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Swollen Lymph Nodes

Definition :
Swollen lymph nodes combined with other signs and symptoms are a common reason people, particularly children, visit their doctors. Most often, lymph nodes swell and become inflamed as a result of an infection. However, there are many possible causes of swollen lymph nodes, including autoimmune diseases, such as rheumatoid arthritis, noncancerous (benign) tumors and cancer.

Your lymph nodes, also called glands, play a vital role in your body's ability to fight off viruses, bacteria and other causes of illnesses. Some 600 lymph nodes are situated throughout your body, with the majority in your head and neck. The lymph nodes that most frequently swell are in your neck, under your chin, in your armpits and in your groin. The site of the swollen lymph nodes may help identify the underlying cause.

Treatment for inflamed, swollen lymph nodes, also known as lymphadenitis, depends on the cause. In some cases, over-the-counter (OTC) pain relievers and warm compresses may be all you need. For more serious cases, treatment of swollen lymph nodes involves treating the underlying cause.

Causes :
The most common cause of swollen lymph nodes is an infection, particularly viral infections such as the common cold. However, there are other types of infection, including parasitic and bacterial, and other possible swollen lymph node causes. They include :

Common infections

  • Strep throat
  • Mumps
  • Measles
  • Ear infections
  • Infected (abscessed) tooth
  • Mononucleosis
  • Wound infections

Other infections

  • Tuberculosis
  • Certain sexually transmitted diseases, such as syphilis
  • Toxoplasmosis — a parasitic infection resulting from contact with the feces of an infected cat or eating undercooked meat
  • Cat scratch fever — a bacterial infection from a cat scratch or bite

Immune system disorders

  • Lupus — a chronic inflammatory disease that can target your joints, skin, kidneys, blood cells, heart and lungs
  • Rheumatoid arthritis — a chronic inflammatory disease that targets the tissue that lines your joints (synovium)
  • Human immunodeficiency virus (HIV) — the virus that causes AIDS

Cancers

  • Lymphoma — cancer that originates in your lymphatic system
  • Leukemia — cancer of your body's blood-forming tissue, including your bone marrow and lymphatic system

Other possible but rare causes include certain medications, such as phenytoin (Dilantin), used to prevent seizures, and certain immunizations, such as for malaria.

When to seek medical advice :
Some swollen lymph nodes return to normal when the underlying condition, such as a cold, resolves. However, see your doctor if you're concerned or if your swollen lymph nodes :

  • Have appeared for no apparent reason
  • Continue to enlarge
  • Feel hard or fixed
  • Are accompanied by fever, night sweats or unexplained weight loss
  • Are red, warm and tender

Symptoms :
Your lymphatic system comprises a network of organs, vessels and glands situated throughout your body. A lymph node is a small, round or bean-shaped cluster of cells covered by a capsule of connective tissue. The cells are a combination of lymphocytes — which produce protein particles that capture invaders, such as

viruses — and macrophages, which break down the captured material. Lymphocytes and macrophages filter your lymphatic fluid as it travels through your body and protect you by destroying invaders.

Lymph nodes occur in groups, and each group drains a specific area of your body. That's why the site of your swollen lymph nodes helps your doctor determine the underlying cause.

Lymphadenitis means inflammation of the lymph nodes. If a lymph node is overwhelmed by invading material, it may enlarge to 1 centimeter (cm) or more and become inflamed. In general, swollen lymph nodes that you can feel (palpate), such as the ones in your neck, are likely to be tender and painful. In addition, you may have the following signs and symptoms, depending on the cause of your swollen lymph nodes :

  • Runny nose, sore throat, fever and other indications of an upper respiratory infection
  • General swelling of lymph nodes throughout your body, indicative of infections such as HIV or mononucleosis, an infection of the glands, or immune disorders, such as lupus or rheumatoid arthritis
  • Red, inflamed skin over the swollen lymph node
  • Swollen limb, possibly indicating lymph system blockage caused by swelling in a lymph node too far under your skin to feel
  • Hardened, fixed, rapidly growing nodes, possibly indicating a tumor (rare)

Dignosis :
Your doctor is likely to take a medical history, ask about when and how your swollen lymph nodes developed, ask about other signs and symptoms, and check your palpable lymph nodes for size, tenderness, warmth and texture. The site of your swollen lymph nodes and your other signs and symptoms will offer clues to the underlying cause.

In addition, your doctor may request laboratory tests to help pin down the diagnosis, including:

  • Blood tests. Depending on what your doctor suspects is causing your swollen lymph nodes, he or she may request certain blood tests to confirm or exclude the suspected underlying condition. The specific tests will depend on the suspected cause, but most likely will include a complete blood count (CBC), which helps evaluate your overall health and detect a range of disorders, including infections, such as mononucleosis, and leukemia.
  • Imaging studies. A chest X-ray or computerized tomography (CT) scan of the affected area may help determine potential sources of infection or find tumors.
  • Lymph node biopsy. If your doctor can't pin down the diagnosis, it may be helpful to remove a sample from a lymph node or even an entire lymph node for microscopic examination.

    The method of biopsy may be fine-needle aspiration (FNA), which your doctor may perform during an office visit or refer you to a surgeon or radiologist for this procedure. In FNA, the doctor inserts a thin, hollow needle into the lymph node and removes (aspirates) cells, which are then sent to a lab for study. Ultrasound — a noninvasive procedure that uses sound waves to create images of organs and tissues — may be used to ensure accuracy.

    In some cases, you may require an excisional biopsy. This type of biopsy — also called surgical biopsy — removes a portion or all of a lymph node through an incision for analysis. A surgeon performs this procedure using local or general anesthesia.

Complication :
If infection is the cause of your swollen lymph nodes and isn't treated, these complications might occur :

  • Abscess formation. An abscess is a localized collection of pus caused by an infection. Pus contains fluid, white blood cells, dead tissue and bacteria or other invaders. An abscess may require drainage and antibiotic treatment. An abscess may cause significant damage if it involves a vital organ.
  • Bloodstream infection (sepsis). A bacterial infection anywhere in your body can progress to sepsis, caused by an overwhelming infection of the bloodstream. Sepsis may result in organ failure and death. Treatment involves hospitalization and intravenous antibiotics.

Treatment:
Swollen lymph nodes caused by a virus may return to normal sometime after the viral infection resolves. Antibiotics are not useful to treat viral infections. Treatment for swollen lymph nodes from other causes depends on the cause :

  • Infection. The most common treatment for swollen lymph nodes caused by a bacterial infection is antibiotics. OTC pain relievers and fever reducers include aspirin, ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others). Aspirin and ibuprofen also have anti-inflammatory properties, which may help reduce the inflammation. Do not give your child aspirin without consulting your doctor because of its link to Reye's syndrome in children. Reye's syndrome is a rare, but serious illness that can affect the blood, livers and brains of children and teenagers recovering from a viral infection.
  • Immune disorder. If your swollen glands are a result of HIV, lupus or rheumatoid arthritis, treatment is directed at the underlying condition.
  • Cancer. Swollen glands caused by cancer require treatment for the cancer. Depending on the type of cancer, treatment may involve surgery, radiation or chemotherapy.
 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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