Swollen Lymph Nodes

Swollen lymph nodes, also known as lymphadenopathy, occur when your body is fighting an infection or disease.

Lymph nodes are tiny organs that filter fluids from the lymphatic system. Any harmful agent filtered from lymphatic fluid, such as a virus or cancer cells, is neutralized with white blood cells called lymphocytes. The inflammation associated with the immune assault will cause the lymph nodes to swell, sometimes to as large as a grape.

Swollen lymph nodes can also sometimes occur due to drug side effects or autoimmune diseases.

This article describes the function of lymph nodes, as well as the symptoms and causes of lymphadenopathy. It also explains how lymphadenopathy is diagnosed and when it is time to see a healthcare provider.

Function and Types of Lymph Nodes

Lymph nodes are an important part of the immune system. These kidney-shaped organs roughly the size of a pea are interconnected through a network of lymphatic vessels that runs throughout the body. Fluids from body tissues drain through the walls of these vessels and are carried to the lymph nodes to be filtered.

If the immune system recognizes something harmful in the lymph node, it will trigger an immune response in the form of lymphocytes. These white blood cells help fight infection and disease.

In total, there are anywhere from 450 to 800 lymph nodes scattered throughout the human body, They are organized in clusters, each of which is given a name based on its anatomical location.

Examples include:

• Occipital lymph nodes, located near the base of the skull
• Mastoid lymph nodes, located behind the ear
• Cervical lymph nodes, located in the neck
• Supraclavicular lymph nodes, found above the collarbone
• Mediastinal lymph nodes, found in the chest cavity
• Axillary lymph nodes, located in the armpits
• Retroperitoneal lymph nodes, located in the abdominal cavity
• Inguinal lymph nodes, located in the groin
• Sacral lymph nodes, located in the back of the pelvis near the rectum

Symptoms of Swollen Lymph Nodes

Lymphadenopathy, also known as adenopathy, describes the swelling of lymph nodes. This is most commonly caused by inflammation, referred to as lymphadenitis.

The swelling may be localized (limited to one area) or generalized (affecting different parts of the body at once). It may be acute (meaning sudden and severe) or chronic (meaning persistent). These features can help your healthcare provider narrow the possible causes.

The symptoms of swollen lymph nodes vary by their location. The main difference is that some swollen lymph nodes are palpable (meaning that you can feel them), while others are non-palpable (meaning you cannot).

Palpable swollen lymph nodes can be recognized by symptoms like:

• Hardened bumps beneath the skin that you can feel beneath the skin, such as in the neck or groin
• Hardened bumps that are visibly seen, such as in the armpit, neck, groin, or behind the ear
• Warmth, redness, tenderness, or pain
• Fever
• Body aches
• Fatigue

In the absence of palpable bumps, a person may only experience fever, body aches, fatigue, or no symptoms at all.

Infectious Causes of Swollen Lymph Nodes

Bacterial, viral, parasitic, and fungal infections are common causes of swollen lymph nodes. Some infections, like an upper respiratory infection, may cause localized swelling, while systemic (whole-body) infections can cause generalized swelling.

Some of the more common infectious causes of lymphadenopathy include:

• Colds and flu
• Dental infections
  
• Ear infections
• Hepatitis
  
• HIV
• Infectious mononucleosis
• Lyme disease
• Mumps
• Parasitic worms (helminths)
  
• Sexually transmitted infections (STIs)
• Shingles
• Staph infection
• Strep throat
• Tonsillitis
• Tuberculosis

Autoimmune Causes of Swollen Lymph Nodes

Lymphadenopathy is common with certain autoimmune disorders. These are diseases in which the immune system mistakenly attacks normal tissues with inflammation.

Autoimmune causes of lymphadenopathy include:

• Dermatomyositis
  
• Kawasaki disease
• Lupus
• Rheumatoid arthritis (RA)
• Sarcoidosis
• Sjogren syndrome
• Still disease (juvenile rheumatoid arthritis)

Autoimmune lymphadenopathy can be difficult to distinguish from infectious lymphadenopathy and may only be identified after early testing fails to uncover an infectious cause.

Medications That Cause Swollen Lymph Nodes

Certain medications can also cause lymphadenopathy. In such cases, lymphadenopathy can be reversed if the drug can be stopped or substituted.

Among the drugs that can cause swollen lymph nodes are:

• Apresoline (hydralazine)
• Cephalosporin antibiotics
  
• Capoten (captopril)
• Dilantin (phenytoin)
  
• Mysoline (primidone)
• Penicillins
  
• Quinidex (quinidine)
• Rituxin (rituximab)
• Sulfa drugs
• Tegretol (carbamazepine)
• Tenormin (atenolol)
• Zyloprim (allopurinol)
  

When Swollen Lymph Nodes Are a Sign of Cancer

Swollen lymph nodes are rarely a sign of cancer. However, painless swelling of one or more lymph nodes is a sign that your condition is not infectious and warrants immediate investigation.

This is especially true if lymphadenopathy is getting worse, spreading to other parts of the body, or is accompanied by symptoms such as loss of appetite, unintentional weight loss, easy bruising, or night sweats.

Among the cancers for which lymphadenopathy is common, include:

• Breast cancer
• Genital cancers (such as penile cancer or vulvar cancer)
• Head and neck cancers
• Hodgkin lymphoma
• Leukemia
• Non-Hodgkin lymphoma
• Melanoma and other skin cancers
• Metastatic cancer (cancer that has spread from other parts of the body)

Diagnosing and Treating Swollen Lymph Nodes

The diagnosis of lymphadenopathy starts with a review of your medical history accompanied by a physical exam. As part of the evaluation, you will be asked when your symptoms started and if the swelling was sudden or if it is persistent.

Additional tests may be ordered to help narrow the possible causes, such as:

• Lab tests, like a complete blood count (CBC), antinuclear antibody (ANA) test, and STI panel
  
• Imaging studies, such as ultrasound, X-ray, computed tomography (CT), or magnetic resonance imaging (MRI)
• Lymph node biopsy

While the treatment of lymphadenopathy can vary by the underlying cause, the swelling, redness, and pain can be eased with a cold compress or over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen).

When to See a Healthcare Provider

Swollen lymph nodes are usually a sign that your body is fighting an infection. If symptoms are mild, they may resolve on their own once the infection is cleared, such as with the flu.

However, swollen lymph nodes should be seen by a healthcare provider if they are:

• Very large and growing
• Painless
• Feel hard, are irregularly shaped, or are fixed in place
• Accompanied by fever, night sweats, or unexplained weight loss

In children, any lymph node larger than about 1/2 inch should be seen by a healthcare provider.

Lymph nodes should return to normal within two to three weeks following an infection. If the swelling doesn’t go down or the lymph nodes still feel tender, see your healthcare provider.

Summary

Swollen lymph nodes (lymphadenopathy) can be caused by an infection, autoimmune disease, medications, and certain cancers. The condition may be mild or severe, localized or generalized, acute or chronic. These factors can help the healthcare provider narrow the possible causes.

The diagnosis of lymphadenopathy may involve a physical exam, imaging studies, lab tests, and a lymph node biopsy. The treatment varies by the cause, but the pain and swelling can usually be relieved with a cold compress or an over-the-counter painkiller like Advil.