noticed during a superficial examination; with retroperitoneal localization of the lesion, characteristic changes can only be identified on an ultrasound or x-ray.

Indirect symptoms of localized lesions in the abdominal cavity may be:

• Sweating;
• General weakness;
• Sustained slight increase in body temperature;
• Digestive disorders, in particular diarrhea;
• Enlarged spleen and liver.

Short-term attacks of fever and diffuse abdominal pain are possible. Patients may experience weight loss, severe pain in the back, caused by mechanical compression of nerve endings or trunks.

With infectious mononucleosis, the patient develops a maculopapular type rash; the pathology that develops against the background of hepatitis is accompanied by jaundice and dyspeptic symptoms. Possible manifestations of urticaria and joint pain.

Diagnostics

Diagnosis of lymphadenopathy begins with a history. In order to identify the most likely causative agent of the pathological process, the doctor asks questions about past injuries, blood transfusions, and organ transplants.

Since swollen lymph nodes are one of the symptoms of some STDs in adult patients, they are asked about the number of sexual partners and likely casual relationships. Lymphadenopathy may indicate very serious problems with health, so the patient should be completely honest.

It is very important to take into account the patient’s age, since retroperitoneal localization of lesions is more typical for children under 12 years of age. The detection of some forms of pathology in adults is a fairly rare and potentially life-threatening phenomenon.

During an external examination, the doctor palpates the affected lymph nodes, determining their number, size, consistency, pain, connections and location.

Confirmation of the presumptive diagnosis is possible after laboratory and instrumental studies. The patient must be sent for a blood test.

The research package includes:

• General clinical analysis;
• General urine test;
• Biochemical analysis;
• Serological analysis;
• HIV test;
• Wasserman test.

In case of pathology in the retroperitoneal region, the following is carried out:

If the oncological nature of the pathological process is suspected, histological and cytological studies are carried out bone marrow and/or a tissue sample from the affected lymph node.

Treatment

Painless enlarged lymph nodes are not always taken seriously by the patient. Manifestations of lymphadenopathy at any age are not the case when you can let everything take its course and self-medicate.

Treatment is prescribed only by a doctor, based on the data obtained during the examination. Tactics are selected individually, therapy is aimed at eliminating the underlying disease.

The course of treatment for lymphadenopathy may include:

When the underlying disease is eliminated, the lymph nodes quickly shrink to normal size.

If a malignant process is confirmed, the patient is prescribed a course of radiotherapy or chemotherapy. If there is no effect from conservative treatment surgical intervention is indicated.

Prevention

Due to the variety of causes and factors that provoke the development of lymphadenopathy, the main preventive measure should be considered the timely identification and treatment of major pathologies of various origins.

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Attention! Materials on the site are published for informational purposes only and under no circumstances can be considered a substitute for medical consultation with a specialist in medical institution. The site administration is not responsible for the results of using the posted information. For questions regarding diagnosis and treatment, as well as prescription medical supplies and determining the regimen for taking them, we recommend that you consult a doctor. Remember: self-medication is dangerous!

Click on pictures to enlarge.

Drawing. Outside, the lymph node is covered with a fibrous capsule, from which trabeculae extend. The afferent lymphatic vessels approach from the convex side. The efferent lymphatic vessel, veins and artery pass through the hilum of the lymph node. Lymph nodes of the cortical layer are located along the periphery, and trabeculae, vascular cords and sinuses of the medulla are located in the center. In the intermediate zone, blood lymphocytes pass into the stroma through the walls of special venules. The zones of the lymph node are populated by strictly defined cells.

Lymph nodes on ultrasound

Lymph nodes are examined with a 7.5-12 MHz linear sensor. For inspection of large conglomerates, a 3-5 MHz convex probe may be useful. See mesenteric lymph nodes

A third healthy people There are small lymph nodes, and the length of individual specimens reaches 3.5 cm. The size and shape of the lymph nodes depend on the location, as well as the age and constitution of the patient.

A normal lymph node on ultrasound is a small (less than 1 cm) hypoechoic formation with a hyperechoic scar in the center; bean-shaped or oval shape; the contour is clear, smooth or wavy. Hypoechoic zone along the periphery - cortex, hyperechoic linear structure - vessels, trabeculae, fatty inclusions, partially medulla. At the hilum, the hyperechoic triangle “cuts” into the parenchyma; here, with color circulation, vessels can be seen.

Drawing. Ultrasound shows normal lymph nodes in the posterior triangle of the neck in a 9-year-old girl (1), a jugular chain lymph node in an elderly woman (2), and an axillary lymph node (3). In areas limited by fascia, the lymph nodes are more elongated in length than those located in loose tissue.

A cross-section of a muscle or vessel can be mistaken for a lymph node. IN color flow mode It is easy to distinguish a lymph node from a vessel. If the sensor is rotated 90°, then the vessels and muscles are a tubular structure, and the lymph node has an oval shape, regardless of the cut.

Drawing. On ultrasound, hypoechoic round formations similar to lymph nodes (1). The sensor is rotated 90°, showing a hypoechoic oval lymph node on the left (red arrow), and a longitudinal section of the mouse on the right (yellow arrows).

Drawing. Ultrasound shows a hypoechoic lymph node surrounded by three anechoic vessels. The color flow mode confirms our guess.

In the elderly, sclerosis of the lymph nodes often occurs - round or oval formations with a pronounced hyperechoic heterogeneous central part and a thin hypoechoic rim; the capsule of the node can be visible in fragments. Some lymph nodes grow together, forming large ribbon-like formations.

Drawing. A 65-year-old woman with a painless “tumor” in the armpit. Ultrasound reveals a round formation with a clear and even contour, size 20x10x15 mm; hypoechoic rim along the periphery and an expanded hyperechoic central part; with CDK, blood flow is in the hyperechoic zone. Conclusion: Axillary lymph node with fatty infiltration of the medulla and transition zone.

Angioarchitecture of a normal lymph node - a portal artery is distinguished, which passes into a linearly located vessel in the central part. If the vascular bed can be traced to the capsule, and the PSV on the portal vein is above 5 cm/sec, we speak of high degree lymph node activity.

Lymphadenopathy on ultrasound

Lymphadenopathy is an increase in size, as well as a change in the shape of one or a group of lymph nodes. This is a symptom of a variety of viral and bacterial infections, but can also be a sign of a malignant process.

When fighting the infection, the lymph nodes become inflamed. Inflamed lymph nodes rapidly “grow” at the beginning of the disease and quickly “deflate” during recovery. On ultrasound, the lymph node is enlarged due to the cortical and pericortical zone, hypoechoic in the periphery and hyperechoic in the center, oval in shape, clear contour, blood flow only in the hilum or absent. If the inflammation extends into the surrounding tissue (periadenitis), an abscess may form.

Drawing. In children with ultrasound, enlarged cervical lymph nodes with preserved architecture are oval in shape, the contour is clear and even, hypoechoic along the periphery with a hyperechoic center. Conclusion: Lymphadenopathy of the cervical lymph nodes.

Drawing. A 6-month-old boy with severe dermatitis. On ultrasound, the cervical (1) and submandibular (2) lymph nodes are enlarged, elongated, hypoechoic along the periphery with a hyperechoic linear structure in the center. Note the submandibular lymph node with a wavy outline. Conclusion: Lymphadenopathy of the cervical and submandibular lymph nodes.

Drawing. On ultrasound, the lymph nodes are enlarged, oval in shape, with a clear and even contour, reduced echogenicity, the cortical zone is somewhat expanded, the central scar is clearly visible; the blood flow in the hilum is increased, the vessels are located correctly - they diverge radially, the subcapsular blood flow is not determined. Conclusion: Lymphadenopathy with signs of a high degree of activity.

Drawing. Child with high temperature, sore throat and bilateral “tumor” on the neck, in general analysis blood atypical mononuclear cells 25%. On ultrasound, the anterior and posterior cervical lymph nodes are enlarged (maximum size 30x15 mm), round in shape, heterogeneous. Please note that the central scar is clearly visible, and the blood flow at the level of the gate is increased. Conclusion: Lymphadenopathy with signs of a high degree of activity. Large groups of enlarged lymph nodes in the neck are characteristic of infectious mononucleosis. Considering the course of the disease and the presence of atypical mononuclear cells, it is likely that the child infectious mononucleosis.

Drawing. A woman complains of a “tumor” in her armpit and elbow. A week ago I had an argument with my neighbor’s cat. On ultrasound, the axillary (top) and ulnar (bottom) lymph nodes are enlarged, round in shape, pronounced hyperplasia of the cortical and pericortical zone, the hyperechoic central scar is preserved; the blood flow is noticeably increased, the vessels are located correctly - radially. Conclusion: Lymphadenopathy with signs of a high degree of activity. At cat scratch disease At the site of a bite or scratch, small pustules form and at the same time nearby lymph nodes become inflamed. One or a group of lymph nodes increase in size to 5-10 cm, become painful, and become denser. Self-healing occurs after 2-4 weeks. Sometimes abscesses and fistulas form.

Tuberculosis of lymph nodes on ultrasound

Tuberculosis most often affects the lymph nodes of the neck, axillary and groin areas. Typically, tuberculous lymphadenitis develops slowly, the lymph nodes are painless, the average size is 3 cm, but sometimes they can reach 10 cm. On ultrasound, the affected lymph nodes are enlarged, hypoechoic, with an unclear contour; pronounced periadenitis and fused lymph node packages can often be seen. Tuberculous lymphadenitis is characterized by a heterogeneous echostructure - anechoic cystic cavities and calcifications. As the disease progresses, an abscess and fistulas may form.

Drawing. An ultrasound scan of the neck reveals a group of enlarged lymph nodes of irregular shape; echogenicity is reduced, there is no central scar; heterogeneous due to anechoic avascular zones - foci of necrosis; blood flow is increased, the course of blood vessels is irregular, subcapsular blood flow is pronounced. Conclusion According to the results of the biopsy: Tuberculosis of the lymph nodes.

Drawing. Ultrasound shows enlarged lymph nodes, irregular in shape with blurred boundaries; echogenicity is reduced, there is no central scar; heterogeneous due to small cystic cavities and hyperechoic inclusions with an acoustic shadow behind (calcifications). Conclusion According to the results of the biopsy: Damage to the lymph nodes by atypical mycobacteria. Histologically, foci of infection with M. tuberculosis and atypical mycobacteria are often indistinguishable. Classic morphological manifestation in both cases, granuloma with caseous necrosis serves.

"God is in the details"

Calcifications in the lymph nodes are characteristic not only of tuberculosis, but also of metastases of papillary thyroid carcinoma.

10 signs of a malignant lymph node on ultrasound

1. Large sizes, more than 10 mm;
2. Round shape, long/short size ratio (L/S)<2;
3. Echogenicity is diffusely or locally reduced down to anechoic;
4. Concentric or eccentric expansion of the cortex;
5. The hyperechoic central scar is thinned or absent;
6. Heterogeneous echostructure due to hyperechoic calcifications and/or anechoic zones of necrosis;
7. An uneven and blurred outline when tumor cells grow into the capsule;
8. Often form large conglomerates;
9. Defective blood flow - the vessels are displaced, chaotically organized, the diameter does not decrease towards the capsule, pronounced subcapsular blood flow, avascular zones, etc.;
10. High resistance index (RI >0.8) and pulsation (PI >1.5).

"God is in the details"

When a lymph node grows slowly, is painless, very dense and literally grows into the tissues surrounding it, there is a high probability of a malignant process.

Lymph nodes in the occipital and parotid regions, as a rule, have a round shape. When evaluating knots, rely not only on shape.

With abscess, tuberculosis, actinomycosis, the central hyperechoic scar in the lymph nodes may be absent.

Sometimes completely hyperechoic lymph nodes are encountered, which is characteristic of fatty infiltration, but cancer cannot be ruled out.

Extracapsular tumor growth often leads to the union of several affected lymph nodes into a shapeless conglomerate with the involvement of surrounding tissues.

Drawing. On ultrasound, lymphadenopathy with echo signs of a malignant process: enlarged (28x16 mm) lymph node, round in shape (D/C<2), гипоэхогенный без центрального рубчика; определяется подкапсульный кровоток, диаметр сосудов не уменьшается по направлению к капсуле, RI 0,88.

Drawing. A 63-year-old man discovered a “tumor” on his neck: it is growing slowly without pain or fever. Ultrasound in the area of ​​the sternocleidomastoid muscle reveals a group of sharply hypoechoic lymph nodes without a central scar, size 10-20 mm; some lymph nodes are round; There are lymph nodes with sharply increased blood flow. Conclusion According to the results of the biopsy: Lymphoma.

Drawing. A 32-year-old woman with a “tumor” on her neck. Ultrasound in the left supraclavicular region reveals one large and several small hypoechoic lymph nodes, round in shape, with a thin central hyperechoic scar; the blood flow is noticeably increased, the vessels are located chaotically, the diameter does not decrease towards the capsule, subcapsular blood flow is pronounced. In the left iliac fossa a “sandwich” is visible - a conglomerate of enlarged hypoechoic lymph nodes, between which lie the mesenteric vessels. Conclusion: Lymphadenopathy with echo signs of a malignant process. A biopsy of altered lymph nodes is recommended.

Drawing. A 50-year-old man complains of hoarseness and a “tumor” on the left side of his neck. Ultrasound reveals a round formation on the neck with a large anechoic cavity in the center—a zone of necrosis. CT scan shows a large tumor in the supraglottic region on the left. Conclusion based on the biopsy results: Enlarged lymph node with metastases of squamous cell carcinoma. Central necrosis of the lymph nodes is typical for squamous cell carcinoma.

Drawing. Ultrasound of a lymph node with metastases of papillary thyroid cancer: heterogeneous echostructure - small anechoic cavities and microcalcifications; the central scar is not defined; subcapsular blood flow is visible.

Drawing. Ultrasound shows a group of enlarged round lymph nodes in the neck: hypoechoic, heterogeneous due to small and large anechoic, avascular zones - foci of necrosis. Conclusion according to the results of the biopsy: Lymph nodes with metastases of adenocarcinoma. The primary tumor could not be found.

Drawing. On ultrasound, metastases of lung adenocarcinoma destroyed the normal architecture of the lymph node: heterogeneous due to the alternation of hyper- and hypoechoic areas, the central scar is absent, the shape of the lymph node is uncertain, the contour is unclear, which indicates infiltrative growth into the surrounding tissues.

Drawing. Ultrasound shows lymphoma (1,2) between the angle of the lower jaw and the submandibular salivary gland, as well as a lymph node (3) with metastases.

Lymphogranulomatosis or Hodgkin's lymphoma is a malignant hyperplasia of lymphoid tissue. The tumor develops from a single focus, most often in the cervical, supraclavicular, and mediastinal lymph nodes. Ultrasound shows a pack of enlarged lymph nodes, clearly demarcated, not growing into the capsule and not merging with each other.

Drawing. Massive lymph nodes in the neck were biopsied and turned out to be Hodgkin's lymphoma.

Take care of yourself Your Diagnosticer!

I am 18 years old. On November 27, I felt that I was getting sick, I thought I had a cold, I took my temperature at home - I don’t remember how long it was, but it was there. My throat turned red and my lymph nodes became inflamed (at first I just felt swelling in the upper third of my neck and didn’t know it was a lymph node). I was treated with Theraflu for 2 days, but didn’t recover much. Within a month after this, the feeling of swelling returned after exposure to cold on the neck. The subfibral temperature remained at 37 - 37.2. For a month I didn’t pay any attention to it. After the new year I passed oak and oam. Oak - increased hemoglobin (168) - the rest is normal, ESR 3mm. Oam - salts in urine (38), the rest is normal. I visited a therapist in January. HIV - negative Hep - negative Fluorography - pure, web - nuclear antigen (I was sick once). The therapist attributed everything to the throat (all this time the throat was red without pain or discomfort + runny nose). The therapist attributed it all to under-treatment of ARVI and stress, which supposedly undermined the immune system. I saw an infectious disease specialist and prescribed the immunomodulator Galavit. There was no improvement, on the contrary, on the first dose the temperature jumped to 37.4, on the second day 37, on the third 36.6, then it returned to 36.9-37. My throat turned even redder + coated my tongue. Also, for two months, the stool came in loose lumps. (There was no diarrhea, rumbling, frequent bowel movements, etc.). I visited an ENT specialist and two other therapists. Everyone palpated only the submandibular lymph node on the right, but they were inflamed on both sides, I felt it. Ultrasound of the abdomen is normal (deformed gall bladder), x-ray of the mediastinum in 2 projections is normal. I did an ultrasound of the cervical lymph nodes: on the left, at the level of the s/w lower jaw, the local lymph node is 9.1x5.8 mm - homogeneous contents of reduced echogenicity, no increased blood flow. On the right, at the level of the angle of the lower jaw and slightly lower along the scalene muscle, there is a homogeneous content of reduced echogenicity, no increased blood flow, and the nucleus does not differentiate at 8.4 x 4.3 mm and 6.2 x 3.3 mm. Lymph nodes in the upper third of the neck on both sides were also found, all within 10.5x2.7 mm. Came with the results to Ph.D. Hemotology - she said that it was not lymphoma, she attributed everything to the throat and skin problems (acne). She referred me to an ultrasound specialist “to calm my soul.” The ultrasound specialist examines many patients with lymphomas and oncology. Found: left chin 7x4.0 mm without diff. Layers. Submandibular: right 16x7mm without diff. Layers, left: 15.7x9mm and 10x4.5 with diff. Layers. Cervical: anterior cervical, upper third: 2 l/u up to 20x7 mm and 19.5x6.8 without diff. Layers. Left: group up to 9x6mm without diff. Layers. Posterior cervical: left upper third 7.5x3.0 with diff. Layers. She said that it didn’t look like lymphoma, that it was most likely due to the throat, and advised me to do an ultrasound in a couple of months and see the dynamics. I suspect lymphoma at best, metastases at worst. Doctor, please tell me if it is possible! Changing the shape and structure of the l/u! For a reason other than oncology (and pulmonary tuberculosis - I have no symptoms of it). As far as I understand, the change in structure and diff. L/u - 100 percent oncology. Is a lymph node biopsy justified in my case?

The human body is constantly exposed to foreign pathological flora and its own defective cells. But there is an immune system that protects a person from pathogenic agents. An important part of it are the lymph nodes. Depending on which group of lymph nodes is enlarged, the inflammatory process is localized in that part of the body. If the iliac lymph nodes become inflamed, this is a sign of pathology of the pelvic organs.

Where are the iliac lymph nodes located?

The iliac (pelvic) lymph nodes are a group of deeply located formations of the body’s immune system. They are located in the pelvic cavity, on its walls and around the organs. The lymph nodes of the iliac region filter lymph, which flows from the deep-lying groups of inguinal nodes.

The iliac lymph nodes are divided into two broad, large groups: parietal and splanchnic. A group of parietal lymph nodes lies along the arteries of the same name, on the walls of the pelvis. All parietal formations are divided into subgroups of external, internal and general lymph nodes. Internal (visceral), located next to the pelvic organs. They include a larger number of subgroups, which include:

• Pararectal - lie in the lower parts of the rectum, on its lateral surfaces.
• Paravesical - single, lie in the lower part of the bladder.
• Circumferential - located between the sheets of the broad uterine ligament.
• Peri-vaginal - lie below the peri-uterine.

The number of such nodes is individual for each person. Normally, their number varies from 10 to 20 formations.

Where do the iliac nodes collect lymph from? Their sizes are normal.

The visceral group of lymph nodes filters lymph, which flows from the organs of the same name. The parietal group of lymph nodes collects lymph from formations that are located on the walls of the pelvis.

All lymph from the external and internal iliac lymph nodes goes through the lymphoid vessels to the group of common iliac lymph nodes. Most often there are about 10 of them and they are arranged in three chains. After filtration by the common iliac nodes, the lymph flows to the subaortic formations. Efferent vessels direct lymph to the final, lumbar lymph nodes.

In a healthy person, most often the lymph nodes cannot be palpated. If they are detected during palpation, then their normal sizes vary from 5 to 10 mm. Usually only the axillary and inguinal lymph node groups can be palpated.

Non-inflamed lymph nodes do not cause any discomfort when palpated, they are elastic. They are not enlarged, have a uniform consistency, and are not fused with the surrounding tissues. The knots roll easily under your fingers, smooth, not hot. If lymphadenopathy or lymphadenitis occurs, patients are concerned about discomfort in the affected area and deterioration in their general condition.

Reasons for enlarged lymph nodes of this group

If the lymph nodes of any group are enlarged, then this is a clear sign of the development of a pathological process in the body. Lymphoid tissue is the first structure that responds to the penetration of pathological agents into the body. The reasons for enlarged lymph nodes can be very diverse. Nodes can enlarge with the following diseases:

With each of these diseases, enlargement of the lymph nodes of the iliac region of varying degrees is possible. First, lymphadenopathy occurs (an increase in the size of the lymph nodes). Afterwards, when the inflammatory process in the body reaches its height, lymphadenitis occurs (inflammation of the node). In addition, the course of the disease can be complicated by inflammation of the lymphatic vessels (lymphangitis).

There is a certain group of diseases in which enlargement of the iliac lymph nodes may occur less frequently:

• Autoimmune diseases - rheumatoid arthritis, sarcoidosis, lupus nephritis.
• Metabolic diseases - lipidoses, Neman-Pick disease.
• Amyloidosis of the kidneys.
• Connective tissue diseases - systemic vasculitis.

If only one group of lymph nodes, or a single lymph node, is enlarged, then they speak of a localized infection. And when it is discovered that several groups of lymph nodes throughout the body are enlarged, then the infectious process is generalized.

What studies reveal enlarged iliac lymph nodes?

A group of iliac lymph nodes is located deep in the pelvis. There is no way to visually assess their increase. It is also impossible to feel them, evaluate their consistency and surface. Sometimes individual nodes of the lymphatic system can be felt during vaginal examination in women. The following clinical signs may indicate enlarged lymph nodes:

• Minor pain in the area of ​​the iliac bones.
• Pain during defecation or urination.
• Constant aching pain in the bladder area.

If there is a suspicion of enlargement of the lymph nodes of the iliac region, then they are examined using additional examinations. They use different methods of laboratory and instrumental diagnostics. The development of the inflammatory process in the human body can be indicated by the following tests:

• Clinical and biochemical blood test.
• General urine analysis with sediment examination.
• Immunological blood test.

These tests can provide information about the development of some pathology in the body. With their help, it is impossible to identify the pathogen or discover the causes of the disease. To find out why the disease occurred, to determine how enlarged the lymph nodes are, the following methods are used:

• Ultrasound diagnostics.
• X-ray examination.
• Puncture biopsy of the affected node.
• Computed tomography (CT).
• Magnetic resonance imaging (MRI).

Such techniques allow you to see the affected area and judge the severity of the pathological process. The main method of studying the structure of an inflamed lymph node is a puncture biopsy. Only with the help of this method can the most reliable diagnosis be made. And also prescribe complete, sufficient and high-quality treatment.

Which doctors deal with this problem?

The first doctors who encounter patients with this disease are a general practitioner, a pediatrician or a family doctor. It is these specialists who conduct a detailed survey of the patient and a thorough examination. The doctor pays attention not only to the affected area, he will also examine and palpate all groups of lymph nodes. The doctor examines all organs and systems of the patient. The therapist or pediatrician prescribes all the necessary tests, makes a preliminary diagnosis and prescribes treatment.

If the patient’s condition is severe and diagnosis is difficult, then consultation with the following specialists may be necessary:

• Surgeon . If a severe purulent process develops (peritonitis, pelvioperitonitis). And also situations when the issue of the need for surgical treatment of lymphadenitis is decided.