Enlarged external iliac lymph nodes cause. Enlarged lymph nodes. Lymphadenitis in children

Reactive lymphadenitis (inflammation of the lymph glands) is a dependent disease. This pathological process is a concomitant symptom of various diseases, both bacterial and viral etiology.

Reactive lymphadenitis characterizes the initial phase (reactive) of disorders, in the form of a primary reaction to the focus of infection in the human body.

The treatment of lymphadenitis itself will not be effective without determining the exact cause that caused the pathological condition.

What is reactive lymphadenitis

Reactive lymphadenitis is part of a general chain of painful changes that are almost asymptomatic. Accordingly, a reactive change in the lymph nodes is the initial manifestation of the disease, the first sign of the body's fight against infection.

For example, with a latent form of tuberculosis (latent), the pathogen (Koch's wand) may be in an inactive phase long time. It can be completely neutralized by the body's defenses without causing any harm to a person.

However, as a result, often, a number of negative impacts, a dormant infection may reactivate. Then, with a high probability, the lymph nodes, as an integral part of the immune system, will be the first to take the hit.

The following factors can provoke the appearance of reactive lymphadenitis:

Chronic inflammation.
Low immunity.
Frequent colds.
Hypothermia.
Long stay in a stuffy, unventilated room.
a lack of sunlight.
Chronic emotional overstrain, severe stress, can trigger the mechanisms of a dormant infection, for example, Koch's bacillus in tuberculosis.
Malnutrition, mono-diets.
Frequent fatigue.
Sedentary lifestyle.
Bad habits(alcohol abuse, smoking).
Avitaminosis.
Often, reactive lymphadenitis occurs in children under 6 years of age due to immature immunity, as a reaction to any focus of inflammation in the child's body. It can be rhinitis, otitis and acute respiratory viral infections.

Clinical manifestations of reactive lymphadenitis

Reactive inflammation in the lymph nodes is a concomitant symptom of a disease.

Often the zone of inflamed lymph nodes indicates a local pathological process in the same area, that is, it is nearby, near the focus of inflammation.

The initial sign of reactive lymphadenitis is reactive lymphadenopathy, as the very first reaction of the body in response to infection.

It can manifest itself by an increase in a different number of lymph nodes and their mild soreness.

Left unattended, this pathological process is aggravated by lymphadenitis, which can be recognized by the following signs:

Enlargement, swelling of the lymph nodes.
Lymph glands are painful on palpation and pressure.
Swelling and redness of the skin over the affected lymph nodes.
The glands are not soldered to the skin and to each other, dense to the touch.

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

General weakness.
Elevated or subfebrile (37 ° C) body temperature.
Headache.
Sleep disturbance.
Cough.
Rhinitis.

Important! If there is severe pain in the area of one lymph node or a whole group of them, an increase in body temperature of more than 38.5 ° C, rapid breathing and heartbeat (signs of purulent lymphadenitis), it is necessary to urgently consult a doctor

The fact is that with reactive lymphadenopathy after treatment of the underlying disease, the lymph nodes almost always return to normal on their own.

However, if the primary pathology is left without appropriate therapy or the treatment is insufficient, the process may be complicated by painful changes in the lymph glands themselves.

In this case, there may be a proliferation of lymphoid tissue, with the development of reactive hyperplasia in the lymph nodes, with a violation of their function.

This can cause their suppuration or the spread of infection to nearby tissues and the entire human body.

What diseases and conditions can be accompanied by reactive inflammation of the lymph glands

Reactive lymphadenitis may accompany diseases such as:

Tuberculosis. Parotid and axillary nodes often become inflamed. Lymphadenopathy may also occur. cervical lymph nodes.
Angina.
Tonsillitis.
pathological process in oral cavity(caries, stomatitis).
Acute mastitis caused by staphylococcus and streptococcus bacteria.
AIDS.
Syphilis.
Diseases of the female and male genitourinary system. For example, hyperplastic (tissue growth). Abnormal changes in the mucous membrane of the uterus (polyps, endometrial hyperplasia). A woman often shows an increase inguinal lymph nodes.
Enterocolitis.
Flu.
Otitis.
Sinusitis.
Teething in infants.
Adenoiditis in children.
Bubonic plague.

Which specialist should be contacted if the lymph nodes are enlarged or inflamed for no apparent reason

Reactive hyperplasia of the lymph nodes is dangerous because it can go unnoticed by the patient.

With general weakness, increased fatigue, subfebrile body temperature, sweating, as well as with any ailment, it is necessary to pay attention to the lymph nodes.

With their increase, pain during palpation, first of all, you need to consult a general practitioner.

After the examination, the doctor can give a referral to such specialists as:

Urologist.
Gynecologist.
Dentist.
Gastroenterologist.
Infectionist.
Mammologist.
Surgeon.

What research can a doctor prescribe

If reactive lymphadenitis is detected, in order to understand the cause of the disease and determine the state of the lymph glands themselves, the doctor may prescribe the following tests:

General analysis of urine and blood (with formula).
Blood for syphilis, HIV, viral hepatitis.
Bacteriological examination of blood, urine. To identify pathogens, to sensitivity to antibiotics.
Tumor markers.
Blood for hormones.
Biochemistry.
Cytological and bacteriological analysis of discharge from the vagina, urethra.
Bacteriological culture of sputum.
Puncture of the lymph node with subsequent cytological examination.

Also, a doctor may recommend that a patient with reactive lymphadenitis undergo such instrumental diagnostics, How:

X-ray (fluorography, mammography, urography).
Computed tomogram (CT).
Magnetic resonance imaging (MRI).
Gastroduodenoscopy.
Sigmoidoscopy.
Bronchoscopy.

Treatment

Reactive lymphadenitis can be the initial symptom of many diseases. Accordingly, his treatment will be based on the elimination of the source of infection itself.

If an infectious agent pathological process bacterial flora acts, then antibiotic therapy is used first of all.

A fungal infection is treated, for example, with drugs such as:

Fluconazole.
Rumikoz.
Orungal.
Nizoral.

To combat a viral infection, the following antiviral agents will be effective:

Interferon.
Tsitovir.
Kagocel.
Amiksin.
Remantadin.
Arbidol.

Important! You can not self-medicate reactive lymphadenitis. This pathology can be a manifestation of various diseases, which can only be determined by a doctor. All of the above drugs are prescribed exclusively by a doctor.

Prevention

Preventive measures for reactive lymphadenitis include the following:

For any symptoms of malaise ( subfebrile temperature body, sweating, chills, fatigue) that last more than 5 days consult a doctor.
Women visit a mammologist and gynecologist once a year. After forty years, undergo a mammogram every 12 months, visit a gynecologist every six months.
Men undergo preventive examinations by a urologist once a year.
In case of prolonged weakness, prolonged cough, consult a doctor.
In wet slushy weather, during epidemics, to increase immunity, you need to take decoctions and tinctures of herbs that strengthen the body's defenses. For example, such as:
- Tinctures of echinacea, eleutherococcus can be purchased at the pharmacy. Take after consultation with the doctor in accordance with the attached instructions.
- Rosehip decoction. This drink can be prepared using a thermos in the following way:

Rinse a thermos with boiling water.
Place in it 2 tablespoons of rose hips washed with running water.
Pour in a liter of freshly boiled water.
Insist 8 hours.
Then strain through 4 layers of gauze into a liter glass container.
Fill in the missing volume with boiled water.

The berries left in the thermos do not need to be thrown away. They can be poured a second time with boiling water and used according to the above scheme.

Also, for the normal functioning of the immune system, the prevention of various diseases, it is necessary to lead a healthy lifestyle. It is necessary to avoid physical and emotional overstrain, engage in feasible physical education, eat well, do not neglect rest, sleep, and be outdoors as often as possible.

When the body is fighting an infection or injury, lymph nodes sometimes swell. Doctors call this reactive lymph node hyperplasia ( reactive lymphadenitis), which is usually not dangerous.

What is the function of the lymph nodes?

Lymph nodes contain B and T lymphocytes, which are the main types of white blood cells. These cells help the body fight bacteria and viruses. Lymph nodes also carry lymph fluid and connect through lymphatic vessels. Together, the lymph nodes and lymph vessels make up the lymphatic system, which is an integral part of the immune system.

When something goes wrong in the body, the lymphatic system produces cells to fight bacteria, viruses, and other causes of illness. Then the lymph nodes begin to swell. Lymph nodes can also enlarge in response to injury, and sometimes they enlarge due to cancer.

Lymph nodes usually enlarge near the injury site. For example, lymph nodes near the pinna may swell when a person develops an ear infection, while lymph nodes in the neck may swell in response to strep throat.

Symptoms of reactive lymphadenitis

The main symptom of a reactive lymph node is swelling. Sometimes the area around the lymph node also swells up. The body contains hundreds of lymph nodes, and they are most often crowned on the neck and around the face, in the groin and armpits. When lymph nodes become enlarged due to infection or injury, they:

less than 1.5 centimeters in diameter;
soft;
mobile.

Swelling is usually only seen in a specific lymph node or group of lymph nodes. A person who has many enlarged lymph nodes throughout the body may have a severe systemic infection or certain types of cancer.

Reactive lymph nodes often accompany an infection or injury, and a person may notice other symptoms of an infection, such as:

fever;
pain near the injury
disease symptoms;
signs of infection near the injury, such as redness or swelling;
nausea.

An enlarged lymph node does not necessarily mean that the infection is serious. In some people, swollen lymph nodes do not cause other symptoms.

Causes

The most common causes of swollen lymph nodes are:

infections such as skin, ear or sinus infections;
exposure to allergens;
skin injury or irritation;
dental health problems such as cavities or stomatitis
exposure to bacteria or viruses;
mononucleosis, a highly contagious virus that can cause various lymph nodes to swell;
skin irritation, such as from acne or rashes.

Sometimes immune diseases cause swollen lymph nodes. Less common causes of a reactive lymph node condition include:

metastases from cancer that spreads from the main location to neighboring lymph nodes;
lymphoma - cancer of the lymph nodes;
sepsis, which is a type of systemic infection that can become life-threatening.

When a person has cancer or a severe infection, they may have many swollen lymph nodes. Swelling in one lymph node is less likely to be a sign of a serious problem.

Reactive lymphadenitis - treatment

Proper treatment for swollen lymph nodes depends on the cause. When a person has no symptoms of an infection, the swelling often goes away on its own. When infections cause lymph node reactivity, a person may need antibiotics. More severe infections may require antibiotics to be given intravenously. People with weak immune systems may need to be hospitalized for even relatively minor infections.

Treatment is available for many forms of cancer, especially if a doctor diagnoses them on early stage. Depending on the type of cancer, a doctor may recommend removal of lymph nodes, chemotherapy, or radiation.

When to See a Doctor

Enlarged lymph nodes can be worrisome, especially if the cause is unclear. However, in most cases, swollen lymph nodes are a sign that the body's immune system is working well. A person with HIV or AIDS who is taking drugs that suppress the immune system, or if the person has a weak immune system, should see a doctor if their lymph nodes are swollen.

Most people can wait 1-2 weeks to see if symptoms go away. You should see your doctor within a day or two if:

enlarged lymph nodes appear after a skin injury;
enlarged lymph nodes in a newborn or infant;
swollen lymph nodes are accompanied by fever.

You can wait about 2 weeks to see if the swelling goes down. If the swelling persists, or if the lymph node becomes hard or larger than 1.5 cm in diameter, see your doctor.

Forecast

Lymph nodes enlarge for many reasons, most of which are relatively harmless. However, a doctor can determine if a person has a serious infection that needs treatment, as well as evaluate other potential causes of reactive lymph nodes.

Sometimes the lymph nodes remain enlarged long after the infection has gone. If the lymph node does not change or become hard, this is usually not a cause for concern.

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 cavity of the small pelvis, on its walls and around the organs. The lymph nodes of the iliac region filter the lymph that flows from deeply located groups of inguinal nodes.

Iliac lymph nodes are divided into two broad, large groups: parietal and splanchnic. A group of parietal (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 more extensive number of subgroups, which include:

Pararectal - lie in the lower parts of the rectum, on its lateral surfaces.
Periuretic - single, lie in the lower part of the bladder.
Periuterine - located between the sheets of the uterine broad ligament.
Peruvaginal - lie below the parauterine.

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, their size is normal

The visceral group of lymph nodes filters the lymph that 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 through the lymphoid vessels goes to the group of common iliac lymph nodes. Most often there are about 10 pieces and they are arranged in three chains. After being filtered by the common iliac nodes, the lymph flows to the subaortic formations. The efferent vessels direct lymph to the final, lumbar lymph nodes.

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

Non-inflamed lymph nodes, when palpated, do not cause any discomfort, they are elastic. They are not enlarged, of a homogeneous consistency, not soldered to the surrounding tissues. The knots roll easily under the fingers, smooth, not hot. If lymphadenopathy or lymphadenitis occurs, patients are worried about discomfort in the affected area, worsening of the general condition.

Causes of enlargement of the lymph nodes of this group

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

With each of these diseases, an increase in the lymph nodes of the iliac region of varying degrees is possible. First, there is lymphadenopathy (an increase in the size of the lymph nodes). After, when the inflammatory process in the body reaches the stage of heat, 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 an increase in the iliac lymph nodes may occur less frequently:

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

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

What studies reveal an increase in iliac lymph nodes

The group of iliac lymph nodes is located deep in the small pelvis. It is not possible to visually evaluate their increase. It is also impossible to feel them, evaluate the consistency and surface. Sometimes individual nodes of the lymphatic system can be felt with vaginal examination among women. The following clinical signs may indicate an increase in lymph nodes:

Minor pain in the iliac bones.
Pain during defecation or urination.
Constant aching pain in the bladder.

If there is a suspicion of an increase in the lymph nodes of the iliac region, then they are examined with the help of additional examinations. Different methods of laboratory and instrumental diagnostics are used. The development of the inflammatory process in the human body can be evidenced by the data of such analyzes:

Clinical and biochemical analysis of blood.
General urinalysis with sediment examination.
Immunological study of blood.

These tests can provide information about the development of some kind of pathology in the body. With their help, it is impossible to identify the pathogen, to detect the causes of the disease. To find out why the disease arose, to identify 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, to judge the severity of the pathological process. The main method for 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 a full, sufficient and high-quality treatment.

Which doctors deal with this problem

The first doctors who encounter patients with such an ailment are a general practitioner, pediatrician or 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 definitely examine and probe all groups of lymph nodes. The doctor examines all organs and systems of the patient. The therapist or pediatrician prescribes all the necessary studies, makes a preliminary diagnosis and prescribes treatment.

If the patient's condition is severe, the diagnosis is difficult, then you may need to consult the following specialists:

Surgeon . If there is a development of a severe purulent process (peritonitis, pelvioperitonitis). As well as situations when the issue of the need for surgical treatment of lymphadenitis is being decided.

Reactive lymphadenitis is one of the components of the general chain pathological changes which are almost asymptomatic. A reactive disorder in the lymph nodes is considered the initial manifestation of a disease, the first symptom of the body's struggle with the infectious process.

For example, with a latent latent form of tuberculosis, the pathogen may be in an inactive stage for quite some time. long time. It can be neutralized by its own protective forces without causing any harm to a 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 hit as part of the immune system.

The reasons for the development of this pathology

The following factors can provoke the occurrence of reactive lymphadenitis:

Inflammatory process of a chronic nature.
Decreased immunity.
Frequent colds.
Hypothermia.
Prolonged stay in a poorly ventilated area.
Lack of sunlight.
Chronic emotional stress, severe stress.
Malnutrition, 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 the immaturity of immunity, as a reaction to any inflammatory focus in the child's body, which can be rhinitis, otitis and respiratory viral pathologies.

Clinical manifestations of the disease

Reactive inflammation of the lymph nodes is a concomitant symptom of a particular pathological process. Its occurrence is provoked by the following pathogenic agents:

Often, the localization of the inflamed 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 different 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 and to each other, they are hard, dense to the touch.

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

excessive weakness;
subfebrile or fever;
cephalgia;
sleep disturbance;
rhinitis;
cough.

If there is 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 contact a specialist.

With reactive lymphadenopathy after therapy of the underlying disease, the state of the lymph nodes always normalizes on its own. However, if primary cause development of a pathological phenomenon will remain without appropriate treatment, the process may be complicated by inflammation of the lymph glands themselves. In this case, growth can be observed with the occurrence of reactive hyperplasia in the nodes and a pronounced violation of 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 of the genitourinary system;
flu;
sinusitis;
otitis;
adenoiditis in a child;
Bubonic plague;
teething in infants.

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 in the form of a reaction to the ingestion of any infection into 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 soreness may be absent.

Depending on the cause that provoked the development of the inflammatory process in the lymph nodes, reactive lymphadenitis (according to the ICD-10, this ailment passes through the R59 code 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 the cellular structure of the inflamed lymph node, purulent, serous and simple lymphadenitis is released. Serous develops with a viral course of the disease or with oncological diseases, purulent - with the bacterial nature of the development of inflammation. Purulent form lymphadenitis is especially dangerous because an abscess or phlegmon may develop.

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

Lymphadenitis in children

Reactive lymphadenitis in a child is a disease in which an inflammatory lesion of the lymph nodes occurs, regardless of their location. This pathology always acts as 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 immunity of the child is not yet sufficiently developed to actively fight against certain diseases. And often the lymph nodes react even to a banal cold. The most common localization of reactive lymphadenitis in children is the neck, armpits, neck and groin.

Cervical lymphadenitis

Clinical manifestations inflammation in the body can 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 causes the reproduction of streptococcus and staphylococcus aureus. Enlargement and soreness of the lymph nodes of the neck are observed in the following diseases:

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

Axillary lymphadenitis

This localization of lymphadenitis is observed when infected with streptococcus, Escherichia or Pseudomonas aeruginosa, pneumococcus or diplococcus. In this case, there are several ways 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 in the development of this pathology

With an increase and soreness of the lymph nodes, it is recommended to consult a therapist. This doctor can refer the patient to narrower specialists: urologist, gynecologist, dentist, gastroenterologist, infectious disease specialist, mammologist or surgeon.

With 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, vagina;
puncture of the lymph node with cytological examination.

The list of instrumental diagnostic methods includes:

x-ray;
computed tomogram;
gastroduodenoscopy;
bronchoscopy;
sigmoidoscopy.

Treatment of the disease in children and adults

How to treat reactive lymphadenitis? This is a common question. Let's look into it in more detail.

Reactive inflammation of the lymph nodes is the initial symptom of many diseases. Accordingly, therapy should be based on the elimination of the underlying pathology and the source of infection.

A qualified specialist should select a treatment regimen.

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

Reactive lymphadenitis characterizes the initial phase (reactive) of disorders, in the form of a primary reaction to the focus of infection in the human body.

The treatment of lymphadenitis itself will not be effective without determining the exact cause that caused the pathological condition.

What is reactive lymphadenitis

For example, with a latent form of tuberculosis (latent), the pathogen (Koch's wand) can remain in an inactive phase for a long time. It can be completely neutralized by the body's defenses without causing any harm to a person.

However, often as a result of a number of negative influences, a dormant infection can become active. Then, with a high probability, the lymph nodes, as an integral part of the immune system, will be the first to take the hit.

The following factors can provoke the appearance of reactive lymphadenitis:

Chronic inflammation.
Low immunity.
Frequent colds.
Hypothermia.
Long stay in a stuffy, unventilated room.
Lack of sunlight.
Chronic emotional overstrain, severe stress, can trigger the mechanisms of a dormant infection, for example, Koch's bacillus in tuberculosis.
Malnutrition, mono-diets.
Frequent fatigue.
Sedentary lifestyle.
Bad habits (alcohol abuse, smoking).
Avitaminosis.
Often, reactive lymphadenitis occurs in children under 6 years of age due to immature immunity, as a reaction to any focus of inflammation in the child's body. It can be rhinitis, otitis and acute respiratory viral infections.

Clinical manifestations of reactive lymphadenitis

Reactive inflammation in the lymph nodes is a concomitant symptom of a disease.

Often the zone of inflamed lymph nodes indicates a local pathological process in the same area, that is, it is nearby, near the focus of inflammation.

The initial sign of reactive lymphadenitis is reactive lymphadenopathy, as the very first reaction of the body in response to infection.

It can manifest itself by an increase in a different number of lymph nodes and their mild soreness.

Left unattended, this pathological process is aggravated by lymphadenitis, which can be recognized by the following signs:

Enlargement, swelling of the lymph nodes.
Lymph glands are painful on palpation and pressure.
Swelling and redness of the skin over the affected lymph nodes.
The glands are not soldered to the skin and to each other, dense to the touch.

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

General weakness.
Elevated or subfebrile (37 ° C) body temperature.
Headache.
Sleep disturbance.
Cough.
Rhinitis.

Important! If there is severe pain in the area of one lymph node or a whole group of them, an increase in body temperature of more than 38.5 ° C, rapid breathing and heartbeat (signs of purulent lymphadenitis), it is necessary to urgently consult a doctor

The fact is that with reactive lymphadenopathy after treatment of the underlying disease, the lymph nodes almost always return to normal on their own.

However, if the primary pathology is left without appropriate therapy or the treatment is insufficient, the process may be complicated by painful changes in the lymph glands themselves.

In this case, there may be a proliferation of lymphoid tissue, with the development of reactive hyperplasia in the lymph nodes, with a violation of their function.

This can cause their suppuration or the spread of infection to nearby tissues and the entire human body.

What diseases and conditions can be accompanied by reactive inflammation of the lymph glands

Reactive lymphadenitis may accompany diseases such as:

Tuberculosis. Parotid and axillary nodes often become inflamed. Lymphadenopathy of the cervical lymph nodes may also occur.
Angina.
Tonsillitis.
Pathological process in the oral cavity (caries, stomatitis).
Acute mastitis caused by staphylococcus and streptococcus bacteria.
AIDS.
Syphilis.
Diseases of the female and male genitourinary system. For example, hyperplastic (tissue growth). Abnormal changes in the mucous membrane of the uterus (polyps, endometrial hyperplasia). A woman often manifests an increase in inguinal lymph nodes.
Enterocolitis.
Flu.
Otitis.
Sinusitis.
Teething in infants.
Adenoiditis in children.
Bubonic plague.

Which specialist should be contacted if the lymph nodes are enlarged or inflamed for no apparent reason

Reactive hyperplasia of the lymph nodes is dangerous because it can go unnoticed by the patient.

With general weakness, increased fatigue, subfebrile body temperature, sweating, as well as with any ailment, it is necessary to pay attention to the lymph nodes.

With their increase, pain during palpation, first of all, you need to consult a general practitioner.

After the examination, the doctor can give a referral to such specialists as:

What research can a doctor prescribe

If reactive lymphadenitis is detected, in order to understand the cause of the disease and determine the state of the lymph glands themselves, the doctor may prescribe the following tests:

General analysis of urine and blood (with formula).
Blood for syphilis, HIV, viral hepatitis.
Bacteriological examination of blood, urine. To identify pathogens, to sensitivity to antibiotics.
Tumor markers.
Blood for hormones.
Biochemistry.
Cytological and bacteriological analysis of discharge from the vagina, urethra.
Bacteriological culture of sputum.
Puncture of the lymph node with subsequent cytological examination.

Also, a doctor may recommend a patient with reactive lymphadenitis to undergo such instrumental diagnostics as:

X-ray (fluorography, mammography, urography).
Computed tomogram (CT).
Magnetic resonance imaging (MRI).
Gastroduodenoscopy.
Sigmoidoscopy.
Bronchoscopy.

Treatment

Reactive lymphadenitis can be the initial symptom of many diseases. Accordingly, his treatment will be based on the elimination of the source of infection itself.

If the bacterial flora acts as an infectious agent of the pathological process, then antibiotic therapy is used first of all.

A fungal infection is treated, for example, with drugs such as:

To combat a viral infection, the following antiviral agents will be effective:

Important! You can not self-medicate reactive lymphadenitis. This pathology can be a manifestation of various diseases, which can only be determined by a doctor. All of the above drugs are prescribed exclusively by a doctor.

Prevention

Preventive measures for reactive lymphadenitis include the following:

For any symptoms of malaise (subfebrile body temperature, sweating, chills, fatigue) that last more than 5 days, consult a doctor.
Women visit a mammologist and gynecologist once a year. After forty years, undergo a mammogram every 12 months, visit a gynecologist every six months.
Men undergo preventive examinations by a urologist once a year.
In case of prolonged weakness, prolonged cough, consult a doctor.
In wet slushy weather, during epidemics, to increase immunity, you need to take decoctions and tinctures of herbs that strengthen the body's defenses. For example, such as:
- Tinctures of echinacea, eleutherococcus can be purchased at the pharmacy. Take after consultation with the doctor in accordance with the attached instructions.
- Rosehip decoction. This drink can be prepared using a thermos in the following way:

Rinse a thermos with boiling water.
Place in it 2 tablespoons of rose hips washed with running water.
Pour in a liter of freshly boiled water.
Insist 8 hours.
Then strain through 4 layers of gauze into a liter glass container.
Fill in the missing volume with boiled water.

The berries left in the thermos do not need to be thrown away. They can be poured a second time with boiling water and used according to the above scheme.

Snoring is always an unpleasant, annoying sound.

Peculiarity inflammatory diseases child.

The human lymphatic system is directly connected with.

Despite the rapid development of medicine, many

HIV infection is one of the most dangerous diseases.

The information on the site is provided for informational purposes only, does not claim to be reference and medical accuracy, and is not a guide to action. Do not self-medicate. Consult with your physician.

Inflamed lymph nodes - a sign of trouble in the body

Lymph nodes have a protective function - they protect the body from infectious agents and the spread of malignant tumors. If there is a purulent infection in the body, the lymph nodes first try to fight it, and then they themselves become inflamed.

Reactive changes in the lymph nodes during inflammation of organs and tissues

Most often, a picture of reactive inflammation develops in the lymph nodes in response to infectious and inflammatory processes in nearby or distant organs. At the same time, an increase in lymph nodes can be expressed to varying degrees, mainly due to edema and hyperplasia. Hyperplasia - do not be afraid (growth) of the tissue. The process of enlargement of the lymph node is associated with an immune response to the inflammatory process in other organs. Lymph nodes are enlarged, painful and not soldered to the surrounding tissues.

Reactive changes in the lymph nodes lead either to the suppression of the infection that caused the inflammatory process, or to the involvement of the lymph node itself in this process.

Inflammatory changes in the lymph nodes

Lymph nodes can become inflamed when they get an infection with a current of lymph or blood and the immune system cannot suppress it. Inflammation of the lymph node is called lymphadenitis. This disease in the vast majority of cases is secondary, that is, it developed against the background of some other inflammatory process - tonsillitis, thrombophlebitis, furuncle, abscess, phlegmon, and so on. Primary lymphadenitis can only occur as a result of an injury in which the infection enters directly into the lymph node.

Depending on the nature and localization of the main inflammatory process, the lymph nodes can be enlarged slightly or very strongly, have a different consistency and appearance. In addition, inflammatory processes in the lymph nodes can occur acutely and chronically. Depending on the nature of the inflammation, serous, hemorrhagic, fibrinous and purulent lymphadenitis are distinguished.

The causative agents of the infection can be pyogenic bacteria (mainly staphylococci), in which case the inflammatory process is called nonspecific, since it proceeds the same way with different pathogens. There are also specific inflammatory processes in the lymph nodes, which have their own characteristics characteristic of a single disease (tuberculosis, actinomycosis, syphilis, and so on).

What do inflamed lymph nodes look like with nonspecific lymphadenitis

In acute nonspecific lymphadenitis, the involvement of the lymph nodes in the process is indicated by their increase in size and reddening of the skin over them. Initially, the inflammation is catarrhal (serous) in nature, without suppuration. The general condition of the patient does not suffer, the lymph nodes are moderately painful and are not soldered to the surrounding tissues.

If the process is not stopped at this stage, then it can take on a purulent character. At the same time, not only the lymph nodes themselves become inflamed and swell, but also the tissues surrounding them, the lymph nodes are soldered with them into a single conglomerate. At the same time, the temperature rises sharply, chills, headache and other signs of general intoxication appear.

Phlegmonous lymphadenitis is especially difficult when pus is not limited to the capsule and can spread through the lymphatic and blood vessels, causing a general infection of the body - sepsis.

Treatment of inflamed lymph nodes depends on the stage of the process. Initial stages(before the formation of an abscess) are treated conservatively with antibiotics and physiotherapy. If suppuration has begun, only surgical treatment will help - opening the abscess.

Chronic inflammation of the lymph nodes Inflammation of the lymph nodes - when an infection occurs against the background of untreated acute lymphadenitis or develops gradually in the presence of a constant focus of infection in the body. Often such foci are diseases of the teeth and ENT organs - caries, chronic tonsillitis, sinusitis, and so on. In this case, in the lymph node, under the influence of the inflammatory process, the lymphoid tissue grows, and it increases in size. Such lymph nodes are extremely rare. Outwardly, they look enlarged, moderately painful (or not painful at all), not soldered to the surrounding tissues. Gradually, the lymphoid tissue in the lymph nodes is replaced by connective tissue and their function decreases. This can lead to impaired lymph circulation and edema.

What do inflamed lymph nodes look like with specific lymphadenitis

With specific lymphadenitis, the state of the lymph nodes depends on the underlying disease. For example, with tuberculous lymphadenitis, intrathoracic lymph nodes are most often affected. Lymph nodes - what our immunity rests on (tuberculous bronchodenitis). These are the initial manifestations common disease organisms that can only be seen on x-rays. Tuberculous bronchodenitis is treated according to all the rules for the treatment of tuberculosis Treatment of tuberculosis is a long process and requires constant monitoring.

Inflamed lymph nodes can tell a specialist a lot.

Non-neoplastic lymphadenopathy. 14.00.29 hematology and blood transfusion

As part of our joint work with the laboratory of ecology of rickettsiae of the State Institution NIIEM. N.F. Gamaleya of the Russian Academy of Medical Sciences, we have introduced serological and molecular diagnostics of Bartonellosis infection into the practice of the State Research Center of the Russian Academy of Medical Sciences. The introduction into practice of methods for diagnosing bartonellosis also contributed to an increase in the frequency of detection of specific infections.

Together, these factors led to a decrease in the proportion of patients in whom nosological diagnosis could not be established. Until 2005, the diagnosis was not established in 55 patients out of 280 (19.6%), after 2005 in 12 patients out of 102 (11.7%).

In the first case, reactive changes precede the diagnosis of the tumor, in the second case, they are detected in patients with a previously proven tumor, when a biopsy is performed for a suspected recurrence, as part of tumor staging, or for other reasons.

In our study, there were 40 (8%) patients in whom reactive changes in the lymph nodes preceded the detection of lymphatic tumors. 19 patients had lymphogranulomatosis, 21 had lymphoma. An analysis of the nature of changes in the lymph nodes that preceded the diagnosis of lymphogranulomatosis and lymphomas made it possible to identify a number of patterns.

Analysis of changes in lymph nodes not affected by the tumor revealed the following histological features: 1) sinus histiocytosis, 2) paracortical reaction with an abundance of plasma cells and macrophages, 3) sclerotic changes/vascular reaction, 4) necrosis.

Sinus histiocytosis of varying severity was observed in 7 of 19 patients (37%) (table 11). 5 patients were subsequently diagnosed with nodular sclerosis, 1 - classic lymphogranulomatosis, lymphoid predominance, 1 - the variant was not defined. In two patients, sinus histiocytosis was so severe that Rosai-Dorfmann disease was initially suspected. Immunohistochemical examination in these two cases revealed positive staining of histiocytes for CD1a and S100. Thus, the possibility of a combination of two diseases is excluded. was a reactive phenomenon accompanying the tumor.

Paracortical hyperplasia was observed in 7 patients (40%), and in 3 patients it was combined with sinus histiocytosis. It was expressed in a significant infiltration of interfollicular zones by plasma cells, macrophages, eosinophils. Nodular sclerosis was diagnosed in 5 patients, mixed cell variant of lymphogranulomatosis was diagnosed in one.

In 4 patients, histological changes in the first biopsy were characterized by a pronounced connective tissue reaction. In these cases, the tissue of the lymph nodes was deformed by growths of hyalinized fibrous tissue of varying severity. All of these patients were diagnosed with nodular sclerosis.

One patient had widespread necrosis.

Table 11. Reactive changes before the diagnosis of Hodgkin's disease

Before lymphogranulomatosis: localization, and dominant histological sign

Interval between biopsies

Localization and variant of Hodgkin's disease

Picture of Rosai-Dorfman disease.

Marginal lymph node adjacent to the conglomerate in the cervical region

Severe sinus histiocytosis

Lymph node from a conglomerate in the same area

Nodular sclerosis, type 2

Severe sinus histiocytosis

Variant not defined

Axillary lymph node on the left.

Paracortical hyperplasia, sinus histiocytosis.

Axillary lymph node on the left

2 weeks

Axillary lymph node on the right.

Paracortical reaction, sinus histiocytosis.

Cervical lymph node on the right. Sinus histiocytosis, Paracortical reaction.

Nodular sclerosis, type II

Lower cervical lymph node on the left

Focal paracortical reaction.

Supraclavicular node on the left

Nodular sclerosis, type II

Axillary lymph node Foci of fibrosis and lipomatosis. Not demonstrative.

Massive growths of connective tissue. Paracortical reaction, many eosinophils and plasma cells.

Conglomerate in the cervical-supraclavicular region. Biopsy of three lymph nodes.

Massive growths of fibrous hyalinized tissue.

Biopsy from the same conglomerate

Not demonstrative. Proliferation of venules in the paracortical zone, sclerosis of the capsule and walls of the arteries, fibrosis of the medulla.

Nodular sclerosis, type 2

Marginal lymph node from the cervical-supraclavicular conglomerate. paracortical hyperplasia.

From the same conglomerate

Nodular sclerosis, type I

Conglomerate of lymph nodes in the cervical region. paracortical hyperplasia. Foci of fibrosis.

From the same conglomerate.

Nodular sclerosis, type I.

Conglomerate in the supraclavicular region on the left. Not demonstrative. Connective and adipose tissue with areas of fibrosis.

From the same conglomerate

Nodular sclerosis, type II.

Axillary lymph node. Most of the node is necrotic. In the subcapsular regions, there are nodular growths of lymphogranulomatous tissue.

Supraclavicular lymph node from marginal conglomerate. Extensive necrosis in the lymph node

Axillary l / y. extensive necrosis

Cervical lymph node, variant not specified

There are 11 patients in this group, of which 5 patients with focal follicular lymphoma (with partial damage to the lymph node tissue) represent a special group, which we consider separately.

Changes in the lymph nodes before the diagnosis of B-cell lymphomas are presented in Table 12. Two patients were subsequently diagnosed with follicular lymphoma, 3 with large B-cell lymphoma, and 1 with mantle zone lymphoma. Three patients in this group had sinus histiocytosis. In two patients, it was so pronounced that it was necessary to carry out differential diagnosis with Rosai-Dorfman's disease. One 73-year-old female patient with follicular hyperplasia was subsequently diagnosed with mantle zone lymphoma. 1 patient had necrosis; the diagnosis was established by another lymph node taken from the same conglomerate. Thus, the most common change in the lymph nodes in patients with B-cell lymphomas was sinus histiocytosis.

Table 12. Reactive changes prior to diagnosis of B-cell lymphomas.

Before lymphoma: localization and most pronounced signs

Interval between biopsies

Localization and variant of lymphoma

Cervical lymph node on the left

Conglomerate in the supraclavicular region

Rosa Dorfman's disease

Peripheral LAP of the upper floor, abdominal LAP

Armpit enlargement. then inguinal lymph nodes

Florida follicular hyperplasia.

Generalized PA+ rash

Cervical lymph node on the right. Lymphoma of the mantle zone.

Node from the same conglomerate. B-large cell lymphoma

Focal follicular lymphoma.

Under our observation there were 5 patients with prolonged follicular hyperplasia, which gradually evolved into follicular lymphoma. In 1 patient, the picture of focal lesions of the lymph node with follicular lymphoma was clear during the initial histological examination. In 4 patients, follicular lymphoma was detected retrospectively using an immunohistochemical study that showed partial damage to the lymph node tissue.

The average age of patients - 46.6 years (range 31 - 63 years) is typical for follicular lymphoma. All patients at the time of the first biopsy had a local increase in lymph nodes, 3 in the inguinal and 2 in the axillary regions. The distribution by localization had no specificity. The interval between biopsies in 2 patients was 1 month, and in these cases, the presence of a tumor was already evident from the clinical data.

In three patients, the clinical picture was different. The interval between biopsies was 18 months (5–34). All had prolonged lymphadenopathy with a significant increase in lymph nodes. Despite this, the lymph nodes were only partially affected. All patients developed generalized follicular lymphoma several years later. None of the patients had bone marrow affected during the first examination. In diagnostics, research on bcl-2, detection of translocation t (14; 18), assessment of clonality are important.

Table 13. Patients with focal follicular lymphoma.

Interval between biopsies

Inguinal left 4 x 4 cm

Focal follicular lymphoma against the background of the preserved structure of the lymph node.

Inguinal left 4 x 3 cm

Follicular lymphoma Local irradiation at a dose of 40 Gray. Remission 9 years

Axillary node on the left 4x5 cm.

Florida follicular hyperplasia. Retrospectively by immunohistochemistry, follicular lymphoma in situ/

Intra-abdominal lymph node Follicular lymphoma

Inguinal 4 x 3 cm

Follicles with large and small reactive centers are arranged in several rows.

Inguinal knot from the same conglomerate 8 x 7 x 5 cm

Follicular lymphoma II gradation.

Axillary node on the right Severe follicular hyperplasia. Already at the first biopsy cytogenetic aberrations were revealed.

2 months (15 from the first biopsy)

Axillary lymph node No diagnosis of lymphoma

Lymph node from the same conglomerate

We have a follow-up of 10 patients in whom the diagnosis of T-cell lymphoma was established by repeated biopsy of lymph nodes or other organs, while the first biopsy did not allow a correct diagnosis (Table 14). Changes in the lymph nodes not affected by the tumor in this group are largely similar to the group of patients with lymphogranulomatosis. However, there were also characteristic features.

The average age of patients - 35.8 years, scatter. Of the 10 patients, 2 had anaplastic large T-cell lymphoma, 3 had Lennert's lymphoma, 2 patients had specific variants of T-cell lymphomas (angioimmunoblastic and hepatolienal), and 3 had peripheral unclassified T-cell lymphomas.

One patient was not taken into account in the analysis of associated tumor changes, since a biopsy of a lymph node taken from the cervical-supraclavicular region revealed granulomatous lymphadenitis and subsequently diagnosed with tuberculosis along with T-cell lymphoma. In 9 patients, out of recurring changes, sinus histiocytosis, paracortical reaction and the formation of epithelioid cell granulomas attracted attention.

Sinus histiocytosis was noted in 5 patients (50%). The reaction was observed mainly from the intermediate sinuses. In most patients, it was focal in nature. Sinus histiocytosis could be detected in distant nodes not adjacent to the tumor.

Paracortical hyperplasia was found in 3 patients with the following diagnoses: angioimmunoblastic lymphoma, large T-cell anaplastic lymphoma and Lennert's lymphoma. Polymorphocellular infiltration of the paracortical zone is typical of T-cell tumors. At the initial stages of the development of lymphoma, when tumor infiltration does not yet lead to the erasure of the pattern of the lymph node, it is extremely difficult to ascertain lymphoma. The interval between biopsies in 3 patients did not exceed 4 months. In all patients, the paracortical reaction was focal. The cellular composition could correspond to the tumor. It can be assumed that in these 3 cases there was an initial lesion of the lymph node with T-cell lymphoma.

A separate group consists of patients with Lennert's lymphoma (lymphoepithelioid-cell variant of peripheral T-cell lymphoma). In our sample, 3 patients with Lennert's lymphoma. Two of them had granulomatous lymphadenitis at the first biopsy (with positive results of determining T-cell clonality), 1 had predominantly paracortical hyperplasia and sinus histiocytosis. Subsequently, all were diagnosed with Lennert's lymphoma.

Table 14. Reactive changes before diagnosis of T-cell lymphomas.

Repeat biopsy, lymphoma variant

Supraclavicular and axillary

angiofollicular hyperplasia, paracortical reaction

Conglomerate in the supraclavicular region. Removed 4 nodes. In two the picture is unremarkable, in one there is necrosis. Only 1 in 4 has lymphoma

Simultaneously from the same conglomerate

ALK+ T-large cell lymphoma

Conglomerate in the cervical region

2 biopsies, the first one took 2 nodes. In one, granulomatous lymphadenitis, in the other, Lennert's lymphoma

From the same conglomerate

Peripheral T-cell lymphoma (Lennert's lymphoma)

Focal paracortical reaction (plasma cells, macrophages). vascular proliferation.

Node unknown

Follicles with a large number macrophages in separate centers. Focal sinus histiocytosis.

Splenectomy, liver biopsy

Hepatolienal T-cell lymphoma

Paracortical reaction (leukocytes, plasma cells). The structure is preserved. Moderately expressed sinus histiocytosis. Areas of sclerosis, karyorrhexis.

Axillary taken on suspicion of relapse 3 years after remission

The structure is preserved. moderate sinus histiocytosis

Peripheral T-cell lymphoma.

Peripheral T-cell lymphoma

Conglomerate in the cervical-supraclavicular region. Granulomatous lymphadenitis. Tuberculosis was later diagnosed

From the same conglomerate

Peripheral T-cell lymphoma.

 not included in the analysis of paraneoplastic changes.

Thus, the most universal features that can be observed in both Hodgkin's lymphoma and B- and T-cell lymphomas are sinus histiocytosis and necrosis. Some features are specific to certain types of lymphomas. The histological picture may be characterized by signs that are more or less characteristic of the underlying disease (sclerosis in lymphogranulomatosis, vascular proliferation in T-cell lymphomas), signs that reflect the reaction of the lymph node compartment to tumor dissemination (sinus histiocytosis), signs of an immune response to the tumor (paracortical reaction ), signs of an initial focal lesion of the lymph node tissue.

The combination of these data allows us to propose the concept of "paraneoplastic lymphadenopathy". This definition has both theoretical and practical implications. Analysis of the nature of histological changes in enlarged, but not affected by the tumor, lymph nodes, allows you to better understand the process of metastasis. A clear understanding of the variants of paraneoplastic changes increases the diagnostic efficiency, in particular, it makes it possible to formulate indications for repeated biopsy. An important observation that justifies the allocation of this concept is the fact that in many patients with lymphogranulomatosis and lymphomas, lymph nodes not affected by the tumor can reach large sizes. We assume that these changes are due to the biological characteristics of the tumor clone in each case, since only this can explain the long history of lymphadenopathy and the significant size of the paraneoplastic lymph nodes.

Analysis reactive lymphadenitis in patients with previously diagnosed tumors.

In 23 cases (6%), reactive changes were detected in the lymph nodes removed due to the alleged recurrence of Hodgkin's disease. Of these, 8 patients (35%) were diagnosed with infection, including 1 case of tuberculosis. In 8 cases, the changes were predominantly atrophic in nature due to chemotherapy.

In 7 cases (30%), reactive changes in the lymph nodes were detected during biopsies performed as part of the staging of extranodal lymphomas. Two patients with cutaneous lymphomas had a paracortical reaction due to dermatopathic changes. In the remaining 5 patients, the picture was unremarkable.

Reactive lymphadenitis against the background of an existing tumor was detected in 16 cases. The reasons for performing a biopsy were suspicion of tumor transformation, search for infection, and clarification of the diagnosis.

The role of auxiliary methods for diagnosing lymphadenopathy.

Examination of patients with lymphadenopathy suggests differential diagnosis with tumors, as well as the exclusion of many infections. The study of B- and T-cell clonality in diagnostically difficult histological variants - follicular and paracortical hyperplasia has not been previously performed. In this work, we investigated the diagnostic significance of determining the rearrangements of antigen receptor genes using PCR to assess clonality.

The diagnosis of most infections that cause lymphadenopathy is well established. However, serological and/or molecular diagnostics of bartonellosis is practically not used in our country. At the same time, in our work, CCC accounts for 4% of the etiological structure of lymphadenopathy and often presents a diagnostic problem. Of great difficulty is the interpretation of the results of serological studies of EBV infection in patients with prolonged lymphadenopathy. Role Epstein-Barr virus in the pathogenesis of prolonged perennial lymphadenopathies is not clear. In this work, we studied the results of serological studies in patients with prolonged lymphadenopathy.

Hyperplasia of the lymph nodes

Hyperplasia of the lymph nodes is serious problems clinical medicine.

In fact, hyperplasia (Greek - over education) is a pathological process associated with an increase in the intensity of reproduction (proliferation) of tissue cells of any kind and localization. This process can start anywhere and results in an increase in tissue volume. And, in fact, such hypertrophied cell division leads to the formation of tumors.

However, it should be noted that lymph node hyperplasia is not a disease, but clinical symptom. And many experts attribute it to lymphadenopathy - an increased formation of lymphoid tissue, which causes their increase. And the lymph nodes are known to enlarge in response to any infection and inflammation.

ICD-10 code

Causes of lymph node hyperplasia

When characterizing the causes of lymph node hyperplasia, it is necessary to clarify that lymphoid or lymphatic tissue (consisting of reticuloendothelial cells, T-lymphocytes, B-lymphocytes, lymphatic follicles, macrophages, dendrites, lymphoblasts, mast cells, etc.) is located not only in the parenchyma of the organs of the lymphatic system : regional lymph nodes, spleen, thymus, pharyngeal tonsils. This tissue is also present in the bone marrow, in the mucous membranes of the respiratory, gastrointestinal and urinary tracts. And if there is a focus in any organ chronic inflammation clusters of cells of lymphoid tissue appear there too - to protect the body from an attacking infection.

But we are interested in the regional lymph nodes, which provide the production of lymphocytes and antibodies, lymph filtration and regulation of its currents from the organs. Today, the causes of lymph node hyperplasia are considered as the reasons for their increase, which is an immune response to any pathological process that changes both the dynamics of tissue metabolism of the lymph node and the ratio of certain cells. For example, when a lymph node reacts to genetically distinct cells (antigens), the production of lymphocytes and mononuclear phagocytes (macrophages) increases; when bacteria and microbes enter the lymph nodes, their metabolic products and neutralized toxins accumulate. And in the case of oncology, hyperplasia of the lymph nodes can involve any of their cells in the pathological process of proliferation. This causes an increase in size, a change in the shape and structure of the fibrous capsule of the lymph node. Moreover, the tissues of the lymph nodes can grow outside the capsule, and in the case of metastases from other organs, they can be displaced by their malignant cells.

Based on this, lymph node hyperplasia can be of infectious, reactive or malignant origin.

Hyperplasia of lymph nodes of infectious etiology

Hyperplasia of the lymph nodes (in the sense of an increase in their size) is a response to infection in diseases such as strepto- or staphylococcal lymphadenitis, rubella, chicken pox, infectious hepatitis, felinosis (cat scratch disease); tuberculosis, HIV, infectious mononucleosis, cytomegaly, tularemia, brucellosis, chlamydia, syphilis, actinomycosis, leptospirosis, toxoplasmosis.

With nonspecific lymphadenitis - depending on the location - there is hyperplasia of the lymph nodes in the neck, mandible or axillary lymph nodes. An increase in axillary lymph nodes was noted with mastitis, inflammation of the joints and muscle tissues. upper limbs, brucellosis, felinose, etc.

For inflammatory processes in the oral cavity and nasopharynx (with actinomycosis, caries, chronic tonsillitis, pharyngitis, bronchitis, etc.), hyperplasia of the submandibular lymph nodes, behind the ear, preglottis and pharynx is characteristic. And with infectious mononucleosis, only the cervical lymph nodes increase.

In the case of rubella, toxoplasmosis, tuberculosis, as well as syphilis, doctors ascertain hyperplasia of the cervical lymph nodes. In addition, in the symptoms of tuberculosis, hyperplasia of the intrathoracic and mediastinal lymph nodes is noted. At the same time, in the lymph nodes, there is a gradual displacement of healthy cells of the lymphoid tissue by necrotic masses of a caseous nature.

Characteristic of tuberculosis and hyperplasia of the mesenteric lymph nodes. In addition, a significant increase in the lymph nodes of the mesenteric part of the small intestine occurs due to the defeat of the gram-negative bacterium Francisella tularensis, which causes tularemia, an acute infectious disease transmitted by rodents and arthropods.

Hyperplasia of the inguinal lymph nodes is noted by doctors with infectious mononucleosis, and toxoplasmosis, brucellosis and actinomycosis, as well as with all infections of the genital area and HIV.

Symptoms of lymph node hyperplasia

Hyperplasia of the lymph nodes, as mentioned above, is a symptom of a wide range of diseases. The most important task is to identify the symptoms of lymph node hyperplasia, confirming or refuting the malignant pathogenesis of increased cell division.

If the lymph node increases rapidly (up to 2 cm and a little more), if there are pain, and the consistency of the node is quite soft and elastic, that is, there is every reason to assert that this lymph node hyperplasia arose as a result of an infectious lesion or an inflammatory process. This is confirmed by reddening of the skin in the area of the lymph node.

When the lymph node enlarges slowly, there is no pain on palpation, and the node itself is very dense - it is likely that the process is malignant. And with metastases, an enlarged lymph node literally grows into the tissues surrounding it and can form “colonies”.

Localization of the hypertrophied lymph node is also important. Hyperplasia of the submandibular, cervical and axillary lymph nodes speaks in favor of its good quality. What can not be said about hyperplasia of the supraclavicular, lymph nodes of the mediastinum, retroperitoneal and lymph nodes in the abdominal cavity.

Where does it hurt?

What worries?

Reactive lymph node hyperplasia

Reactive hyperplasia of the lymph nodes occurs as a response of the immune system to pathologies of the same immune nature. These pathologies include:

autoimmune collagenoses (rheumatoid arthritis and polyarthritis, periarteritis nodosa, systemic lupus erythematosus, scleroderma, Hamman-Rich syndrome, Wegener's granulomatosis); - Wagner's disease or dermatomyositis (systemic disease of skeletal and smooth muscles and skin)
storage diseases (eosinophilic granuloma, Gaucher disease, Niemann-Pick disease, Letherer-Zive disease, Hand-Schüller-Christian disease).

In addition, the reactive form may be accompanied by serum sickness (allergies to the use of immune serum preparations of animal origin), hemolytic anemia(hereditary or acquired), megaloblastic anemia or Addison-Birmer disease (which occurs when there is a deficiency of vitamins B9 and B12), and chemotherapy and radiation therapy for cancer.

Among autoimmune diseases of the endocrine system, lymph node hyperplasia is characteristic of hyperthyroidism (Graves' disease), the cause of which lies in the increased production of thyroid hormones by the thyroid gland. With this pathology, hyperplasia of the lymph nodes is generalized with increased mitosis of the lymph follicles.

Experts emphasize that reactive lymph node hyperplasia is characterized by significant proliferative activity and, as a rule, affects the lymph nodes in the neck and lower jaw.

From the point of view of cytomorphology, the reactive form has three types, the most common of which is the follicular form.

Follicular hyperplasia of the lymph nodes

Histological studies have shown that a feature of follicular hyperplasia of the lymph nodes is the size and number of secondary follicles that form antibodies, as well as the expansion of their reproduction centers (the so-called light centers), which are significantly higher than the norm of lymphoproliferation. These processes occur in the cortex of the lymph nodes. At the same time, secondary follicles behave quite aggressively, displacing other cells, including lymphocytes.

Follicular hyperplasia of the lymph nodes in the neck is diagnosed as a characteristic symptom of angiofollicular lymphoid hyperplasia or Castleman's disease. With a localized form of this disease, only one lymph node is enlarged, but this is manifested by periodic pain in the chest or in the abdomen, weakness, weight loss, and fever attacks. Researchers attribute the cause of Castleman's disease to the presence of the herpes virus HHV-8 in the body.

Malignant hyperplasia of the lymph nodes

Hyperplasia of the lymph nodes of malignant etiology can affect regional nodes throughout the body. The primary ones are lymphomas.

Prolonged enlargement of the supraclavicular lymph nodes may indicate an oncological disease of the esophagus, stomach, duodenum, intestines, kidneys, ovaries, testicles.

Hyperplasia of the cervical lymph nodes is observed with tumors of the maxillofacial localization, with melanoma in the head and neck. In patients with tumors of the lungs or mammary glands, oncopathology will necessarily manifest itself as hyperplasia of the axillary lymph nodes. In addition, it happens with blood cancer.

Hyperplasia of the cervical and lymph nodes of the mediastinum are characteristic of sarcoidosis (with the formation of epithelioid cell granulomas and their subsequent fibrosis).

With leukemia, with malignant neoplasms in the pelvic organs, metastases of cancer of the prostate, uterus, ovaries, rectum, both hyperplasia of the lymph nodes in the abdominal cavity and inguinal lymph nodes are usually noted.

With Hodgkin's lymphoma, as a rule, there is a persistent increase in the cervical and supraclavicular nodes, as well as hyperplasia of the retroperitoneal and lymph nodes of the abdominal cavity. The significant size of the latter cause violations of the functions of the intestines and pelvic organs. In the case of non-Hodgkin's lymphoma against the background of anemia, neutrophilic leukocytosis and lymphopenia, hyperplasia of the cervical and intrathoracic lymph nodes (near the diaphragm), as well as nodes in the elbow and popliteal folds, is found.

Diagnosis of hyperplasia of the lymph nodes

Diagnosis of lymph node hyperplasia should take into account and correctly evaluate all the factors that led to the occurrence of this syndrome. Therefore, a comprehensive examination is necessary, which includes:

general blood analysis,
biochemical blood test (including for toxoplasmosis and antibodies),
blood immunogram,
tumor marker analysis,
general urine analysis,
a swab from the throat for the presence of pathogenic flora,
serological tests for syphilis and HIV,
Pirquet and Mantoux test for tuberculosis,
Kveim test for sarcoidosis
x-ray (or fluorography) of the chest,
ultrasound examination (ultrasound) of the lymph nodes,
lymphoscintigraphy;
biopsy (puncture) of the lymph node and histological examination of the biopsy.

In half of the cases, an accurate diagnosis is possible only with the help of a histological examination after taking a sample of the tissues of the lymph node.

What needs to be examined?

How to investigate?

Who to contact?

Treatment of lymph node hyperplasia

Treatment of lymph node hyperplasia depends on the cause of its occurrence, and therefore there is no single therapeutic regimen and cannot be. But, according to doctors, in any case, complex therapy is necessary.

If the enlargement of the lymph node is caused by an inflammatory process, but it is necessary to fight the infection that led to the inflammation. For example, in the treatment of acute lymphadenitis in the early stages of the disease, compresses are used, but with purulent inflammation they are strictly prohibited. Doctors prescribe antibiotics to such patients, taking into account the resistance of specific pathogenic microorganisms to them. Thus, most staphylococci are resistant to drugs of the penicillin group, neutralizing the effect of the drug with the help of the beta-lactamase enzyme. It is also recommended to take vitamins and take a course of UHF therapy.

In treatment related to tuberculosis or other specific infection, treatment is prescribed according to the schemes developed for each specific disease.

In the case of a diagnosed autoimmune disease, which caused the occurrence of hyperplasia of the lymph nodes, or the malignant nature of the reproduction of cells of the lymph node, no compresses and antibiotics will help. Keep in mind that in the case of lymph nodes and pathological proliferation of their tissues, self-treatment is absolutely unacceptable!

Prevention of hyperplasia of the lymph nodes - timely examination and treatment, and in case of incurable pathologies - the implementation of all the recommendations of experienced and knowledgeable doctors. Then it is possible not to bring the disease to extremes, when hypertrophied tissues turn into a malignant neoplasm.

Prognosis of lymph node hyperplasia

Any prognosis of lymph node hyperplasia - with such a diverse "range" of its pathogenesis - rests on the root cause. With nonspecific infection, the prognosis is the most positive. However, there are some nuances here: any “elementary” and enlargement and inflammation of the lymph nodes - in the absence of proper diagnosis and adequate treatment - has every chance of leading either to sepsis or to an appointment with an oncologist with lymphoma ...

Medical Expert Editor

Portnov Alexey Alexandrovich

Education: Kyiv National Medical University. A.A. Bogomolets, specialty - "Medicine"

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Reactive changes in the lymph nodes

Literature review from the dissertation for the degree of candidate of medical sciences.

The work was performed at the Federal State Institution Russian Scientific Center for Roentgen Radiology of Roszdrav (Director - Academician of the Russian Academy of Medical Sciences, Professor V.P. Kharchenko).

The dissertation defense took place on 27.06.05. at a meeting of the Dissertation Council D.208.081.01 at the Federal State University of the Russian scientific center radiology department of Roszdrav (Moscow, Profsoyuznaya st. 86).

Summary to the literature review.

Based on the analysis of domestic and foreign literature (179 sources in total), the effectiveness of ultrasound diagnostics in determining the cause of enlarged lymph nodes is shown. A range of issues that have not been sufficiently reflected in previous studies have been identified and a preliminary plan for studying additional opportunities has been drawn up ultrasound in the diagnosis of the nature of lymphadenopathies.

1. Relevance of the problem.

3. Age features of the LU.

1. Relevance of the problem.

The problem of differential diagnosis of the nature of enlarged lymph nodes (lymphadenopathy - LAP), including in children, is very relevant. This is due to the variety of nosologies associated with PAP, as well as the complexity of the differential diagnosis of its causes. LN biopsy has been and remains the final stage in the differential diagnosis of malignant and benign LAP, but the indications for its timely performance have not been determined and are established either empirically or with a detailed clinical picture of the disease.

However, significant advances have been made in imaging techniques over the past decade. Among them, echography is undoubtedly the leading one. Increasing the resolution of echography in B-mode allows you to visualize structures that were previously inaccessible to the study. Although echography cannot make a histological diagnosis, further diagnostic and therapeutic procedures can be planned based on a number of echographic criteria that reflect the structure of the LN. However, to date, B-mode sonography does not give unambiguous signs of malignancy. Modern high-frequency ultrasonic transducers make it possible to bring the echoanatomy of superficial lymph nodes closer to their morphostructure. Theoretically, this should increase the resolution of the method and more clearly formulate the indications for invasive diagnostic methods.

Based on the foregoing, it seemed relevant to us to conduct a study on the development of lymph node echosemiotics in the context of the use of new ultrasound technologies for the differential diagnosis of PAP.

The functions performed by the lymphatic system are varied.

Lymphatic capillaries collect interstitial fluid along with normal and pathological cells, microorganisms and antigens, electrolytes and colloids located there for filtering into the lymph nodes. The lymph enters the venous bed through the thoracic lymphatic duct and supraclavicular vein. Thus, the drainage function of the lymphatic system is carried out, and taking into account the return of the interstitial fluid to the bloodstream, the implementation of the function of restoring homeostasis is carried out.

LNs themselves perform vital functions such as the production of lymphocytes, as well as lymph filtration and body defense. Working as a filter, LNs neutralize microorganisms that are formed during inflammation, decay products, protecting the body from the spread of infection. They can be a barrier to the spread of malignant tumor cells, as well as serve as a site for the development of a primary tumor of the hematopoietic system. Thus, an increase in the size of the LN may be a consequence of 1) an increase in the production of normal lymphocytes, macrophages in response to the introduction of foreign elements into the node; 2) proliferation of malignant tumor cells; 3) fatty infiltration in diseases of lipid metabolism; 4) replacement with connective tissue after chronic inflammatory diseases and involution. That is why the reaction of LU to wide range infectious, autoimmune and neoplastic processes (Table 1.1).

Before the age of 30, up to 80% of lymphadenopathies are benign, while after 50 years, only 40% of them are benign.

Table 1.1. Some of the reasons causing swollen lymph nodes.

a Viral infections.

b - Bacterial infections.

c - Fungal infections.

2. Malignant tumors

b – Metastases of solid tumors.

3. Autoimmune diseases

4. Lipid metabolism disorders (Gaucher disease, Neumann-Pick disease).

5. Diseases of unspecified etiology.

6. Constitutional hyperplasia (thymic-lymphatic status).

In children, the immune system, of which LNs are a part, is especially vulnerable and sensitive to adverse environmental factors, since it is in the stage of structural and functional maturation and has a large functional load. In this regard, in children in childhood it is often difficult to answer the question of whether this LN hyperplasia is a manifestation of a pathological process, or is it a constitutionally determined condition (IV Davydovsky).

The maximum size of the LN normally ranges from barely visible to 2-2.5 cm. They depend on a number of factors, one of which is age. In children and adolescents, hyperplasia of LN groups is often observed in areas most susceptible to antigenic influences (cervical-supraclavicular, inguinal). In adults, there is a gradual involution of lymphoid tissue and a decrease in the size of the LN. The size of normal LNs is also affected by the features of the constitution and the state of the function of the hormonal system.

However, in the human body there are several specific LNs, the dimensions of which exceed 10 mm, including the jugulo-digastral LN (another name is Kütner's LN), located in upper third neck (its dimensions often reach 30 mm in diameter).

Most children have small palpable lymph nodes of the cervical, axillary and inguinal groups, but the detection of posterior parotid, supra-/subclavian groups is regarded as pathological.

2. Anatomy of the lymph node.

Each LU is covered on the outside with a connective tissue capsule, from which thin branches extend inside the organ - capsular trabeculae. In the place where the efferent lymphatic vessels leave the LU, the node has a slight depression - the gate (hilum). In the region of the gate (hilus), the capsule thickens rather strongly, forming a portal thickening, protruding into the node. Connective tissue portal trabeculae extend from the portal thickening into the parenchyma of the LN. The longest of them connect with capsular trabeculae.

In LU, to which lymph flows from the extremities (inguinal, axillary), one gate is more common, in visceral - up to 3-4 gates. Through the gate, arteries, nerves enter the LU, veins and efferent lymphatic vessels exit.

Inside the LN, between the trabeculae, is the reticular stroma. It is represented by reticular fibers and reticular cells that form a three-dimensional network with loops of various sizes and shapes. The cellular elements of the lymphoid tissue are located in the stroma loops.

The LU parenchyma is subdivided into cortical and medulla. The cortical substance occupies the peripheral parts of the node and contains lymphoid nodules. Inward from the nodules, directly at the border with the medulla, a strip of lymphoid tissue stands out - a thymus-dependent zone containing mainly T-lymphocytes. In this zone there are post-capillary venules lined with cubic endothelium, through the walls of which lymphocytes migrate into the bloodstream.

The parenchyma of the medulla is represented by strands of lymphoid tissue. They are connected to each other with the formation of complex weaves. The parenchyma of the lymph nodes is permeated with a dense network of channels - lymphatic sinuses, through which lymph flows through the lymph nodes. Under the capsule there is a subcapsular (marginal) sinus, extending with its ends directly to the gate (hilus) of the node. From it, intermediate (at the beginning cortical, and then cerebral) sinuses depart into the parenchyma of the LU, which in the region of the gate of the organ pass into the portal sinus. The subcapsular sinus also opens into this sinus. In the lumen of the sinuses there is a fine-loop network that acts as a filter.

Lymph enters the LU through the afferent lymphatic vessels, vasa afferentia. These vessels in the amount of 2-4 approach the convex side of the node, pierce the capsule and flow into the subcapsular (marginal) sinus. Then, through this sinus and through the intermediate ones, which are located in the parenchyma of the node and communicate with each other, the lymph enters the portal sinus. From the portal sinus, 1-2 efferent lymphatic vessels, vasa efferentia, leave the LN. Through the efferent lymphatic vessels, lymph from one node is directed to the following LUs lying in the path of its current or collector vessels - lymphatic trunks and ducts.

Each LU includes from 1-2 to 10 small branches from the nearest arteries, subsequently the arterioles are divided into capillaries, the venules formed from the capillaries merge into veins heading to the gates of the LU and leaving the node together with the efferent lymphatic vessels. .

LNs are almost always located in adipose tissue in the form of separate accumulations and groups. They are interconnected by many anastomoses. There are serial, parallel, collateral and combined types LU connections.

The shape of the LU is also variable. Small LNs are round and oval, medium-sized LNs are round and bean-shaped, large LNs can be oval, segmental, and even ribbon-shaped. The shape of the LU is largely determined by its localization and environment. The LU has a round shape if there is no pressure from the surrounding tissue on it. For example, on the neck, the lymph nodes are normally oval. In the axillary zones, normal lymph nodes can be round.

3. Age features of the LU.

In newborns, the LN capsule is still very delicate and thin, so it is difficult to feel them under the skin. By the age of one year, the LN can already be felt in almost all healthy children.

Most children aged 3-6 years have some hyperplasia of the peripheral lymphoid apparatus. Maslov M.S. pointed out that “lymphaticism” is inherent, basically, to the entire child population, and that to one degree or another, all children under 7 years old are lymphatics. Vorontsov I.M. believes that in children early age there may be various types of lymphaticism arising from overfeeding or due to repeated viral infections. However, in all situations, true lymphatic diathesis must be differentiated from acceleration, alimentary and immunodeficiency lymphatism. The prevalence of lymphatic diathesis in children preschool age is 3-6%, and according to other sources it reaches 13%.

It is believed that normally in healthy children no more than three groups of lymph nodes are usually probed. Submental, supraclavicular, subclavian, thoracic, ulnar, popliteal lymph nodes should not be palpable. However, to date, the criteria for the norm and pathology of the lymph nodes in childhood have not been finally developed and the comparison of the size of the lymph nodes with grain, peas, cherries, beans, forest or walnut irrational, gives incomparable results. According to the literature, in most children, cervical lymphadenopathy has an infectious and inflammatory nature (92.5%), in 4.5% of cases - tumor, in 2.7% - infectious-allergic. Moreover, the most common causative agent of nonspecific lymphadenitis in children is Staphylococcus aureus.

Age-related changes of the involutive plan (decrease in the amount of lymphoid tissue, proliferation of adipose tissue) in the LN are observed already in adolescence. Connective tissue grows in the stroma and parenchyma of the nodes, groups of fat cells appear. At the same time, the number of LUs in regional groups decreases. Many small lymph nodes are completely replaced by connective tissue and cease to exist as organs of the immune system. Nearby LNs fuse with each other and form larger nodes of a segmental or ribbon-like shape.

In any case, the presence of palpable LNs in a child, the size of which exceeds age norms, is an indication for clarifying their nature. At the present stage, for this purpose, it is possible to use technical means, primarily echography.

4. The use of echography for the study of lymph nodes, historical background.

In 1975, Willey pioneered the use of 5.0 MHz ultrasonic transducers to assess cervical lymph nodes. Until the mid-1990s, it was indicated in the literature that the structure of normal LNs was not distinguishable by echography. Unaltered LNs often could not be differentiated from the surrounding fatty tissue, especially when they were less than 5 mm in size. The scarcity of the information received was due to the low capabilities of the equipment used at that time. The emergence of higher-frequency sensors 7.5-13 MHz, and the use of new technologies today make it possible not only to identify affected lymph nodes, but also in most cases to visualize normal ones.

5. Technology of ultrasound examination of peripheral lymph nodes.

Examination of the lymphatic collectors of the head and neck area is performed with the patient lying on his back with a roller placed under the shoulder girdle and simultaneous extension of the neck. Special preparation for the study is usually not carried out. When examining the right half of the neck, the patient turns his head to the left, and when examining the left half - to the right. In this position, the sternocleidomastoid muscle moves more medially, which allows better visualization of the vascular bundle. In those cases when the patient experiences significant discomfort in the position with the head thrown back, the study of the suprahyoid region and carotid triangles was also performed in the normal position of the patient's head, but without a headrest.

Before assessing the state of the lymphatic collector of the head and neck region, it is necessary to determine the main anatomical landmarks, namely the common carotid artery and internal jugular vein and their relationship with surrounding structures. Inspection begins with an assessment of the anterior neck while moving the sensor from the hyoid bone to the jugular notch in the transverse plane. Then the head is turned to one side and a transverse and longitudinal examination of the lateral sections of the neck is performed from the angle of the lower jaw to the supraclavicular region along the sternocleidomastoid muscle. Also, when examining the LU of the head and neck, the periparotid region is examined in the transverse and longitudinal plane.

In our study, we used the existing classification of the lymph nodes of the head and neck, according to which they are divided into following groups :

1) deep cervical LU;

2) lymph nodes of the posterior triangle;

3) supraclavicular LU;

4) chin LU;

5) submandibular LU;

6) periparotid LU.

Deep extravisceral and retropharyngeal lymph nodes of the neck cannot be detected by echography due to the inaccessibility of their location for this diagnostic method. Most LNs in the circumcervical region are drained by a chain of deep jugular LNs. Only from the occipital LU does the lymph flow directly into the accessory spinal lymphatic collector.

According to the classification of N. Rouvierre (1932), deep cervical lymph nodes are divided into anterior and lateral groups [cit. according to 11].

The anterior ones are located anterior to the inner jugular vein, mainly in the upper part of the neck between the digastric muscle and the hyoid bone.

Lateral internal jugular lymph nodes collect lymph both directly from organs and tissues and through a system of other lymph nodes. This lymphatic collector drains the nasal fossa, tonsils, tongue, hard palate, thyroid, ear, submandibular and sublingual salivary glands.

The supraclavicular region is examined using a linear probe 6-10 MHz. To assess the state of the LU in this regional zone, the ultrasound transducer is moved in the projection of the anterior supraclavicular triangle. In the search for LU, the areas of location of such vessels as common carotid arteries, brachiocephalic artery and vein are examined. An important role is played by the detection in the supraclavicular region of the lymph nodes located on the anterior fascia (superficial). Supraclavicular LNs are regarded as LNs of the second order for the upper quadrants of the breast. In the case when lymphatic vessels from the upper quadrants of the mammary glands flow into the supraclavicular LU, they are both first and second order lymph nodes.

When conducting an ultrasound examination of the axillary region, the patient is located on his back with his arm raised and at the same time laid aside. Linear and convex MHz sensors are used, taking into account the thickness of the subcutaneous tissue. The reference point in the search for LU, as in other regions, was the large vascular trunks: the axillary vein and the external thoracic artery.

To these lymph nodes, lymph flows from the outer quadrants of the mammary gland, the anterior and lateral sections of the chest wall and upper division anterior abdominal wall.

To assess the condition of the subclavian LU, a linear or convex probe 5.0-10 MHz (depending on the thickness of the soft tissues of the anterior chest wall and subcutaneous tissue) is installed along an oblique line connecting the clavicle and axillary region.

Inspection of the inguinal-femoral region is performed with a linear sensor 6-10 MHz (depending on the thickness of the subcutaneous tissue), with the sensor moving along the inguinal fold and with revision of the inguinal vascular bundle. It is also necessary to examine the area of the internal femoral triangle, as well as the LN located in the subcutaneous tissue of the suprapubic region.

6. Ultrasound anatomy of the lymph nodes.

Until the mid 90s. the point of view was generally accepted that the normal structure of the lymph nodes is not visualized by echography and that even large lipomatous lymph nodes cannot be distinguished from the surrounding fatty tissue. In recent years, publications have appeared in which the authors, using high-frequency sensors (10-13 MHz), describe the echostructure of normal LNs, as well as its changes both in vitro and in vivo at various pathological conditions.

Sonography today is the most accessible imaging method that allows assessing the condition of almost all regional lymph nodes, which significantly complements the clinical data on the extent of the tumor.

According to the results of Pamillo M . et al. , the correctness of the assessment of metastatic lesions of the axillary lymph nodes is 32% according to palpation and 73% with echography. X-ray computed tomography and magnetic resonance imaging (CT and MRI) are also used to assess the state of the lymph nodes, but ultrasound, in comparison with them, taking into account the developed echosemiotics of the lesions of the lymph nodes, with almost the same information content, compares favorably with simplicity, accessibility and cost-effectiveness. There are a few works in the literature, according to which ultrasound with power Doppler mapping (EC) gives better results than contrast-enhanced CT in differential diagnosis of the nature of small round cervical lymph nodes, and when using both methods, the diagnostic accuracy increased to 94%.

The fundamental works in describing the echosemiotics of the lymph nodes in the study in the B-mode were the work of researchers who studied the state of the lymph nodes in the neck.

An unchanged LN in the echographic image is, as a rule, an oval-shaped formation with a diameter along the long axis from 5 to 10 mm, with even, well-defined contours, a hypoechoic marginal part and a hyperechoic core. The size of the transverse diameter of the LN up to 10 mm is taken as the norm, although, according to a number of authors, the dimensions of normal LNs in different areas may be different. According to Goldberg V.V. cervical lymph nodes less than 5 mm in the greatest dimension are difficult to detect, and the largest transverse diameter of more than 8 mm should be considered pathological. According to van den Breckel, lymph nodes with a diameter of 7 mm or more identified in the neck area are suspicious for the presence of a pathological process. For the jugulo-digastral lymph node, this size can normally exceed 8 mm. According to some authors, the detection of many lymph nodes with a transverse diameter of more than 10 mm suggests the presence of lymphoma, which requires a morphological study. There is no clear information in the literature regarding the size of the LN in normal conditions and in lipomatosis.

According to Gortenuti G. , with echography in 67.6% of healthy people, one or two cervical lymph nodes are detected. Their configuration is oval, the contours are even, clear, echogenicity along the periphery is reduced, the central part (gate area) is somewhat increased echogenicity. There was no relationship between the detection of normal lymph nodes by ultrasound, age and gender of patients. According to Gortenuti G ., if the LN is visualized in the elderly, this most likely indicates an inflammatory or neoplastic nature of the lesion.

According to Bruneton et al. , the frequency of detection of superficial cervical and axillary lymph nodes with echographic signs of involutive (lipomatous) changes in adult patients increases with age. This point of view is also confirmed by pathoanatomical data, indicating that during normal age-related involution, as well as due to the processes of scarring, fibrosis and lipomatosis (after banal inflammation), there is a change in the size and structure of the lymph nodes. It is important to note that lipomatous changes are more common in axillary and inguinal LNs.

According to Gortenuti G. , up to 55% of lymph nodes visualized by echography and involved in the pathological process are non-palpable. This is consistent with literature data indicating that digital examination has low sensitivity and allows detection of LNs in only 32-33% of cases of PA.

In recent years, the technical equipment of ultrasound rooms has improved significantly, and under these conditions, it has become possible to increase the accuracy of differential diagnosis of benign and malignant lesions in the neck up to 96% by using ultrasound signs. According to Greetcman W. when detecting metastases in the lymph nodes of the neck, the indicators of sensitivity, specificity and accuracy of the palpation method are 69%, 87% and 80%, with echography these indicators reach 92%, 84%, and 89%, respectively. Sonographic examination of axillary lymph nodes does not allow achieving such high diagnostic rates. This is primarily due to the fact that the axillary lymph nodes differ in structure from the lymph nodes located in the neck.

In the ultrasound assessment of the benign or malignant nature of the changes in the LN, according to the literature, seven parameters must be taken into account:

Shape (round or oval);

Presence or absence of an image of the LU gate area;

Thickness (anterior-posterior dimension) of the gate area;

The thickness of the crust LU;

Echostructure of the LN cortex;

The nature of vascularization in color Doppler mapping (CDC);

The presence or absence of extracapsular spread of the pathological process.

Let's dwell on the meaning of individual parameters.

1. When analyzing the nature of the lesion of the LN, an important role is played by the assessment of the form. For this, the ratio of P / PZ (transverse and anterior-posterior diameters) (Solbiati index) is used. If the P / PZ index is less than 1.5, then the accuracy of echography in the differential diagnosis of unchanged or reactively altered lymph nodes with tumor lesions is relatively low - sensitivity 71%, specificity 65%. If the ratio P / PZ becomes equal to 2, then the sensitivity increases to 81-95%, and the specificity - to 67-96%.

2. The second parameter that should be taken into account is the presence of a hyperechoic central line-core or the image of the gate of the LN. Based on a comparison of ultrasound and pathological data, we can say that the gate area corresponds to a dense network of lymphatic sinuses. The lymphatic sinuses converge in the central part of the lymph nodes, and the space between them is occupied by connective tissue.

At normal dimensions, when the thickness of the core does not exceed the normal ratio with the total thickness of the LU, fatty infiltration does not play a significant role in the formation of a hyperechoic image of the gate. However, when comparing ultrasound images of the lymph nodes with a predominance of fat replacement in vitro, a thickening of the central hyperechoic line of the hilar region was noted. Back in 1985 Marchal G. suggested that the hyperechoic band is fat, and in 1990 Rabaltelli L. proved that hyperechoic signals in the core of the LN correspond to blood vessels and connective tissue, and fat has low echogenicity. In benign processes in the LN of the pelvic and inguinal regions, fat deposition is closely related to the width of the image of the LN gate area. The main reason leading to the thickening of the gate zone is an increase in the number of intermediate and terminal lymphatic sinuses and vessels as a result of their proliferation against the background of chronic inflammatory stimulation. If the LN cortex is preserved, the identification of a hyperechoic core by echography always characterizes a benign process. However, it must be remembered that B-mode and CFM show the hilum from different positions, and the absence of an image of the hilum in B-mode does not necessarily mean that there are no vessels in this area. .

Acute inflammation and malignant processes cause progressive thinning of the core, which leads to the complete disappearance of the image of the LN gate.

Up to 85-90% of lymph nodes with a wide elliptical core, repeating the general shape of the node, according to morphology, have benign changes. In malignant processes, a number of works describe either a significant thinning of the core, or the complete absence of its visualization in 67-92% of cases. On the contrary, according to the observation of Evans et al. , a hyperechoic core in malignant processes was detected in 58% of cases. The explanation for this phenomenon may be that most of the LNs studied by these authors were small in size. In the initial stages of a malignant lesion of the lymph nodes, there is not sufficient destruction of the convergent central lymphatic sinuses, which does not lead to erasure of the image of the gate of the lymph nodes. In some cases, against the background of massive fatty infiltration, the entire LN becomes completely hyperechoic. This pattern is observed in elderly and debilitated individuals with reduced immune status and also accompanies chemotherapy and radiation therapy. In this case, against the background of benign changes in the LU, it becomes impossible to identify the area of the gate.

In a small number of cases (4-6%), the gate area may not be detected in the structure of absolutely normal LNs. Identification of a false image of the gate (hyperechoic structure that mimics the image of the gate) of the LN was noted in 3-8% of cases. False hyperechoic image of the LN hilum may be due to metastasis of well-differentiated squamous cell carcinoma. The same changes may be the result of coagulative necrosis leading to fibrosis. Coagulative necrosis in the lymph nodes (in the form of an anechoic area) occurs as a manifestation of ischemic degeneration. Such ischemia can accompany both inflammatory and malignant processes in the lymph nodes. Necrotic foci can be traced in specifically affected LNs larger than 1 mm in size, but can also occur in smaller nodes. In the affected LN, when it is replaced by a tumor tissue, hypoxia processes begin with a tumor size of 3 mm.

The hyperechoic zone in the central part of the LN against the background of coagulation necrosis has a more rounded shape and is always accompanied by cystic inclusions up to the involvement of the entire volume of the node in this process. All this makes it possible to distinguish this pathology from the normal image of the LN gate.

3. The thickness of the cortical (cortical) layer of the lymph nodes was especially carefully studied by Vassallo R. The author analyzed the significance of the state of not only the area of the gate, but also the thickness of the cortical layer in various pathological conditions. It has been established that a thin cortical layer (T), the thickness of which does not exceed ½ of the transverse diameter of the hilum region (D), is most often observed in benign processes in the LN. In malignant processes, a narrow cortical layer is detected only in 9% of cases and only when there is an extensive lesion of the hilum region due to hyperechoic metastatic masses. This process is also known in the literature as a symptom of "cockade". Concentric expansion of the cortical layer or thickening of the hypoechoic rim of the LN is observed in 70% of patients with diffuse or total replacement of the cortical layer with malignant tissue. The same picture of a wide hypoechoic contour is observed in 30% of cases with benign hypertrophy of peripheral lymphoid follicles. As assessed by Vassallo R. et al. with significant cortical thickening in most patients, the increase in LN is of malignant origin. In contrast, the benign character is most often characterized by the image of a wide LN core and a relatively narrow cortical layer.

With the same disease, lymph nodes can have a different internal structure.

The degree of hypoechogenicity (up to an anechoic image) of lymphomas depends on the homogeneity of the arrangement of cellular elements;

The echogenicity of the affected lymph nodes increases during chemotherapy due to the processes of tumor cell death and their replacement with fibrous tissue;

Hyperechoic echostructure of the lymph nodes is observed with large metastases, when the zones of tumor infiltration alternate with normal areas of lymphoid tissue;

The anechoic image of the lymph nodes may be due to frequent areas of necrosis in metastases of keratinizing squamous cell carcinoma, or in papillary thyroid cancers;

Polymorphic heterogeneous echostructure can occur due to the alternation of hyperechoic areas (as a result of coagulative necrosis) and areas of cystic degeneration occurs in tuberculous lesions of the lymph nodes;

Pronounced calcification of the cortical layer occurs in granulomatous diseases, or after chemotherapy and radiation with metastases in the lymph nodes;

Microcalcifications inside the node are often detected by echography in papillary or medullary thyroid cancers;

Recently, pulsed wave Doppler and color Doppler mapping (CDM) have been used to assess the condition of superficial LNs.

Literature data on the values of Doppler indicators (pulse-wave Doppler and color doppler) in case of LN lesions of various nature are characterized by a variety of digital criteria and the lack of a unified concept of their application. So, according to Choi M. (1995), the pulsation index (IP) and resistance index (RI) are significantly higher in metastatic lesions (0.92 and 2.66, respectively) than in the inflammatory nature of the changes (0.59 and 0.9, respectively) of the LU. In later studies, these data have been confirmed. However, there was a significant overlap between the ranges of RI and PI values in benign and malignant processes in the lymph nodes. The sensitivity of pulsed wave Doppler is 53% with a specificity of 97%. According to other data, high levels of the RI resistance index are noted in reactive lymphadenopathy, while in malignant processes, low numbers of the RI resistance index are noted with a simultaneous high diastolic component. According to Trofimova E.Yu. (2000), tumor-affected lymph nodes are characterized by high values of the IP and RI indices - they were 0.73±0.1 and 1.49±0.44, respectively.

A number of authors adhere to the point of view that only indices of IR ³ 0.9 and IP ³ 1.8 are reliable criteria for malignancy. In the work of Hebrang, 2002, 100% specificity for lymph node metastasis was noted with RI > 0.8 and PI > 1.8; a positive predictive value of 100% for acute lymphadenitis is shown for RI<0,5 и PI <0,6; также показана статистическая значимость конечной диастолической скорости (КДС). При КДС >9cm/s shows 100% negative predictive value for metastases. If CDS was less than 1 cm/s, then 100% specificity and positive predictive value for metastases were observed. At the same time Tschammler A . (1995) believes that such high indexes when performing spectral assessments of blood flow in the lymph nodes can be explained by a very low diastolic component, which is not always determined by echography. But there are other opinions: some authors suggest using only low resistance indices as a criterion for a malignant lesion of the LU. Other experts testify to the absence of significant differences in RI values in benign and malignant lymphadenopathies. This opinion can be confirmed by the presence of vessels with low and high resistance in the same LN diseases. Low-resistance flow may be detected during acute inflammation as edema and vasodilation cause a real increase in blood flow in the capillary network. Low RI and PI reflect an increase in the number of small vessels in the capillary network. Active neoangiogenesis occurs against the background of the production of tumor angiogenesis factor, which is produced by cancer cells. With reactive proliferative changes in the lymph nodes, new vessels are also formed in them at the level of arterioles and venules, which makes differential diagnosis difficult. On the other hand, a decrease in the number of vessels, leading to an increase in peripheral resistance, may be due to compression of small arteries that occurs with an increase in acute inflammation, as well as due to the processes of fibrosis and vascular infiltration during chronic inflammation or against the background of tumor tissue growth. It is not surprising that in a number of publications, the authors recognize the uselessness of spectral analysis and evaluation of peripheral vascular resistance indices as a differential diagnostic criterion for LN lesion. In experimental studies in vivo and with the use of dummies, it was found that with the help of color flow it is possible to detect blood vessels with a diameter of 0.1 mm. This is the diameter of the arterioles. It has also been established that if the high-speed flow in a vessel does not provide a Doppler frequency shift of 37.5 MHz, the blood flow in this vessel cannot be visualized.

This is especially true for tissue blood flow in small peripheral vessels of the LN cortex. That is why the blood flow detected by color flow may not reflect the actual perfusion of the lymph nodes. In phantom studies, it has been confirmed that the maximum blood flow velocities are inversely proportional to the diameter of small vessels. It is this that is the main obstacle to the real estimation of velocities in small vessels using CFM.

Color Doppler allows you to identify venules and arterioles located in the LN tissue centripetally. Ohnesorge I. , Steinkamp H . noted the presence of a central vessel in acute lymphadenitis. A group of specialists led by Tschammler A. identified types of vascularization that are suspicious of a malignant tumor. One of them includes avascular zones. These zones in histological analysis were either areas of necrosis or poorly vascularized zones of tumor invasion of the lymph nodes. Another sign suspicious of malignancy is the presence of accessory peripheral vessels. These accessory vessels were histologically characterized by either areas of neovascularization or were vessels in the remaining (unaffected) subcapsular tissue of the lymph nodes. Turlington V. found that malignant lymphadenopathies are characterized by a chaotic distribution of blood flow inside the LN.

The variety of vascular changes at various stages of LN diseases has led many researchers to abandon the calculation of these indices. In the works of Riccabona M. (2000) it is noted that an accurate differentiation between inflammatory processes in comparison with an infiltrating malignant lesion is impossible even with the help of Doppler techniques, including power Doppler.

Tschammler A. (1995), analyzing the nature of the lesions of superficial LNs when comparing the echomorphological criteria obtained in the B-mode, the results of spectral analysis (pulse-wave Doppler) and the C (E) DC data on the intranodal blood flow of the LN, indicates the subjectivity of the classification of the vascular pattern and the possibility of some bias in assessing their diagnostic value, the lack of strict standardization of research and the different diagnostic capabilities of ultrasound equipment.

There is a clear contradiction: on the one hand, data on the high diagnostic significance of C(E)DC in assessing information about the vascularization of parenchymal organs, on the other hand, the inconsistency of the results obtained in a number of studies in relation to C(E)DC of LU.

According to Calliada F. et al. (1992) in normal or reactive LNs (even when using equipment capable of detecting low velocities), blood flow is limited to the area of the LN gate or not detected at all. In metastases without necrotic masses, with the use of CDI, a diffuse increase in vascularization is noted with a wide range of velocities and an atypical concentration of vessels in the cortical layer. The authors, in the process of searching for malignant changes in intranodal angioarchitectonics using CDI (focal perfusion defects, pathological aberrant course of central vessels, displacement of intranodal vessels, subcapsular vessels), noted the specificity of the method 77%, sensitivity 96% and reproducibility of results 90-96%. In low-grade non-Hodgkin's lymphoma, there is a root-like distribution of vessels with a main, central, and lateral daughter trunks. In highly differentiated non-Hodgkin's lymphomas, color doppler reveals chaotically located short and tortuous vessels, while in Hodgkin's lymphoma, the short vascular pole is formed by a small artery and vein. With inflammatory adenopathy, vascularization in the central sections of the lymph nodes can sometimes be detected.

Most of the publications highlighting the possibilities of using CDI for the differential diagnosis of LN lesions do not provide data on the parameters of the equipment. Only a few researchers provide an indication of the use of certain threshold values of B- and Doppler modes. Inadequate adjustment of the device reduces the probability of detecting intranodal blood flow signals and worsens the diagnostic quality of color flow. Flow mode , power (power) and threshold (threshold) are the most important parameters that should be adjusted accordingly. In this regard, it becomes clear why a number of researchers have come to the conclusion that due to the lack of standardization of equipment and parameters for duplex and triplex echography, these studies do not have significant clinical significance for the differential diagnosis of lymphadenopathy.

The introduction of color Doppler techniques has increased the amount of information obtained from LN sonography. However, even now it is clear that vascular changes in the LN occur even more unpredictably than even the morphological restructuring of the parenchyma and stroma.

At the same time, when assessing the conditions of the lymph nodes using power Doppler mapping (EC), great hopes are given by the ability of this technique to detect a greater number of vessels than color doppler. Therefore, it is very important that this method find its place in the evaluation of lymphadenopathy. This is especially true for capillary vessels with a low blood flow velocity. The EC method is easier to standardize and has greater accuracy. . The high diagnostic accuracy of this method is based on the characteristics of LN perfusion. However, EC does not yet allow differentiation of small (less than 8 mm) metastases without necrosis or micrometastases from reactive LNs. Tschammler A ., Beer M . (2002) carried out a comparative analysis of EC and CDC in the differential diagnosis of lymphadenopathy and concluded that EC reveals more intranodal blood flow signals than CDC, but the diagnostic value of this method is low due to an increased risk of false positive results. According to other data (2003), the combined use of both methods had a sensitivity of 98%, a specificity of 70%, a positive predictive value of 87%, a negative predictive value of 88%, an overall accuracy of 88% and led to the conclusion that echography or B-mode and C (E)DCs have the same overall accuracy in differentiating between benign and malignant lymphadenopathies.

Echographic equipment of various firms and classes is characterized by a wide range of diagnostic capabilities, so it is necessary to clarify the scope of these capabilities in LU diseases. In this regard, it is necessary to further study and evaluate the possibilities of new technologies for B-mode echography and Doppler techniques.

So, according to recent studies, the differential diagnostic efficiency of echography increases with the use of tissue harmonics, three-dimensional imaging and a contrast agent. The use of contrast with intensification of the Doppler signal even by 20 decibels makes it possible to increase the diagnostic significance of echography for solving the problem of differential diagnosis of benign and malignant lymphadenopathies. . However, the results of one of the latest studies (2003) on the use of an ultrasound contrast agent showed that, despite the detection of more vessels, the use of contrast does not increase the diagnostic value of CDI and EC with an increase in superficial LNs. Measurement of the volume of lymph nodes using a three-dimensional automatic program, according to some researchers, can provide additional information for the differential diagnosis of malignant and benign lymphadenopathy; since the volume of nodes affected by the tumor varies from 0.444 to 4.442 cubic meters. see, and in benign processes, the volume of the lymph nodes is from 0.143 to 1.176 cubic meters. cm. .

7. Inflammatory, reactive lymphadenitis.

The penetration of infection into the lymph nodes does not always cause their real inflammation - lymphadenitis, which is morphologically characterized by hyperemia, pronounced edema and inflammatory leukocyte infiltration of the lymph nodes. In a significant proportion of cases, there is a LN response in the form of hyperplasia, which is morphologically manifested by moderate hyperemia of the node and proliferation of mature cellular elements of the lymphoid series. It is this reaction that ensures the performance of the LU barrier function. Depending on the duration of the infection, as well as on the ratio of the virulence of the flora and the adequacy of the response of the immune system, inflammatory hyperplasia of the LN can be acute or chronic.

According to the generally accepted classification, LN inflammation can occur in the form of acute serous lymphadenitis, chronic lymphadenitis, and exacerbation of chronic lymphadenitis. However, many authors attribute chronic lymphadenitis to inflammatory hyperplasia of the lymph nodes, since it is morphologically characterized not so much by the phenomena of hyperemia, edema and inflammatory leukocyte infiltration of the lymph nodes, but by hyperplasia of its lymphoid elements and proliferation of connective tissue.

Depending on the individual reactivity of the organism, the state of its immune system, the aggressiveness of the infection, there are several options for depicting the inflammatory process in the LU.

The complexity of assessing inflammatory processes in the lymph nodes is associated with the widespread use of antibiotics and anti-inflammatory drugs. The use of these drugs in the early stages of lymphadenitis leads to the suspension of the increase in the size of the LN and the rapid normalization of its echostructure.

With reduced immunity in response to the infectious process, reactive and hyperplastic changes in the LN are minimal, which does not allow them to be distinguished from the normal LN by echography.

Both in unchanged LN and in reactive lymphadenopathy, echography always reveals a hyperechoic core and a hypoechoic marginal sinus. This is due to the fact that as a result of most inflammatory and reactive changes (with the exception of granulomatous infection such as tuberculosis), there is a diffuse and homogeneous involvement of various sections of the lymph nodes in the process without a significant increase in size, which allows it to maintain an oval shape.

Subacute lymphadenitis with a greater severity of the inflammatory process on ultrasound than with reactive changes is characterized by blurring of the differentiation of structures in the hilar region against the background of a decrease in the overall echogenicity of the lymph nodes. The size of the LNs is enlarged, the width of the hypoechoic image of the marginal sinus and the ratio of the transverse and longitudinal diameters practically do not change, however, the multiplicity of LNs involved in the process, visualized in the form of "beads", is characteristic.

The ultrasound picture of acute lymphadenitis is characterized by an increase in size, a spherical shape, a significant decrease in echogenicity (up to anechoic), and a sharp pain when pressed with a sensor. Quite often, an anechoic image of the LN indicates its purulent fusion, which is confirmed by puncture data. If at the same time the LU capsule remains intact, then an abscess is formed, and if the capsule melts and pus enters the surrounding tissues, adenophlegmon develops. The development of edema and infiltration of the surrounding LN tissue is defined as "periadenitis".

Against the background of adequate anti-inflammatory therapy, there is a change in the internal structure of the lymph nodes. Its size decreases, the overall echogenicity increases due to a decrease in edema and cell infiltration. At the end of the inflammatory process in the LN, it either ceases to differentiate against the background of surrounding tissues, or its ultrasound image does not differ from the structure of a healthy LN.

8. Changes in the lymph nodes in certain infections.

With viral infections in children, an increase in the LU of the neck, submandibular and parotid-chewing areas is often observed. These changes have a number of specific features. Firstly, in adenoviral infections, lymph nodes of several anatomical regions are affected, which is explained by the hematogenous spread of the infection. In this, viral lymphadenitis differs from bacterial lymphadenitis, in which the infection of regional lymph nodes occurs through the lymphogenous route through the "entrance gate". Secondly, LNs often reach large sizes (up to 2-2.5 cm), and several large nodes can be detected simultaneously in one patient. Thirdly, with such large sizes, the lymph nodes usually have an average degree of decrease in echogenicity, which rather indicates the proliferation of lymphoid tissue in them, rather than edema and inflammatory infiltration.

An increase in regional lymph nodes can be considered the leading clinical sign of cat-scratch disease. Lymphadenopathy occurs in the region closest to the scratch, it is unilateral and asymmetric. Several lymph nodes may be involved in the process, although a number of authors more often noted monoadenitis. However, 10-20% of patients may have not only regional, but generalized lymphadenopathy, and both mesenteric and paratracheal nodes may increase. The latter phenomenon indicates a breakthrough by the infection of the regional immunological barrier. LN sizes vary from 1 to 5 and even 10 cm in diameter. Lymphadenopathy, as a rule, persists - it lasts from 2 to 4 months, and sometimes from six months to 2 years. Approximately 1 in 10 patients may have suppuration of an enlarged LN, sometimes with a breakthrough of pus outward. Pathological changes in cat scratch disease in the lymph nodes are nonspecific (reticular cell hyperplasia, rarely giant cells, granuloma formation, multiple micro/macroabscesses), specific serological diagnosis has not been fully developed, so it often becomes necessary to differentiate from lymphogranulomatosis, tularemia, brucellosis, tuberculosis, venereal granuloma. Echographically, according to the literature, the changes were also not specific and were characterized by fuzzy external contours of the LN, significantly reduced echogenicity, the presence of central hyperechoic areas with uneven contours (echogenic gates) and/or central anechoic zones (areas of necrosis).

The distal amplification of the echo signal is significantly associated with the large size of the node or with its suppuration. Other authors indicate with high certainty that there are no changes in the surrounding tissues during felinosis. According to the C(E)DC data, there is a diverse structure of the vascular network, and the predominant feature is high vascularization.

Tuberculosis of peripheral lymph nodes among lymphadenopathy of various etiologies is detected in 28% of cases, and in the structure of extrapulmonary tuberculosis it reaches 50%. In adult women, it makes up more than one third of all lymphadenopathies, while in children, its share is small - 3.7%. In this case, the LU of the maxillofacial region and neck are most often affected. When verifying LN tuberculosis, among the whole complex of clinical and laboratory research methods, the most sensitive and specific is the morphological study of LN biopsy specimens and the results of ex juvantibus treatment. According to the literature, echographic signs that allow one to suspect the tuberculous nature of the LU lesion are avascularity when using EC, the presence of displaced vessels in the hilar region, and low vascular resistance. Sonographic signs characteristic of tuberculous lymphadenitis are blurred external contours, swelling of the surrounding soft tissues, intranodal cystic necrosis, formation of conglomerates, distal enhancement, the presence of hyperechoic inclusions located along the periphery of the node in the form of a “crown” (caseous necrosis or calcification at the site of inflammation). However, the possibility of similar echographic features in tuberculosis lesions, metastases, and benign reactive lesions often requires histological analysis for a definitive diagnosis.

Infectious mononucleosis is one of the most frequently mentioned diseases in the etiology of lymphadenopathy, especially among children of preschool and primary school age. According to the literature, LNs in infectious mononucleosis had the following echographic features - a rounded shape (85%), a wide echogenic central echo complex, repeating the external contours of the node, according to the CFD, the central-radial location of the chyle vessels (75%) .

9. Damage to the lymph nodes by malignant tumors.

With lymphogenous metastasis, tumor cells of the primary tumor with lymph flow reach the cortex of the LN, and then the region of the gate of the LN. As a result of microthrombosis of the lymphatic vessels, the tumor embolus settles in the lymph nodes and begins to grow. Only echography is able to detect subclinical metastasis (a focus from 3 mm in size). In most cases, the metastatic process is characterized, first of all, by the involvement of the LN cortex with its multifocal lesion. Tumor replacement of the lymphoid tissue leads to a rounding of the LN shape and a change in the ratio of the transverse and longitudinal diameters. At the same time, the heterogeneity of the LU structure is noted. At the initial stages of replacement of the LN's own tissue with the tumor contours, its contours are clear, with a tendency to increase in unevenness as the size of the metastasis increases. With further progression of the tumor process and its exit beyond the capsule of the LN, the association of several affected LNs into a conglomerate is often observed. Extracapsular growth of lymph node metastasis often leads to the involvement of surrounding tissues in the tumor process. When vessels are involved in the tumor process, their displacement or compression is revealed, as well as a decrease in the clarity of the boundaries of the vessel during infiltration or fouling with its tumor conglomerate. The less normal elements of the LN remain, which means the more tumor tissue, the more homogeneous the structure of the formation and the lower its echogenicity. The more heterogeneous the internal structure of the metastasis, the more reflective surfaces, the richer and more heterogeneous the LN echostructure. For some histological forms of tumors, an increase in the overall echogenicity of the affected LN with large metastases is characteristic.

According to the literature, three histological forms - metastases of squamous cell carcinoma, melanoma and glandular thyroid cancer - differ from each other with a high degree of certainty - 91.4%. With metastases of squamous cell carcinoma in the lymph nodes, a cystic-solid type of structure (67.7%) and a heterogeneous internal structure (80%) are more common. With metastases of glandular cancer, a “solid” type of structure is more often observed (68%), a homogeneous internal structure (77%), echogenicity from medium to increased (77%). In thyroid cancer, the structure of the metastasis is identical to the echostructure of the tumor of the thyroid tissue. Melanoma metastases are characterized by a cystic-solid type of structure (60%) and cystic (40%), a heterogeneous internal structure (56%), and an almost anechoic image of the internal structure (62%).

Malignant lymphomas are the most common tumor lesion of lymph nodes in patients aged 20 to 40 years. According to the literature, a definitive differential diagnosis between lymphoma and lymphadenitis is often not possible on the basis of B-mode ultrasound and CFM. Therefore, clinical evaluation and biopsy are required in most cases. . Nevertheless, echographic signs are noted by many authors; 1) rounded shape, i.e. the ratio of long to short diameter is less than 2.0 (78%), 2) absence or narrowing of the chyle (100%), 3) identification of multiple lymph nodes, 4) tendency to merge, 5) uneven contour, 6) presence of hypoechoic masses with heterogeneous internal echo signals, 7) increased perfusion both in the center and in the periphery, 8) rare peripheral subcapsular vessels (possibly with the exception of rare subtypes with a high degree of malignancy) .

Summing up this review, we can conclude that technical progress has significantly expanded the possibilities of non-invasive ultrasound diagnostics of lymph node pathology. However, its place in the diagnostic complex has not yet been clearly defined, which is especially evident in the literature on pediatric practice. In the available literature, there is not enough information about the comparative effectiveness of various echography techniques in the conditions of using modern equipment. The possibilities of echography in evaluating the effectiveness of anticancer therapy have been little studied. Thus, the echographic diagnosis of lymphadenopathy is full of contradictions; the place and significance of Doppler echography techniques in differential diagnosis is not entirely clear. All this formed the basis for planning this study.