Edema of cervical lymph nodes
In physical examination, it is determined whetherenlargement of lymph nodes localized or generalized, assessing their consistency, size and mobility, revealing the presence or absence of soreness in palpation, symptoms of inflammation of surrounding tissues, areas of damaged skin and other possible external foci of infection, determine the size of the spleen. In adults with enlarged cervical lymph nodes it is necessary to consult an otorhinolaryngologist and find out whether the patient smokes.
An increase in the lymph nodes of one group is considered local or regional, and an increase in the lymph nodes of three or more non-adjacent groups is generalized.
Many of the listed in Table. 61.1 diseases can be accompanied by both local and generalized enlarged lymph nodes, so the diagnostic value of this sign is small.
Enlargement of the supraclavicular lymph node on the left more oftenall due to the so-called Virchow metastasis. the source of which are tumors of the gastrointestinal tract. In supraclavicular lymph nodes can also metastasize tumors of the lungs, genital organs and mammary glands.
In case of physical examination,take into account the size and consistency of the lymph nodes. If the lymph nodes are smaller than 1 square cm (1 x 1 cm or less), it is almost always indicative of a reactive increase.
In one retrospective studythe results of biopsy of lymph nodes in patients 9-25 years old are analyzed. It was established that lymph nodes, the maximum size of which exceeded 2 square cm, were significantly more often affected by a tumor or granulomatous process. In another similar study, the border size was 2.25 square cm (1.5 x 1.5 cm). If the size of the lymph nodes is less than or equal to 1.5 square cm, but no systemic diseases, infectious mononucleosis and toxoplasmosis are found. then observation is necessary.
The consistency of the lymph nodes can be soft,dense or elastic, and the surface is smooth or bumpy. Assess mobility of lymph nodes, tenderness in palpation and adhesion to each other and surrounding tissues. Soreness is caused by the extension of the capsule and indicates a rapid increase in the lymph node. characteristic for inflammation.
An increase in the intrathoracic lymph nodes (visceral) and enlarged abdominal visceral lymph nodes are usually detected with a targeted examination. The enlarged hilar lymph nodes sometimes show up in case of an accidental x-ray examination or when examining the increase in peripheral lymph nodes.
Differential diagnosis with increaselymph nodes of mediastinum and an increase in the lymph nodes of the roots of the lungs are carried out between lung diseases and systemic diseases, for which a typical lesion of the lymph nodes of this group.