I. Infectious lymph node enlargement
(A) Non-specific lymphadenitis
The enlarged lymph nodes in the corresponding drainage area caused by acute and chronic infection of local tissues are called non-specific lymphadenitis. The inflammatory manifestations are often accompanied by fever and increased white blood cells after treatment the lymph nodes can often be reduced in size chronic non-specific lymphadenitis is often the result of chronic inflammation in the corresponding area swollen lymph nodes of medium hardness often without localized redness, swelling and pain of acute inflammation. Wen Peng, Department of Whistling Medicine, Shandong Chest Hospital
Acute nonspecific lymphadenitis is characterized by the coexistence of local infection and enlargement of lymph nodes in the corresponding area. For example, acute infections of the five facial organs or the head often cause enlargement of lymph nodes in the neck, under the jaw, behind the ear, behind the occiput, etc.; acute infections of the chest wall of the upper trunk breast cause enlargement of lymph nodes in the axilla; infections of the lower extremities and perineum cause enlargement of lymph nodes in the groin. Those with past nasopharyngeal or oral infections followed by inguinal lymph nodes caused by chronic inflammation of the lower extremities and genital organs
(B) Atopic infectious lymph node enlargement
1. Lymph node tuberculosis
Primary and secondary lymph node tuberculosis can be classified as primary lymph node tuberculosis if there is no other primary tuberculosis lesion to be found, and secondary lymph node tuberculosis is secondary lymph node tuberculosis if it appears after the lesions of chest, lung, abdomen or genital organs, etc. The best site of lymph node tuberculosis is the cervical lymph node group, and most of the tubercle bacilli invade through tonsil caries to form primary lymph node tuberculosis. The swelling is hard and painless, and further development of the lymph nodes and the skin and lymph node adhesions fuse into a mass, forming a mass that is not easy to move. In the late stage, caseous necrosis liquefies and forms a cold abscess, which then breaks down into a chronic ulcerated thin tube and leaves a scar after healing.
2.Filarious lymphangitis and lymphadenitis
Infection with filariasis and filarial parasites can cause chronic lymphangitis and lymphadenitis, with clinical symptoms varying according to the location of the lesion, most commonly in the inguinal lymph nodes, and if the lower extremity lymphatic drainage is obstructed, it can cause rubbery swelling of the lower extremity.
3. STD lymph node enlargement
(1) Soft chancre: painful genital ulcers caused by Streptococcus ducreyi (Streptococcus soft chancre) with green necrotic exudate covering the surface of one or both inguinal lymph nodes swollen with obvious pain and tenderness, easily septicized and broken.
(2) Lymphogranuloma venereum: caused by Chlamydia trachomatis L1L2 and L3 serotypes, the main lesions are in the lymphatic tissues, initially in the external genitalia, anus, rectum, etc. Painless papules or ulcers may appear after a few days.
(3) inguinal granuloma: painless granulomatous ulcers of the genitalia and nearby areas caused by bacillus Dono-vania.
(4) Syphilitic lymph node enlargement: symmetrical inguinal lymph node enlargement often occurs about 1 week after the appearance of hard chancre on the external genitalia about 3 weeks after infection with syphilis, and is hard, not red, not painful, not fused and not adherent.
(5) AIDS (AlDS) lymph node enlargement: prone to fatal infections such as Pneumocystis carinii pneumonia, which can be complicated by tumors such as Kaposi’s sarcoma, and some people develop chronic lymph node syndrome, which manifests as generalized lymph node enlargement, with inguinal lymph node enlargement being the most obvious.
4.Snake venomous lymphadenitis
In addition to local symptoms, venomous snake bites often cause inflammation of lymphatic vessels and lymph nodes in the corresponding areas, and the diagnosis is mainly based on medical history.
(iii) Enlarged lymph nodes caused by systemic infections
Many systemic infectious diseases can cause lymph node enlargement in a wide range of pain or pressure pain may not be obvious, often accompanied by fever, hepatosplenomegaly, etc. The common ones are as follows
1. Infectious mononucleosis
Caused by EBV mostly seen in adolescents with a self-limiting course usually 1 to 2 weeks mainly manifested as irregular fever pharyngitis lymph nodes hepatosplenomegaly lymphocytosis in the blood and the presence of abnormal lymphocytes positive serum heterophilic agglutination test
2.Rubella
Rubella virus causes a common respiratory tract infection most commonly seen in children with swollen lymph nodes and rash appearing at the same time has diagnostic significance after 1 to 2 fever rash rapidly spreads over the trunk and extremities palms and soles of the feet often without rash swollen lymph nodes most commonly behind the ear under the occipital bone the back of the neck is its characteristic rash usually lasts 3
d after remission of the swollen lymph nodes often take several weeks to fully recover
3. Measles
Most commonly seen in children initially with fever and upper whistle khat symptoms measles part of the membrane spots (Koplik
spots) for the early features of the disease fever 3 to 5 d rash on the palms and soles of the hands and feet also have a rash when the rash can be swollen lymph nodes liver tiles throughout the body
4.Cat scratch disease
Acute infectious disease caused mainly by cat scratching was previously thought to be a virus, but now it is more likely to be caused by a small polymorphic gram-negative bacillus scratched skin can be seen as herpes pustules crust or small ulcer formation can have weeks of slight fever 1-2 weeks after scratching corresponding drainage area lymph nodes swollen with pressure pain some lymph nodes can be suppurative specific antigen intradermal test positive pus bacteria Culture negative saturated silver stain to find polymorphic gram-negative small bacilli
5. Tsutsugamushi disease
For tsutsugamushi rickettsiae infection vector tsutsugamushi mite larvae bites appear papular rash into water sores after rupture central necrosis brown scab called scorch demented scab near the swollen lymph nodes pressure pain not purulent generalized superficial lymph nodes mildly enlarged rash often appear in the 5th to 7th d spot rash or maculopapular rash chest back abdomen more some cases may have hepatosplenomegaly natural course about 3 weeks epizootic reaction Oxk strain positive can confirm the diagnosis
6.Brucellosis
There is a long-term fever mostly flaccid fever partly wavy type most specific multiple joint soreness orchitis sweating more history of contact with sick cattle and sheep serum agglutination test helps to diagnose
7.Glandular plague
Swollen lymph nodes are the first lesions to appear during an epidemic inguinal lymph nodes are the first to be involved followed by axillary cervical lymph nodes often with heavy systemic symptoms swollen and painful lymph nodes can be softened and septicized pus is found in the pus to confirm the diagnosis of plague bacillus
8. Scarlet fever
Swollen lymph nodes mostly in the neck and submandibular body skin scarlet rash and flaking after fading strawberry tongue pharyngitis pharyngeal swab culture often has the growth of group B group A streptococcus
9.Leptospirosis
often have foot and intestinal muscle pain and pressure pain hemoptysis gangrene local lymph node enlargement accounted for 20% of the whole body lymph node enlargement 15% of the most common inguinal lymph nodes followed by axillary lymph nodes Leptospira agglutination lysis test more than 1:400 potency is positive with high specificity and sensitivity
10.Rat bite fever
Acute infectious disease caused by rodent bites with small spirochetes as the etiologic agent, with high fever, local hard nodular ulcers, local lymph node enlargement, pressure pain, rash, etc.
11.Toxoplasmosis
The end hosts are cats and felines, birds, mammals and human intermediate hosts. In humans, infection is associated with swallowing undercooked meat or drinking water contaminated with oocysts. examination
12. Rabbit fever
It is an acute infectious disease caused by Tularemia, mainly manifesting fever, skin ulcers, local lymph node swelling and a large whistling symptoms, such as conjunctival congestion, etc. History of contact with rabbits or insect bites to confirm the diagnosis depends on bacterial isolation and positive immune response.
13. Black fever
Patients with high fever liver and spleen lymph node enlargement anemia leukopenia leishmania can be found in the bone marrow vesicles
Second, neoplastic enlargement 1, leukemia
Leukemia often has enlarged lymph nodes, but the degree of enlargement does not discriminate between the various types of leukemia. Generally speaking, lymph node enlargement is more pronounced in acute or chronic lymphocytic leukemia. Acute non-lymphocytic leukemia and chronic granulocytic leukemia may also have enlarged lymph nodes. However, the number of sites is not as extensive and obvious as in lymphocytic leukemia. Chronic granulocytic leukemia can be distinguished by the characteristics of cell types and primitive cells in the blood and bone marrow and by cytochemical staining. The lymph nodes of the latter may be enlarged and adhere to form a mass, which is hard but not painful, and the hepatosplenomegaly is often obvious.
2.Malignant lymphoma
Hodgkin’s disease and non-Hodgkin’s lymphoma are divided into two categories. Both are characterized by chronic progressive painless lymph node enlargement, which is easily detected early in the supraclavicular fossa of the neck or axilla, while those in the chest and abdomen are not easily detected early before symptoms of pressure appear. The swollen lymph nodes are soft and mobile in the early stage without pressure pain, and when they increase rapidly, they are hard and may have light pressure pain. Sometimes the swollen lymph nodes can temporarily shrink on their own and are easily misdiagnosed as lymphadenitis. Reed-sternberg (R-S) cells (microscopic cells); non-Hodgkin’s lymphoma is characterized by a single form of tumor cells or lymphoid tissue cells without R-S cells.
3. Plasma cell tumor
(1) Multiple myeloma: It is a malignant tumor with abnormal proliferation of plasma cells, mostly seen in middle-aged and old people over 40 years old.
① bone with osteolytic damage.
② abnormal plasma cell (myeloma cells) infiltration in bone marrow greater than 10%.
(iii) The presence of large amounts of M protein in the blood or urine Multiple myeloma. There is often an extramedullary infiltration that causes lymph node enlargement Myeloma may appear in large numbers in the blood in advanced stages Myeloma cells often > 20% absolute value > 2.0×109/L is called plasma cell leukemia.
(2) Primary macroglobulinemia: a malignant proliferative disease of plasma cell-like lymphocytes that secrete large amounts of IgM. The age of onset of the disease is more than 50 years old and the clinical manifestations are anemia, hemorrhage, hepatosplenic lymph node enlargement and neurological symptoms due to increased blood viscosity, visual impairment, Raynaud’s phenomenon, vascular embolism symptoms, etc. Serum electrophoresis shows M component immunoelectrophoresis confirms monoclonal IgG in the bone marrow. Lymphocyte infiltration can confirm the diagnosis
(3) heavy chain disease: a class of plasma cells or abnormal lymphocytes malignant proliferation and produce a large number of monoclonal heavy chain and heavy chain fragments of the disease onset of more than 40 years old clinical manifestations vary, but most have lymph node enlargement persistent proteinuria without bone damage signs diagnosis is mainly based on serum immunoelectrophoresis and related physicochemical characteristics
4.histiocytosis
(1) Malignant histiocytosis (malignant group): often presents with hyperthermia, anemia, hemorrhage, lymph nodes, hepatosplenomegaly, and systemic failure, diagnosed mainly by repeated bone marrow smears and lymph node biopsies for abnormal histiocytes and multinucleated macrophages of various morphologies.
(2) histiocytosis X: also known as Lange-rhan histiocytosis is a group of rare diseases of unknown etiology characterized by the proliferation of well-differentiated histiocytes and involving the liver, spleen, lymph nodes, lungs, bone marrow, skin, etc. The lesions are also divided into three types according to the degree of cell differentiation: ①Letterer-Siwe disease The main manifestations of the disease are: ①Letterer-Siwe disease, which mostly develops within 1 year of age with high fever and red maculopapular rash and inspiratory symptoms, and hepatosplenic lymph node enlargement; ②Hand-Schuller-Christian disease, which is mostly seen in children and young people with cranial defects, proptosis and uveitis as the three main features; ③Eosinophilic granuloma of bone, which is mostly seen in children with osteolytic destruction of long bones and flat bones as the main manifestations. The diagnosis and typing of this disease should be based on clinical radiological and pathological examination. The diagnosis is more accurate if the tissue cells are confirmed to be Langerhans cells.
C. Reactive lymph node enlargement
1.Reactive lymphadenopathy
Certain drugs or biological products can cause fever, rash, lymph node enlargement, etc. Those caused by common chemical drugs are called drug fever, such as callitrizine, methyldopa, isoniazid, phenytoin sodium, etc. Those caused by various vaccines and other biological products are called serum sickness.
2.Adult Still’s disease
Adults with juvenile rheumatoid arthritis mainly manifest as chills and high fever lymph nodes, liver and spleen can be mildly enlarged and have a transient red maculopapular rash and muscle and joint pain is not obvious a few can be complicated by multiple pluritis (pericarditis pleurisy, etc.) leukocytosis neutrophils predominantly fast sedimentation but no obvious foci of infection can be found in the blood rheumatoid factor antinuclear antibodies lupus cells, etc. are negative antibiotic therapy is ineffective a lot of salicylic acid The majority of patients have a good prognosis except for a few years after the occurrence of joint deformity, but can relapse.
3.Allergic subsepsis
Wissler-Fanconi syndrome, also known as Wissler-Fanconi syndrome, is most common in children and is characterized by chronic recurrent fever, recurrent episodes of transient polymorphic rash and joint symptoms, enlarged lymph nodes, liver and spleen, increased white blood cells, rapid sedimentation, and clinically similar to sepsis, but with negative blood and bone marrow cultures. The difference between this disease and adult Still’s disease is that this disease is mostly seen in children with mild joint symptoms and rarely causes joint deformities.
4. Acute necroproliferative lymphadenopathy
The main manifestations are high fever, swollen lymph nodes in the neck, axilla, lung, etc. Superficial lymph nodes with pressure pain, transient leukopenia, ineffective antibiotic treatment, effective corticosteroid treatment, and pathological examination showing extensive coagulative necrosis of lymph nodes surrounded by reactive histiocytes without neutrophil infiltration.
5. Systemic lupus erythematosus (SLE)
Most commonly seen in young and middle-aged women with long-term irregular fever typical rash joint symptoms symptoms of multi-organ damage symptoms of leukocyte reduction immunological abnormalities, etc. Some cases are accompanied by local or generalized lymph node enlargement
IV. Other lymph node enlargement
1.Nodular disease
It is a multisystemic granulomatous disease of unknown etiology with enlarged lymph nodes up to the size of walnuts, hard and non-adherent enlarged lymph nodes can be in the upper axilla of the neck and easily invade deep lymph nodes. x-ray can show nodular alveolitis and enlarged hilar and mediastinal lymph nodes with positive skin Kveim test and negative tuberculin skin test. like changes
2. Fatty deposition disease
The common ones are Niemann-Pick disease, Gaucher disease, which occurs in infants and children. The latter can also be found in the bone marrow slides of chronic granulocytic leukemia hodgkin’s disease and multiple myeloma, but they are not deficient in glucocerebrosidase, which can be distinguished.