Lymph nodes are filters that purify lymph from bacteria, viruses, toxins and cell decay products. All these agents enter the lymph from peripheral tissues and are neutralized by immune cells in the lymph nodes. In addition, they also undergo maturation of the T-cell link of immunity: T-helpers and T-killers, which are responsible for antitumor and antiviral protection of the body.
Lymph nodes that collect lymph from a specific part of the body are called regional lymph nodes. From the lower extremities, the perineum and the genital organs, lymph flows through the inguinal lymph nodes. They lie to the right and left of the perineum in the region of the inguinal ligament and large vessels of the lower limb, covered from above with subcutaneous fat and skin. Inflammation of the lymph nodes of the groin is called lymphadenitis of the inguinal region. The disease occurs in people of both sexes and more often develops in children, young and mature people.
It should be understood that not any enlargement of the lymph nodes in the groin is called lymphadenitis. A similar reaction occurs when exposure to viral infections, excessive sun exposure, autoimmune processes, overheating, and indicates the activation of the T-cell link of immunity. Immune cells in the nodes actively multiply and develop, which leads to functional hyperplasia (increase in the number) of lymphoid tissue. In healthy people, up to 5 groups of lymph nodes can be enlarged, which is not considered pathology. The conclusion is that in the word lymphadenitis means inflammatory changes in the tissue of the lymph node, which will be discussed below.
In an overwhelming number of cases inguinal lymphadenitis is caused by pathogenic and conditionally pathogenic microorganisms. They penetrate into the lymph nodes from the focus of inflammation, which is localized in the external genitalia, perineum, or in the tissues of the lower limb. The main pathogens of lymphadenitis include:
- Mycobacterium tuberculosis;
- yersinia pestis (plague stick);
- franciella tularensis (the causative agent of tularemia);
- tick-borne encephalitis virus;
- HIV ;
As a rule, inflammation of the inguinal lymph nodes develops against the background of the underlying disease, as a manifestation of dissemination of the pathogen with the current of the lymph. The following conditions lead to the appearance of lymphadenitis:
- furuncles of the lower extremity and perineum;
- infected abrasions, cuts, wounds;
- suppurated trophic ulcers;
- osteomyelitis of the bones of the lower limbs ;
- erysipelas of lower limbs, lower abdomen, buttocks;
- venereal diseases (syphilis);
- fungal nail and skin stop;
- phlegmon or abscess in the tissues of the lower limb and perineum.
Sometimes lymphadenitis is one of the signs of a growing tumor of lymphoid or other tissues:
- lymphomas ;
- lymphogranulomatosis ;
- metastases of melanoma located on the lower extremities, perineum, buttocks;
- metastases of tumors of external genital organs.
In each sex-age group, the most common causes of lymphadenitis can be identified:
- – инфицированные ссадины и раны нижних конечностей, опухоли лимфоидной ткани, остеомиелит; in children - infected abrasions and wounds of the lower extremities, tumors of lymphoid tissue, osteomyelitis;
- – половые инфекции (сифилис, хламидиоз), гнойные процессы вульвы (вульвит, бартолинит), инфицированные трофические язвы нижних конечностей, рожистое воспаление кожи; in women - sexual infections (syphilis, chlamydia), purulent processes of the vulva (vulvitis, bartholinitis), infected trophic ulcers of the lower extremities, erysipelas of the skin;
- – венерические болезни (сифилис, хламидиоз), воспалительные заболевания наружных половых органов (баланопостит, уретрит), фурункулы на ягодицах, нижних конечностях, опухоли лимфоидной ткани. in men - venereal diseases (syphilis, chlamydia), inflammatory diseases of the external genitalia (balanoposthitis, urethritis), furuncles on the buttocks, lower limbs, lymphoid tissue tumors.
What happens in the lymph nodes
Inflammation, regardless of the cause, always proceeds according to the same scenario. Any of the above factors (viruses, bacteria, tumor cells) damage the structure of the lymph node, as a result of which the biologically active substances are released from the damaged cells. The latter trigger a whole cascade of responses designed to stop the further spread of the pathogen. These include:
- vasodilation, leading to stagnation of blood in the lymph node;
- increased vascular permeability for blood plasma and immune cells;
- the exit of the liquid part of the blood into the tissue of the lymph node with the formation of edema;
- migration of leukocytes from the bloodstream into the lumen of the lymph node.
It would seem that the lymph nodes are filled with immune cells, why they are not able to cope with the pathogen themselves? The fact is that T-lymphocytes work in close cooperation with other immune cells and without their help "do not see" the enemy. In addition, their main function is the destruction of their own cells in the body, in which there have been some changes. For antimicrobial protection, neutrophils and monocytes of blood respond, they are in large quantities rushing to the focus of inflammation on the distress signal.
The further development of events depends on the stage at which the enemy can be destroyed:
- заканчивается на стадии формирования отека и активации иммунитета; Serous inflammation ends at the stage of edema formation and activation of immunity;
- – при гибели большого количества нейтрофилов, клеток лимфоузла и бактерий; festering - with the death of a large number of neutrophils, lymph node cells and bacteria;
- – при гнойном расплавлении капсулы лимфоузла и распространении процесса на прилежащую подкожно-жировую клетчатку. phlegmon - in purulent melting of the capsule of the lymph node and the spread of the process to the adjacent subcutaneous fat.
— это основной клинический признак пахового лимфаденита. Enlargement of lymph nodes is the main clinical sign of inguinal lymphadenitis. They stick out from under the skin in the form of rounded formations (a lump on the bend of the leg in the groin area), the skin above them is normal or hyperemic, they are painful on palpation. The general pattern is that the more pronounced the destructive process in the lymph nodes, the worse the patient's condition.
сопровождается выраженными болями в паху, из-за которых больной вынужден ограничивать движения в тазобедренном суставе. Purulent lymphadenitis is accompanied by severe pain in the groin, because of which the patient is forced to restrict movement in the hip joint. Any attempt to divert the limb stretches the inguinal ligament and causes him substantial suffering. The restricted purulent cavity is sometimes independently opened with the expiration of the yellow-green thick mass from it. With the further spread of the process with the formation of phlegmon, the general condition of the patient deteriorates sharply:
- his temperature rises to 39-40 degrees C
- it breaks muscles and joints, the head hurts, there is no appetite.
At the beginning of the process, the inflamed lymph nodes are mobile and not soldered with the underlying tissues. Gradually, the process captures subcutaneous fat and the capsule of neighboring nodes, resulting in the formation of motionless painful lymph nodes. The skin above them is usually changed - it acquires a purplish-cyanotic stagnant color, which persists for a long time in the form of a spot of hyperpigmentation.
The described clinical picture is the result of the influence of nonspecific microflora (staphylo-, streptococcus, Escherichia coli, Proteus, Klebsiella). Specific pathogens cause a characteristic change only in them in tissues, which we consider below. Most of the listed diseases occur both in adults and in childhood. Features of inguinal lymphadenitis in children - a violent reaction of lymphoid tissue for inflammation with a pronounced increase in lymph nodes.
Cat scratch disease - felinosis
The disease develops 1-2 weeks after a cat scratch or bite (most often homeless kittens) infected with one of the pathogenic types of chlamydia. A red spot forms on the site of the healing abrasion, which gradually transforms into a small skin ulcer. A couple of weeks later, regional lymphadenitis develops, and a large bubo is formed. The patient's condition worsens by this time, he has a high fever and signs of severe intoxication.
The disease develops slowly, the bubbling occurs after 2-3 weeks. Often, it forms a fistula, through which dense greenish pus is prominent. To confirm the diagnosis is important contact with the cat in the anamnesis, a prolonged course of the disease, the detection of antibodies in the patient's blood. Read more about the symptoms and treatment of felinosis .
Mycobacterium tuberculosis enters the inguinal lymph nodes rather rarely, usually from the gastrointestinal tract, bones and skin of the lower extremities, genital organs. They are well protected against the immune aggression of the body and freely travel through lymphatic vessels with a current of lymph. Mycobacteria settle in one or more lymph nodes of one group and cause in them a specific inflammation.
With tuberculosis lesions, 3 types of lymphadenitis are distinguished:
- – в лимфоузлах происходит усиленное размножение Т-лимфоцитов, они существенно увеличивают объем узла и делают его консистенцию плотной. Infiltrative - in the lymph nodes there is an increased reproduction of T-lymphocytes, they significantly increase the volume of the node and make its consistence dense. The course of the disease is benign, the nodes are not painful, they are not soldered to the surrounding tissues, the skin over them is not changed.
- – в полости лимфоузлов происходит распад ткани с нагноением и образованием творожистой крошковидной массы (казеозного некроза). Caseous - in the cavity of the lymph nodes there is tissue disintegration with suppuration and the formation of a curdled crumbous mass (caseous necrosis). Outwardly they increase in size, become dense, painful, soldered to the underlying tissues and skin. The skin at the site of the inflammation turns red, in some cases holes (fistulas) are formed on its surface that communicate with the lymph node cavity. Through them, pus and caseous masses come out, healing them slowly, through the formation of a scar.
- – характеризуется длительным течением, слабой выраженностью воспалительного процесса и преобразованием лимфоидной ткани в рубцовую. Indurative - characterized by a prolonged course, a weak manifestation of the inflammatory process and the transformation of lymphoid tissue into cicatricial. The lymph node decreases in size, becomes immobile, very dense. Soreness in palpation is moderate or weak, gradually it comes to naught.
Tuberculous lymphadenitis is accompanied by low temperature rise, increased fatigue, weakness, weight loss. The diagnosis is confirmed by isolation of mycobacterium tuberculosis from the contents of the node (see how TB is transmitted ).
Inguinal lymphogranulomatosis is the most common form of chlamydia infection in Europe. Infection occurs with unprotected sex. Initially, the genitals form a small painless erosion, which quickly heals without treatment. After 1,5-2 months in the groin, one or more lymph nodes increases, they are welded together, with tissues, the skin over them blushes.
Gradually, the nodes soften, through-holes are formed on their surface through which yellow-green pus is released outward. At the time of suppuration, the patient's condition worsens: his body temperature rises and intoxication develops. In the outcome of the disease, elephantiasis is formed in a number of cases - a pronounced swelling of the entire lower limb on the side of the lesion due to a violation of lymph drainage. The diagnosis is confirmed by the detection in the blood of specific antichlamydia antibodies.
Inguinal lymphadenitis in men and women often causes pale treponema - the causative agent of syphilis . The increase in lymph nodes occurs in the first stage of the disease, after several weeks from infection, which occurs sexually. At the site of infection, a painless dense tubercle is formed up to cm in diameter. Within 7-10 days, inguinal lymph nodes increase, usually on both sides.
All changes are inconspicuous for the patient character, since they do not bring any discomfort. Diagnosis of the disease is carried out by detecting specific antibodies in the blood and moving treponem in smears from the genital tract.
Bubonic form of plague
The disease is rare in the modern world, but the natural foci of the pathogen are still present in the countries of Central Asia (Uzbekistan, Tajikistan). The intensification of migration processes increases the risk of swine drift into our country, therefore, there is a certain epidemiological alertness towards it. The disease is transmitted through a bite of a flea or rat, after which a person becomes contagious to others.
Most often, plague occurs with the formation of buboes not far from the site of infection. Bubon - a large (3-5 cm) inflamed lymph node, in the cavity of which there is a pronounced disintegration of tissues and suppuration. When the plague, its contours are indistinct, it quickly cools with surrounding tissues, the skin above it is purple-cyanotic. The general condition of the patient is extremely difficult, it is exhausted by a high fever and general intoxication of the body. Confirmation of the diagnosis is carried out by bacteriological inoculation on the nutrient media of the material from the patient (blood being separated from the bubo).
Bubonic form of tularemia
In our country, the disease occurs in the steppe and forest-steppe zones (Bashkiria, Smolensk region, Orenburg region, Dagestan). Infection occurs when contact with rodents' skins and through the bites of bloodsucking insects. Bubo is formed near the site of the pathogen.
Tularemia bubon has clear contours, it is not soldered to the skin and adjacent lymph nodes. It slowly increases in size, suppuration occurs not earlier than the 3rd week from infection, the reverse development of the process is also prolonged. The patient's condition suffers moderately, pain in the groin is tolerable and does not disturb the activity of a person. The diagnosis is confirmed by the detection in the blood of antibodies to the pathogen and allergic test with tularemia toxin.
An isolated increase in inguinal lymph nodes occurs when metastasizing tumors from nearby tissues and, in some cases, at the onset of lymphoma or lymphogranulomatosis. Metastases cause a specific inflammation, in which the affected node becomes so dense that it is compared in hardness to the tree. Pain sensations are weak or absent at all, surrounding tissues are not involved in the inflammatory process.
With tumors of the lymphoid tissue all the lymph nodes of the inguinal group increase. The patient's condition worsens slowly, gradually, characterized by pronounced weakness and weight loss. Increase in temperature to 38-39 degrees C occurs with the disintegration of tumor tissue, with lymphogranulomatosis fever is easily transferred. The diagnosis is confirmed by a cytological examination of the lymph node's contents - it contains atypical cells.
Diagnosis of the disease is established on the basis of anamnesis, patient complaints, examination and palpation of the inguinal region. To determine the cause of lymphadenitis, the doctor uses laboratory tests and instrumental methods of investigation.
Anamnesis and complaints
The onset of the disease can be acute and gradual, depending on the characteristics of the pathogen. Data on unprotected sex, lower limb injuries, contacts with a cat, and the presence of tuberculosis or syphilis in the immediate environment are important. Patients complain about:
- discomfort in the groin;
- an increase in inguinal lymph nodes;
- painful sensations when walking, movements in the hip joint;
- feeling of heat and tension in the groin;
- redness of the skin above the inguinal nodes;
- the formation of fistulas on the skin through which pus / liquid / curds mass is released.
Examination and palpation
When examining the inguinal region, the doctor draws attention to the size of the lymph nodes, their mobility, the severity of the inflammatory process. On the active inflammation speak such signs as:
- Sharp soreness of the lymph node during palpation;
- pronounced edema of tissues surrounding the lymph node;
- immobility of the node due to its adhesion to surrounding tissues;
- dense-elastic consistency of the lymph node;
- bright red skin over the changed node.
The softening of the center of the inflamed node is a sign of the formed purulent cavity inside it. If its wall is spontaneously opened and the process captures subcutaneous fat, then in the groin area a painful compaction site is detected without clear boundaries - phlegmon. Fistulous passages on the skin look like holes through which pus and necrotic masses are excreted.
At a tumor process the inflammation is expressed to a lesser degree:
- an enlarged lymph node is insignificant;
- redness of the skin is weak or absent;
- The nodes do not weld to the underlying tissues;
- Painful sensations moderate or subtle;
- lymph nodes are hard to touch ("potatoes in a bag").
Laboratory and instrumental tests
To confirm the diagnosis, the doctor prescribes:
- general blood test - in the inflammatory process, the color index decreases, the number of leukocytes increases, the acceleration of the ESR;
- biochemical blood analysis - lymphadenitis causes an increase in the concentration of C-reactive protein, seromucoid in the serum, hyperproteinemia occurs in tumors of the lymphoid tissue (excessive protein content in the plasma);
- general urine analysis - in adults inflammation can detect protein in the urine, in children - ketone bodies;
- – они позволяют установить причину воспаления; the analysis of blood on specific antibodies to pathogens - they allow to establish the cause of inflammation;
- – изучение под микроскопом содержимого лимфоузла дает информацию о характере воспаления, возбудителе и наличии опухолевых клеток; microscopic examination - studying under the microscope the contents of the lymph node gives information about the nature of the inflammation, the pathogen and the presence of tumor cells;
- – происходит рост колонии микроорганизмов, благодаря чему можно определить вид, род возбудителя и его чувствительность к антибиотикам. bacteriological culture of the material from the lymph node to the nutrient media - the colony of microorganisms grows, so that the species, genus of the pathogen and its sensitivity to antibiotics can be determined.
Among the instrumental methods used:
- – позволяет определить изменения в легких при туберкулезе, обнаружить кальцинаты в лимфоузлах; X-ray - allows to determine changes in the lungs with tuberculosis, to detect calcifications in the lymph nodes;
- УЗИ – исследуются размеры узла, наличие и характер содержимого, состояние рядом лежащих тканей, нарушение оттока лимфы;
- биопсия пахового лимфоузла – его прокалывают иглой и забирают содержимое в шприц для дальнейшего исследования;
- ПЭТ – назначается при подозрении на метастазирование в паховые лимфоузлы для обнаружения первичной опухоли.
Вопросами лечения пахового лимфаденита занимаются различные специалисты в зависимости от основной патологии. Чаще всего он попадает в поле зрения:
Паховый лимфаденит у женщин иногда ведут гинекологи, если он сочетается с патологией по их профилю. Во многих случаях отдельную терапию лимфаденита не проводят, так как он самостоятельно проходит после устранения причинного заболевания. Если лимфоузлы в течение длительного времени не возвращаются к исходным размерам, проводят сеансы прогревающей физиотерапии (УВЧ, магнит, лазер).
Активного лечения требуют случаи гнойного воспаления лимфоузлов. Пациенту назначают курс антибактериальных препаратов широкого спектра действия, противовоспалительные и антигистаминные средства. Для предотвращения спаивания лимфоузлов в ряде случаев проводят электрофорез с ферментными препаратами (лидазой) .
При созревании гнойной полости, образовании свищей, флегмоны выполняется хирургическое вмешательство. Доктор под местной анестезией вскрывает лимфоузел, удаляет из него гной и разрушенные ткани, промывает его полость антисептическим раствором и неплотно ушивает несколькими швами. В узле остается дренаж, по которому воспалительный экссудат выходит наружу и проводится повторное промывание лимфоузла.
Воспаление паховых лимфоузлов в большинстве случаев – это не отдельное заболевание, а признак инфекционного или опухолевого процесса в области нижних конечностей и промежности. Попытки самостоятельно устранить лимфаденит сродни симптоматическому лечению, которое облегчает состояние больного, но никоим образом не влияет на развитие самого заболевания. Для назначения адекватного лечения и установления причины болезни необходимо посетить врача и пройти обследование.