Enlarged Lymph Nodes

Enlarged Lymph Nodes: Overview

Alternative Names: Lymphadenopathy

The lymphatic system is a complex network of thin vessels, valves, ducts, nodes and organs.  It helps to protect and maintain the fluid environment of the body by producing, filtering and conveying lymph and by producing various immune blood cells. The lumps that you feel in your neck or under your jaw when you have a cold or a sore throat are called lymph nodes.  Lymph nodes are part of the body's immune system.  They help to destroy infectious germs, such as viruses (e.g.  the common cold virus) and bacteria (e.g.  strep).  The lymph nodes make antibodies that will help keep you from being infected with a particular germ in the future.

The lymph system is present throughout the body.  Common areas where enlarged lymph nodes can be felt (palpable nodes) include the groin area (inguinal region), armpit (axilla), the neck (there is a chain of lymph nodes on either side of the front of the neck, both sides of the neck, and down each side of the back of the neck), under the jaw and chin, behind the ears, and over the occiput (prominence on the back of the head).  Their function is the same regardless of their location.

There are also lymph nodes that you can not feel, in your abdomen, pelvis and chest.

Lymph nodes play an important part in the body's defense against infection.  Swelling might occur even if the infection is trivial or not apparent.

Lymphadenitis is an infection and inflammation of one or more of the lymph nodes and usually results from an infection that begins near a lymph node.  Often caused by Staphylococcus aureus bacteria, this condition affects the nodes in the neck, groin and armpit.  It sometimes strikes individuals who have had coronary artery bypasses using a saphenous vein from the leg: The removal of this vein is accompanied by removal of related structures of the lymphatic system, lowering immunity to infection.

Acute lymphangitis is a bacterial infection in the lymphatic vessels which is characterized by painful, red streaks below the skin surface.  This is a potentially serious infection which can rapidly spread to the bloodstream and be fatal.

Lymph nodes are filters that can catch malignant tumor cells or infectious organisms.  When they do, lymph nodes increase in size and are easily felt.

While lymph nodes are the most common cause of a lump or a bump in the neck, there are other, much less common causes, e.g., cysts from abnormalities of fetal development or thyroid gland enlargement.  Usually, your doctor can tell the difference on a physical examination.

Causes and Development

When lymph nodes are active in fighting infection, they may become swollen and painful.  Usually, the pain is mild, and the lymph node does not get much bigger than 2 centimeters (slightly under 1 inch) in size.

Swelling of lymph nodes generally results from localized or systemic infection, abscess formation, or malignancy; other causes of enlarged lymph nodes are extremely rare.  By far the most common cause of lymph node enlargement is infection.  As a rule, when swelling appears suddenly and is painful, it is usually caused by injury or an infection.  Enlargement that comes on gradually and painlessly may result from malignancy or tumor.

Common causes of enlarged lymph nodes:

  • Infectious mononucleosis (behind the ears or neck)
  • Rubella, also known as German measles (behind the ears)
  • Tuberculosis (above the collar bone)
  • Mumps (salivary glands)
  • Ear infections or sore throat (neck glands, sometimes)
  • Infection in the scalp (behind the ears or in back of the head)
  • Impacted tooth (swollen gums)
HIV disease or AIDS; cat-scratch fever; juvenile rheumatoid arthritis; serum sickness; leukemia; Hodgkin's disease; non-Hodgkin's lymphoma; canker sores; drugs (such as phenytoin); typhoid vaccination; salivary duct stones.  Any persistently swollen lymph gland requires careful diagnostic study.

Lumps in the armpit (axilla) may arise from various causes, including:

  • Bacterial
    • localized infection, possibly somewhere in the arm or breast draining into the glands of the armpit, or infection within the armpit itself
    • cat scratch disease
    • ascending lymphangitis
    • lymphadenitis, lymphangitis
  • Viral
  • Malignant
  • Fungal
    • sporotrichosis
  • Antigenic
    • smallpox vaccination
    • typhoid vaccine
    • measles, mumps, rubella vaccine (rare)
    • allergic reaction possibly caused by sulfa drugs, iodine, or penicillin
  • Other
    • lipomas (harmless fatty growths)
    • benign cyst
    • normal breast tissue (breast tissue extends into the armpit area)
Cysts and superficial infections in the skin of the armpit may follow shaving or use of antiperspirants (as compared to deodorants).  This occurs most frequently in adolescents just beginning to shave.  Subcutaneous abscesses may also produce large painful lumps in the axilla.  Lumps may be produced by enlargement of the lymph nodes secondary to bacterial infections, viral infections, antigenic stimulation (as from vaccinations), and malignancy.

Treatment and Prevention

Generally, if you have symptoms of a cold or other minor infection, give the glands about 2 weeks to go back to normal.  No specific treatment for them is needed.  If the glands are small (less than 2cm or 3/4 inch across), are in your groin or under the chin, and you are a young adult, this is considered normal.  Children tend to have a more active lymphatic system, so their glands may feel enlarged.

In general, always check with your health care provider to determine the nature of the lump.  Do not try to diagnose lumps without professional help.

For a lump in the armpit caused by an infected, painful gland, follow the instructions about the proper treatment for the underlying infection.

Prognosis; Seek medical attention if...

Soreness in lymph glands usually disappears in a couple of days without treatment.  Glands become painful due to the rapid swelling of the gland in the early stages of fighting the infection.  It takes much longer for the gland to return to normal size than it did to enlarge.

A lump in the armpit caused by a generalized viral infection will eventually disappear without therapy.  A lump in the armpit caused by an allergic reaction will go away after the provoking substance is removed.  No treatment is necessary for a lump in the armpit caused by normal breast tissue, and usually no treatment is necessary for a cyst.  A lump in the armpit caused by a lipoma (fatty growth) is harmless, unless it grows so large that it causes discomfort.  For a lump in the armpit caused by a malignancy, follow the appropriate cancer treatment recommended by a doctor.

Call your health care provider if:

  • after several weeks of observation the glands do not get smaller
  • swollen glands are red and tender
  • glands are hard, fixed to the skin, or are growing rapidly
  • swollen glands are located behind the ear and there is also a scalp infection
  • symptoms such as weight loss, night sweats, fatigue, or prolonged fever are also present
  • one or more glands get larger over a period of 2-3 weeks.

KEY

Weak or unproven link: may be a sign or symptom of; may increase risk of
Weak or unproven link:
may be a sign or symptom of; may increase risk of
Strong or generally accepted link: often increases risk of
Strong or generally accepted link:
often increases risk of
Definite or direct link: is a sign or symptom of
Definite or direct link:
is a sign or symptom of
Moderately useful: often helps with
Moderately useful:
often helps with