Lymphadenitis is an inflammation of the lymph nodes. Acute lymphadenitis almost always arises as a complication of a local focus of infection - a boil , an infected wound or abrasion, etc. Pathogens (often staphylococcus ) penetrate the lymph nodes with lymph flow through the lymphatic vessels, and often without inflammation of the latter, that is, without lymphangitis (cm.).
Purulent foci on the lower extremity are complicated by inguinal lesions, less often - popliteal nodes; on top - axillary, less often - ulnar; on the head, in the mouth and throat - neck. By the onset of acute lymphadenitis, the small focus of infection that caused it may already disappear (for example, a festering foot rubbing heals).
Acute lymphadenitis of superficial lymph nodes is first manifested by small pains in the groin , under the arm, etc., where an enlarged and dense, slightly painful knot with clear contours, well-mobile (“rolls” under the skin) is palpable. Then the pain and swelling of the node increase, its contours lose their clarity, mobility is limited (periadenitis — transition of inflammation to the capsule of the node and the adjacent fiber). The temperature may rise. With the further development of the process, the node undergoes purulent melting with the formation of an abscess and the appearance of fluctuations (see Cracking ), and when the pus breaks into the surrounding cellulose, there is phlegmon (adenophlegmon), accompanied by high temperature, severe general condition, significant swelling, reddening of the skin. Subsectoral phlegmon is very dangerous (see). It is possible acute lymphadenitis of several nodes of this group, which are affected one by one or simultaneously. In the first case, after a breakthrough or opening of one abscess, a new one appears next to it, in the second case, the inflamed nodes merge into a common “bag”, and when it suppresses, a large purulent cavity is formed, sometimes divided by several partitions.Go
There is also a consistent damage to several groups of lymph nodes (for example, first elbow, then axillary). Such a course is especially dangerous - it threatens with sepsis (see).
The diagnosis of superficial acute lymphadenitis is uncomplicated. With the appearance of swelling and soreness of the lymph nodes, the presence of a source of infection or at least a trace of it indicates acute lymphadenitis.
To detect the first signs of lymphadenitis, it is necessary to touch the regional lymph nodes with each purulent wound, abrasion, abscess on the foot , hand, etc. Recognition of deep acute lymphadenitis is often difficult. The only symptom may be a feverish state; in such cases, inpatient examination of the patient is required.
Prevention : prevention of infection with minor cuts, abrasions (iodine alcohol solution, aseptic dressing), scuffs, immediate removal of splinters, treatment of sore throat, removal of carious teeth, etc.
Treatment of acute lymphadenitis: first - rest, heat (warming compress, warm water bottle), antibiotics by prescription. Treatment of the primary focus of infection - opening of an abscess, purulent bladder, removal of crusts from a festering surface, etc. When a fluctuation occurs, and even more so when phlegmon develops, an incision is immediately made , and then treated as if it were an infected wound (see Wounds, injuries ) .
Chronic lymphadenitis - most often tuberculous. Mycobacterium tuberculosis enters the lymph nodes with blood or lymph from the tuberculosis focus (mainly from the lesion in the lung). Of the superficial lymph nodes, the neck is most often affected. Initially, their swelling slowly, almost painlessly increases, the nodes gradually merge into “bags”, then they are melted to form a “cold” (without a significant temperature increase) abscess. The skin reddens, becomes thinner, an abscess breaks out with the release of caseous (curdled) masses and the formation of persistent festering fistula. The disease lasts from several months to several years. With a favorable course, the fistula heals with time, the infiltrate resolves.Go
Treatment : use of antibacterial agents ( ftivazid , PASK , etc.) as prescribed by the doctor, enhanced nutrition and other restorative measures, removal of the affected nodes is sometimes indicated. Each patient with chronic lymphadenitis is subject to examination in the hospital, especially since a slowly increasing lymphadenopathy, their gradual merging into a general “package” without acute inflammatory phenomena is observed also in lymph node sarcoma , lymphoma granulomatosis (see), etc. Tuberculosis lymphadenitis of bronchial lymph nodes - see. Bronchoadenitis. See also Lymphatic system .
Lymphadenitis (lymphadenitis; lymph + Greek. Aden — gland) is an inflammation of the lymph nodes. Lymphadenitis is more often observed as a complication of acute, subacute and chronic inflammatory processes (furuncle, phlegmon, ulcer, fistula, etc.). Lymphadenitis is accompanied by an increase in lymph nodes.
Pathogenesis . The infection enters the lymph nodes with lymph flow from the primary purulent focus, it can occur without prior lymphangitis, sometimes the primary focus is so small that by the time lymphadenitis occurs, it is not possible to detect the site of infection. In rare cases, it is possible the infection in the lymph nodes hematogenous.
Lymphadenitis should be considered as a manifestation of the barrier function of the lymphatic system, which limits the spread of the infection and its toxins, but in some cases lymphadenitis may be the cause of the development of a severe purulent process (sepsis).
Pathological anatomy . In acute lymphadenitis, hyperemia and serous infiltration of the parenchyma of the node, proliferation of elements of the reticular tissue and leukocyte infiltration are observed. The further infiltration with polynuclears is enhanced, and the exudate can become purulent. There are three forms of acute lymphadenitis: simple, or catarrhal, hyperplastic and purulent. In the initial phases of catarrhal and hyperplastic lymphadenitis, the inflammatory process may subside or take a chronic course. When purulent lymphadenitis occurs destruction of the lymph node and purulent fusion. Pus can remain for a long time within the capsule of the lymph node, limited to the pyogenic membrane, forming an abscess. Sometimes there is a rapid disintegration of the capsule, and pus erupts into the surrounding tissue.
When purulent lymphadenitis usually develops periadenitis - inflammation of the surrounding tissue. When purulent melting of cellulose an abscess is formed that surrounds the remnants of the lymph node, or a phlegmon develops. Especially hard putrid adeno-phlegmon.
Acute lymphadenitis . Acute lymphadenitis begins with pain in the region of the regional lymph nodes and their enlargement with serous and hyperplastic forms. Enlarged lymph nodes are well palpated, their soreness is insignificant. With the development of a purulent process, the pain increases, a dense infiltration is determined, which masks the lymph node contours, the temperature rises, hyperemia and edema sharply increase. The patient spares the affected area (especially sharp pain is noted in lymphadenitis of the inguinal region). Then a fluctuation appears in the area of infiltration. If the abscess is not opened, the pus erupts outside or adeno-phlegmon occurs, a dense and painful infiltrate builds up in the subcutaneous and intermuscular tissue. It is possible to transfer the process to the adjacent lymph nodes.
Complications of purulent lymphadenitis, in addition to abscess and adenophlegmon, may develop a common infection, thrombophlebitis of the adjacent veins, corroding the walls of blood vessels, followed by bleeding.
The diagnosis of superficial lymphadenitis is not difficult. With deep lymphadenitis of the extremities, spontaneous pain and swelling are noted. The diagnosis is clarified when a primary inflammatory focus is detected, which served as the source of lymphadenitis.
The prognosis for superficial purulent lymphadenitis, timely treated, favorable; when passing purulent inflammation to the surrounding tissues - serious.
Treatment of the serous form of lymphadenitis is conservative: rest, warmth, intramuscular administration of penicillin, Novocainic blockade according to A.V. Vishnevsky are recommended. At the same time, treatment of the primary focus (opening of the abscess, drainage of the wound, etc.) is necessary.
In case of purulent lymphadenitis, surgery is indicated - incision, removal of pus, dead tissue, drainage of the open purulent cavity, antibiotics, sulfonamides.
Chronic lymphadenitis develops during infection caused by weakly virulent pathogens (for example, in case of infectious eczema, iodermia, etc.). Chronic lymphadenitis of specific origin is more often a tuberculous etiology, this affects the cervical lymph nodes, rarely bronchial and retroperitoneal. Chronic lymphadenitis is also observed in congenital and acquired syphilis.
Chronic lymphadenitis is characterized by an increase in lymph nodes. When nonspecific infection revealed a separate mobile enlarged lymph nodes, painless on palpation. In tuberculosis, packages of nodes of medium density are palpable; when syphilis enlarged nodes are very dense. Suppurations in chronic nonspecific lymphadenitis are rarely observed. Tuberculous lymphadenitis is characterized by caseous melting of lymph nodes, which occurs in the absence of pronounced general phenomena. When a diagnosis is made, it is sometimes difficult to resolve the issue of the etiology of chronic lymphadenitis (tuberculosis, syphilis, lymphogranulomatosis), which is of great importance for proper treatment.
The differential diagnosis of lymphadenitis with metastasis of malignant tumors to the lymph nodes is important. The bumpy surface of the infiltrate in chronic lymphadenitis may cause suspicion of a neoplasm, and therefore, for diagnostic purposes, it is sometimes necessary to resort to puncture or biopsy.
In tuberculous lymphadenitis with caseous decay, fistulas can form, purulent infection can join with the development of cellulitis and even sepsis, or the process ends with tissue sequestration and scarring.
The outcome of chronic lymphadenitis of non-specific origin is more often scarring and gradual wrinkling of lymphoid tissue. Sometimes the proliferation of connective tissue in the lymph nodes of the extremities in chronic lymphadenitis can lead to persistent stasis with the development of dense edema of the limbs and often elephantiasis.
Treatment of chronic lymphadenitis should be aimed at eliminating the underlying disease. The removal of nodes is not indicated, except for tuberculous lymphadenitis with caseous decay, fistulas, and adherent purulent infection. In the prevention of lymphadenitis, measures to prevent minor injuries (iodine lubrication, aseptic dressings, protective patches, etc.) and timely treatment of primary foci of infection (dissection and drainage of purulent foci, rest) are of great importance.