Inguinal Enlarged Lymph Nodes by A.Griguolo

Generality

Enlarged inguinal lymph nodes are a clinical sign found on infections, tumors and autoimmune diseases.

Furthermore, they are a possible side effect of certain drugs and vaccines.

Characterized by one or more painful swellings, enlarged inguinal lymph nodes are easy to diagnose; their identification, in fact, requires a simple palpatory examination of the inguinal region.

The treatment adopted in the presence of enlarged inguinal lymph nodes depends on the triggering cause; for this reason, during the diagnostic phase, it is essential for the doctor to conduct an investigation into the causal factors.

Short review of what the lymph nodes are

Lymph nodes are small ovoid organs of the lymphatic system, having a very important immune role ; in fact, they act as collection points for part of the B and T lymphocytes (cells of the immune system ), in order to intercept and destroy any germs, foreign substances and / or neoplastic cells circulating in the lymph (the lymph is the fluid similar to the plasma, which flows along the lymphatic vessels and receives the waste tissue present tissues).

Acting similarly to purifiers, lymph nodes are often referred to as biological filters.

What are Enlarged Inguinal Lymph Nodes?

Enlarged inguinal lymph nodes are a typical sign of various medical conditions, including infections, tumors, autoimmune diseases, particular drug therapies and vaccines.

Since in medicine, the presence of enlarged lymph nodes is indicated with the specialized term lymphadenopathy, the enlarged inguinal lymph nodes can also be defined with the expression " inguinal lymph nodes ".

Two important terminological notes, to better understand enlarged inguinal lymph nodes

• Lymphadenopathy, swollen lymph nodes and enlarged lymph nodes are synonymous.
• The adjective "lymph node" indicates "everything attributable to the lymph nodes".

Outline of anatomy related to inguinal lymph nodes

The inguinal lymph nodes are the lymph nodes of the thigh located in the anatomical region called the groin .

Placed under the so-called inguinal ligament, the lymph nodes can be classified into two groups: the group of superficial inguinal lymph nodes and the group of deep inguinal lymph nodes .

The superficial inguinal lymph nodes are located just below the skin, are about ten and have the task of receiving and discharging the lymph coming from: genitals, lower abdomen, lower back, anus, perineum, buttocks, thighs into the deep inguinal lymph nodes legs.

The deep inguinal lymph nodes, on the other hand, reside far below the skin (in a structure known as the femoral triangle), may vary in number between 3 and 5 units and, in addition to receiving lymph from the superficial inguinal lymph nodes, have the assignment to host the sap coming from: the lower parts of the lower limbs, the clitoris (in women) and the penis (in men).

The final passage of the lymphatic drainage which has the inguinal lymph nodes as protagonists sees the discharge of the lymph reaching the deep inguinal lymph nodes in the external iliac lymph nodes.

Causes

Taking up concepts already provided in the previous section of this article, enlarged inguinal lymph nodes recognize various causes, including: infections, tumors, autoimmune diseases, the use of certain drugs and the practice of certain vaccinations.

The enlarged inguinal lymph nodes, therefore, can be a consequence of pathological states of different severity or a side effect deriving from the administration of certain pharmacological products.

Enlarged inguinal infections and lymph nodes

The infections responsible for the phenomenon of enlarged inguinal lymph nodes include:

• Sexually transmitted diseases . Some well-known examples of such medical conditions are gonorrhea, syphilis, venereal lymphogranuloma, cancer (or venereal ulcer) and genital herpes.

• Some viral infections, such as mononucleosis, viral orchitis or AIDS .
• Bacterial infections affecting the skin and subcutaneous tissues, including muscles and bones.
• Toxoplasmosis . It is a parasitic disease (parasitosis), due to the parasite Toxoplasma gondii.

  It can be asymptomatic (ie without symptoms) or symptomatic (ie associated with a symptomatology); when it is symptomatic, besides the enlarged inguinal lymph nodes, it causes: headache, fever, myalgia, tiredness and sore throat.

• The bubonic plague . Supported by the bacterium Yersinia pestis, it is a bacterial infection that has as its preferred target, in humans, the lymphatic system.

  An example of zoonosis (ie infection transmitted by animals), bubonic plague is responsible for lymphadenopathy in several parts of the body; in fact, in addition to enlarged inguinal lymph nodes, it is also associated with enlarged lymph nodes in the neck and enlarged axillary lymph nodes.

Enlarged inguinal tumors and lymph nodes

In the list of tumors related to the presence of enlarged inguinal lymph nodes, appear:

• Leukemias . They are malignant tumors of the blood that affect the white blood cell progenitor cells. Elements of the so-called cellular component of blood, white blood cells are an integral part of the immune system, therefore they have the task of defending the body from threats from outside and from within.
• Lymphomas . They are malignant tumors that specifically affect the lymph nodes.

  There are two types of lymphoma: Hodgkin's lymphoma and non-Hodgkin's lymphoma.

  The presence of a lymphoma is often associated not only with enlarged inguinal lymph nodes, but also with the enlargement of the axillary lymph nodes and lymph nodes of the neck.

• Tumors to the pelvic organs and the possible consequent metastases. Examples of pelvic tumors, from which the phenomenon of enlarged inguinal lymph nodes may arise, are the tumor of the anus and the tumor of the vulva.

  As a rule, the enlargement of a group of lymph nodes, observed in the presence of a malignant tumor, represents the signal that the malignant tumor in question has spread elsewhere, compared to its place of origin.

• Melanomas . A melanoma is a malignant tumor of the skin, which can cause enlargement of the lymph nodes in its vicinity.

Autoimmune diseases and enlarged inguinal lymph nodes

Among the most known autoimmune diseases associated with the phenomenon of enlarged inguinal lymph nodes, there are: rheumatoid arthritis and systemic lupus erythematosus .

Rheumatoid arthritis is a form of arthritis (inflammation of the joints), which involves the degeneration of the joint capsule belonging to the mobile joints (or diarthrosis).

Systemic lupus erythematosus, on the other hand, is a multisystemic inflammatory disease, that is, a disease that causes inflammation in various organs and tissues of the human body (the term "multisystem" refers precisely to the multiplicity of organs and tissues involved).

Important : rheumatoid arthritis and systemic lupus erythematosus are characterized by the presence of enlarged inguinal lymph nodes, when they are in their most advanced stages.

In other words, enlarged inguinal lymph nodes distinguish rheumatoid arthritis and systemic lupus erythematosus only when these two conditions have been consolidated and have been in place for some time.

Enlarged inguinal lymph nodes and medications

Among the drugs that, in the list of side effects, also include the phenomenon of enlarged inguinal lymph nodes, include:

• Allopurinol, a medicine specifically indicated for the treatment of gout ;
• Medications for epilepsy known as phenytoin and carbamazepine (NB: carbamazepine is also used in the treatment of dipolar disorder);
• Penicillin drugs, indicated for the treatment of some bacterial infections;
• Pyrimethamine, a drug indicated for the treatment of malaria ;
• Sulfonamides .

Vaccines and inguinal lymph nodes enlarged

Vaccines that have the inguinal lymph nodes as side effects are the trivalent vaccine (against measles, mumps and rubella) and the typhoid vaccine .

Symptoms and Complications

Enlarged inguinal lymph nodes involve the formation, obviously at the level of the groin, of one or more often painful swellings .

The pain resulting from enlarged inguinal lymph nodes can be a constant presence or only manifest itself upon palpation of the swelling.

Did you know that ...

The bubonic plague owes its name to the fact that the inguinal lymph nodes and axillary lymph nodes swell to the point of resembling buboes.

Sharp or gradual enlargement: what does it depend on?

Enlarged inguinal lymph nodes can result from an acute enlargement process - where by acute is meant fast in occurrence - or from a gradual enlargement process .

As a rule, the enlargement of the inguinal lymph nodes is acute when the underlying cause is an infection, whereas it is gradual when the responsible factor is an autoimmune tumor or disease.

Associated symptoms

Depending on the triggering condition of lymph node enlargement, the presence of enlarged inguinal lymph nodes may be accompanied by more than a few symptoms and other signs.

More specifically, the symptoms and signs that may complete the presence of an inguinal lymphadenopathy include:

• Temperature;
• Unexplained weight loss;
• Headache;
• Myalgia;
• General fatigue;
• Sore throat;
• Lesions and genital ulcers;
• Axillary lymphadenopathy (enlarged axillary lymph nodes) and lymphadenopathy of the neck (enlarged lymph nodes on the neck).
• Profuse sweating, especially at night.

Complications

In the presence of enlarged inguinal lymph nodes, the possible appearance of complications depends on the severity of the underlying cause of the lymph node enlargement and the remaining symptoms.

Examples of conditions that induce inguinal lymphadenopathy and from which, given their severity, complications may arise are: leukemia, lymphoma, AIDS and more serious infections.

When should I go to the doctor?

Enlarged inguinal lymph nodes are a sign not to be underestimated, but rather to be submitted to the attention of the attending physician, when:

• They appeared without obvious explanations and, after 2 weeks, have not yet returned to their normal dimensions;
• They are accompanied by the enlargement of other lymph nodes (eg: axillary lymph nodes, inguinal lymph nodes etc.);
• They are accompanied by a variegated and / or serious symptomatology (eg: fever, lesions and genital ulcers, weight loss without reason, chronic fatigue, etc.).

Diagnosis

To detect the presence of enlarged inguinal lymph nodes, the palpatory examination of the inguinal area is sufficient, performed during a classic physical examination .

What is the next step?

Once the presence of enlarged inguinal lymph nodes has been detected, the physician initiates the investigations necessary to identify the cause triggering the lymph node enlargement process. The diagnosis of the causes of enlarged inguinal lymph nodes is essential for the most appropriate therapy planning.

The diagnostic procedure through which it is possible to trace the causal factors of an inguinal lymphadenopathy always starts from the anamnesis and the narration of the associated symptoms, presented by the patient; therefore, depending on the circumstances and what emerges from the surveys just mentioned, it can continue with:

• Blood test (CBC, ESR, C-reactive protein etc.);
• Inguinal ultrasound ;
• Percutaneous needle biopsy of an enlarged lymph node.

Therapy

In the presence of enlarged inguinal lymph nodes, the treatment adopted varies according to the triggering cause. In practical terms, this means that the presence of enlarged inguinal lymph nodes due to a skin infection requires a cure other than an inguinal lymphadenopathy due to a lymphoma.

In the next section, the article will discuss the treatment envisaged in some of the most important circumstances responsible for enlarged inguinal lymph nodes.

Examples of treatment in the presence of enlarged inguinal lymph nodes

• If the inguinal lymph nodes are enlarged due to syphilis, the treatment foresees the administration of the antibiotic penicillin G-benzathine or, in case of allergy towards such antibiotics, other antibacterial medicines of similar power.
• If the enlarged inguinal lymph nodes depend on a melanoma, the therapy involves the surgical removal of the tumor mass, combined with chemotherapy or (but more rarely) radiotherapy.
• If enlarged inguinal lymph nodes depend on non-Hodgkin's lymphoma, the patient can benefit from treatments such as chemotherapy, radiotherapy and / or stem cell transplantation.
• If the enlarged inguinal lymph nodes are related to the use of a certain drug, the remedy generally consists in interrupting the use of the drug in question (or, alternatively, waiting for the conclusion of the pharmacological treatment).

Clinical meaning

The clinical relevance of enlarged inguinal lymph nodes varies according to the severity of the triggering condition; in other words, the more the clinical significance of the causal factor is important, the more the swollen inguinal lymph nodes must cause concern and call attention to the doctor.