What causes the lymph nodes to swell

Lymph node swelling over a month: always invasive diagnostics!

Enlarged lymph nodes are found in a wide variety of diseases. The cause of the enlargement is predominantly infections, immunological processes, neoplasms or metabolic diseases. In malignant lymphoma, the lymphatic tissue itself is neoplastically changed.

How do you come to the correct diagnosis quickly? And what should be considered in the differential diagnostic clarification? Dr. Wolfram Jung and Professor Lorenz Trümper, Department of Hematology and Oncology at the Center for Internal Medicine at the University Hospital Göttingen, in their certified advanced training article "Large lymph nodes - what's behind it?"

Important questions in the context of the anamnesis mainly concern the duration and dynamics of the lymph node enlargement, accompanying symptoms and the history. Rapidly growing lymph nodes are often a sign of a florid disease: In addition to inflammatory, neoplastic causes such as tumors with a high proliferation rate (e.g. aggressive lymphomas or small-cell lung carcinoma) are possible. Slowly growing lymph nodes are found in chronic leukemia, low-grade non-Hodgkin lymphomas and chronic inflammation.

Fever as an accompanying symptom is typical of bacterial or viral infections. In immunological diseases, arthralgia, muscle weakness and rashes often occur at the same time as the fever. With malignant lymphoma, there is often a fever above 38 ° C, night sweats or weight loss.

When clarifying an infectious origin, sexually transmitted diseases such as HIV, hepatitis B, syphilis or herpes simplex should also be considered, as well as intravenous drug use. In the case of migrants, depending on their ethnic origin, a parasitic or rare bacterial infection (such as trypanosomiasis, leishmaniasis or coccidioidomycosis) can be the cause, as is the case with travelers after a corresponding stay abroad.

The division into localized and generalized lymphadenopathies is helpful for diagnosis. In the latter, at least two non-contiguous anatomical regions are affected; Here, attention is paid primarily to general symptoms. In the case of localized lymphadenopathy, the associated region is examined for infections, skin and mucous membrane lesions, erythema and tumors, and pain.

There is no generally valid standard value for the size of the lymph nodes. In adults, palpable lymph nodes up to 1 cm in diameter are considered normal, and inguinal ones up to 1.5 cm. An enlargement over 1.5 cm usually has a malignant cause.

The scope of laboratory diagnostics is based on the most likely differential diagnoses. However, it should always include the blood count, differential blood count, platelets, liver values ​​and lactate dehydrogenase. Abdominal sonography and chest x-ray are also generally indicated. Invasive diagnostics (biopsy or, if lymphoma is suspected, an excision) should be performed for any lymph node swelling that lasts longer than a month. (mar)

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