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Reactive lymph nodes of G.Bertelli

Generality

Reactive lymph nodes are found due to activation of the immune system in response to various paraphysiological or pathological conditions.

When this phenomenon occurs, the patient generally manifests lymphadenopathy (generalized or local volume increase) and tenderness, especially on palpation.

The causes of reactive lymph nodes are mainly inflammatory or infectious, but this manifestation may also signal the presence of neoplastic cells.

What are

What do you mean by Reactive Lymph Nodes?

Reactive lymph nodes are those lymph nodes that are inflamed and increased in volume compared to their physiological size, which vary from a few millimeters to about one centimeter.

Their response is often a cause for concern, but, in most cases, indicates that the immune system is doing its duty .

In most cases, the lymph nodes become reactive when they respond to an infection . However, their activation may also depend on inflammation or a neoplastic problem .

What are lymph nodes?

  • The lymph nodes, also called lymphatic glands or lymph glands, are small peripheral organs, oval or roundish, which participate in the defense of our body.
  • The lymph nodes are scattered along the course of the lymphatic vessels, in very precise points of the body (neck, armpits, groin etc.), where they can sometimes be perceived by touch. This particular distribution allows them to behave like "sentinels", to which a specific body district has to be assigned to monitor . More in detail, the lymph nodes are found at the level of the lymphatic collectors, or areas of the lymphatic system that perform an action of drainage of liquids from the tissues.
  • Thanks to this filtering activity, lymph nodes can detect the presence of external agents (such as bacteria, viruses or fungi), but also elements inside our body, such as cancer cells. When this happens, they increase in volume ( lymphadenopathy ), as a proliferation of cells of the immune response occurs within them. Often, it is this enlargement of the lymph nodes that leads people to seek medical attention.

Types and distribution of Reactive Lymph Nodes

Lymph nodes can be classified according to the cause that determined their reactivity and the area of ​​competence.

Depending on the area in which they are located, it is possible to give meaning to the reactive lymph nodes and have indications on the pathology . For example, an inguinal reactive lymph node will have a different meaning than a reactive lymph node in the neck.

It should be noted, however, that there are infectious or inflammatory diseases that cause the generalized enlargement of the lymph nodes (ie in three or more sites): these are usually systemic viral diseases (varicella, measles, etc.) or autoimmune diseases ( such as rheumatoid arthritis and systemic lupus erythematosus).

Depending on their position in our body, lymph nodes can be classified into:

  • Head and neck lymph nodes, including:
    • Latero-cervical reactive lymph nodes: located in the lateral area of ​​the neck, just below the ear. Generally, they are referred to as "lymph nodes in the neck";
    • Submandibular lymph nodes or "lymph nodes of the throat": they are found at the level of the area under the chin, at the level of the salivary glands.
  • Lymph nodes of the upper limb and chest wall, including:
    • Axillary lymph nodes: they are those near the armpit. Of these, the sentinel node is part, very important when there is a suspicion or diagnosis of breast cancer;
    • Mediastinal lymph nodes: present at the level of the mediastinum, ie the space between the two lungs.
  • Lymph nodes of the lower limb and abdominal wall, including:
    • Inguinal lymph nodes.
  • Visceral lymph nodes : they are the deepest glands (for this, they are not palpable) that deal with the intestine, liver, pancreas, stomach, esophagus, lungs, heart, kidneys, bladder, ureter and organs of the reproductive system.

Depending on the reason that determined the reactivity of the lymph nodes, it is possible to distinguish:

  • Paraphysiological causes : the reactive lymph nodes are often related to a situation of non-specific inflammatory nature, ie not consequent to the action of a pathogen. An example is the enlargement of the lymph nodes of the axillae or groin, after a particularly aggressive epilation or depilation.
  • Inflammatory causes : in this case, the reactive lymph nodes depend on an inflammation caused by pathogenic agents, such as, for example, viruses or bacteria or when it is caused by an inflammation linked to autoimmune diseases.
  • Neoplastic causes : sometimes, the lymph nodes are reactive due to the presence of neoplastic cells that cause the onset of an inflammatory state. Often, these lymphatic glands are also atypically vascularized, ie there is a disorganization of the blood vessels due to the tumor process.

Finally, reactive lymph nodes can be differentiated into:

  • Benigni : the cause that led to the increased volume of lymph nodes and their reactivity is a pathology of a non-neoplastic nature. In this case, a wide, hyperechoic structure - defined ilo - that occupies the central part of the reactive lymph node, whose presence is considered a sign of kindness, is found on the ultrasound examination.
  • Malignant : the triggering cause is a solid tumor located near the reactive lymph nodes, a hematologic neoplasm or a metastasis. As anticipated, the most significant difference between benign and malignant lymph nodes is given by the presence of peripheral vascularization of the latter.

Causes and Risk Factors

The lymph nodes become reactive, swelling in volume due to various causes, usually of a paraphysiological or pathological nature.

Inflammation

Often, the increase in nonspecific volume of lymph nodes is attributable to inflammations of an unknown nature or not associated with pathological conditions.

An example of this is:

  • The enlargement of the lymph nodes of the axillae or groin that can occur after a particularly aggressive depilation or epilation .
  • The reactivity of a lymph node in the inguinal region resulting from skin lesions or insect bites on legs or abdomen;

In other cases, the reactive lymph nodes result from inflammatory processes related to specific diseases, identifiable during the diagnostic procedure.

For example:

  • The reactivity of the submandibular or latero-cervical lymph nodes can signal phlogosis of the salivary glands, gingival infections in progress or represent a consequence of previous dental operations;
  • Visceral reactive lymph nodes may be indicative of inflammatory bowel diseases, such as Crohn's disease or celiac disease;
  • The presence on a hand or arm of skin cuts, animal scratches and tick bites can easily lead to the onset of lymphadenopathy, which manifests itself precisely with a reactive lymph node of the axillary group.

Infections

Reactive lymph nodes are found in the presence of viral, bacterial or other infectious diseases.

Among the bacterial infections that can determine lymph node reactivity are:

  • Pneumonia (mediastinal reactive lymph nodes);
  • Pharyngitis (latero-cervical and submandibular reactive lymph nodes);
  • Otitis and tonsillitis (submandibular or latero-cervical reactive lymph nodes);
  • Tuberculosis (reactive lymph nodes of the neck);
  • Cat scratch disease (reactive axillary lymph nodes).

The main viral infections that can cause reactive lymph nodes, however, are:

  • HIV (generalized lymph node reactivity);
  • Cytomegalovirus (submandibular or latero-cervical reactive lymph nodes);
  • Cold sores (submandibular or latero-cervical reactive lymph nodes);
  • Genital herpes (inguinal reactive lymph nodes);
  • Infectious mononucleosis (latero-cervical or submandibular reactive lymph nodes);
  • Flu or cold (reactive latero-cervical and submandibular lymph nodes, with associated symptoms such as sore throat and fever);
  • Tuberculosis (reactivity of latero-cervical lymph nodes):
  • Measles and varicella (reactivity of latero-cervical lymph nodes);
  • Otitis or mumps (parotid reactive lymph nodes);
  • Hepatitis B or C virus (visceral reactive lymph nodes).

Sexually transmitted diseases, such as syphilis, venereal lymphogranuloma or candida, can cause an increase in the volume and reactivity of the inguinal lymph nodes.

Finally, there are also parasitic infections, such as toxoplasmosis, which can cause reactivity of the lymph nodes in the neck.

Autoimmune disorders

Reactive lymph nodes can be associated with autoimmune diseases, such as:

  • Rheumatoid arthritis ;
  • Systemic lupus erythematosus ;
  • Connectivity ;
  • Sarcoidosis .

In this case, the immune system is abnormally activated against a molecule or structural component normally present in the cells of our own organism.

Being, in this case, systemic inflammation, also the reactivity of the lymph nodes will be widespread and generalized.

In Hashimoto's thyroiditis, an autoimmune thyroid disease, one of the various manifestations is the enlargement of the latero-cervical lymph nodes only.

tumors

Although this represents a small percentage of cases, many neoplastic processes cause a lymph node reactivity, with an evident increase in volume. The tumor cells coming from the various organs, in fact, go to localize inside the lymph nodes ( lymph node metastases ) causing an inflammatory reaction . This phenomenon results in the presence of both neoplastic diseases of the blood and the lymphatic system (such as leukemia and lymphoma), which determine a generalized reactivity of the lymph nodes, and solid tumors, in which there is an increase in the volume of the lymph nodes located near the tumor affected organ.

Symptoms and Complications

Reactive lymph nodes: how are they presented?

Reactive lymph nodes manifest themselves with an increase in volume and are almost always painful .

Depending on the cause, other signs and symptoms may be associated, such as:

  • Temperature;
  • Chills;
  • Excessive sweating;
  • Poor appetite and weight loss;
  • Difficulty swallowing;
  • Neck stiffness.

In the case of infections, for example, reactive lymph nodes also activate an inflammatory process, or an inflammatory reaction is triggered to induce and support the immune response. In addition to causing pain to the touch, the presence of phlogosis can also cause redness and a sensation of heat, at the level of the skin above the enlarged lymph node gland.

Furthermore, the appearance of rhinitis, cough or conjunctivitis may suggest the presence of an infection of viral origin, mostly of the upper respiratory tract. A decay of the general conditions associated with reactive lymph nodes and persistent fever indicates, instead, a bacterial etiology .

When associated with a tumor pathology, the reactive lymph nodes increase in size due to the presence of tumor cells, but they are rarely accompanied by a real immune and inflammatory reaction. Therefore, there is no pain or redness and, to the touch, the gland is hard and not very mobile. Instead, benign reactive lymph nodes tend to maintain some mobility with respect to the surrounding tissues.

Diagnosis

Reactive lymph nodes: when to seek medical attention

When a lymph node is enlarged on palpation, it is advisable to contact your doctor to determine if further diagnostic investigations are necessary, to better frame the origin of reactivity.

In general, the ultrasound examination can determine whether the lymph node is reactive or not and, in some cases, biopsy will be required.

However, the causes may be non-specific, or not attributable to a particular condition. Therefore, it is possible that lymph nodes are only kept under control, without therapy being required.

Reactive lymph nodes: what tests are needed?

In some cases, the diagnosis of reactive lymph nodes is established through a simple physical examination . This involves the observation and palpation of the glands; if reactive, these can be so enlarged that they can be seen with the naked eye. During the visit, the doctor will consider some factors, such as: size of the reactive lymph node, site of the bulge (reflects the part of the body where the inflammatory process or tumor is located), age of the patient, signs and accompanying symptoms, features to the touch, etc.

Other times, the detection of reactive lymph nodes is accidental, ie it is discovered following imaging techniques and other diagnostic tests prescribed to investigate the presence of a pathology.

These findings may include:

  • Ultrasound : it is a non-invasive examination, during which the reactive lymph nodes are generally hyperplastic, that is, they are enlarged. Based on some parameters (shape, motility, vascularization, consistency and size of the gland), the examination allows to discriminate between benign and malignant causes . When the ultrasound is not conclusive, a cytological sample is taken, preferably with an excisional lymph node biopsy .
  • Computed tomography (CT) : it is a radiographic survey that allows the identification of reactive lymph nodes and is able, based on size and morphology, to give indications on the presence of possible lymph nodes suspected for malignancy.
  • Mammography : the reactive lymph nodes that appear are usually those of the axilla. Based on the parameters defined by the instrument and interpreted by the radiologist, the mammographic survey is able to discriminate between benign and malignant lymph nodes.

Treatment and Remedies

The treatment of reactive lymph nodes is closely related to the triggering cause .

Among the possible therapies related to the swelling and inflammation that caused its appearance are:

  • Non-steroidal anti-inflammatory drugs : they are indicated by the doctor in the case of non-specific lymph node reactivity, caused by inflammatory phenomena of an unknown or non-pathological nature;
  • Antibiotics : they are prescribed if the lymph nodes are reactive for bacterial infections;
  • Immunosuppressants and corticosteroids : these drugs are usually prescribed in case of lymph node reactivity related to autoimmune diseases;
  • Chemotherapy or radiotherapy : they are indicated in case the reactive lymph nodes are linked to a tumor pathology.

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