difference between swollen and shotty lymph nodes

Right-sided supraclavicular nodes drain parts of the lung and mediastinum and are signals of intrathoracic lesions, particularly in the lung and esophagus. When it is not part of generalized lymphadenopathy, it is suggestive of a primary malignancy in either the abdomen or the chest. Supraclavicular adenopathy is almost always abnormal. However, a unilateral cervical mass that is firm and nontender should always raise the question of an undetected nasopharyngeal carcinoma. Bilateral cervical adenopathy is also prominent in tuberculosis, coccidioidomycosis, infectious mononucleosis, toxoplasmosis, sarcoid, lymphomas, and leukemias. Oropharyngeal and dental infections can also cause cervical adenopathy. For example, posterior auricular adenopathy suggests rubella, whereas unilateral anterior auricular adenopathy is associated with lesions of the conjunctiva and eyelids with the resultant oculoglandular syndrome seen in trachoma, tularemia, cat-scratch fever, tuberculosis, syphilis, epidemic keratoconjunctivitis, and outbreaks of adenovirus type 3 pharyngoconjunctival fever. In the absence of generalized adenopathy, enlargement of specific cervical lymph node groups can be helpful diagnostically. Starting from the top of the neck and going down, all of the various cervical lymph node chains should be evaluated including the preauricular, posterior auricular, occipital, superior cervical, posterior cervical, submaxillary, submental, inferior deep cervical, and supraclavicular, as noted in Figure 149.1.

The examiner's right hand explores the left side of the patient's neck and then the left hand of the examiner explores the right side of the patient's neck. For an examination of lymph nodes of the neck, the patient either sits or stands facing the examiner. Palpate in a systematic fashion, encompassing all accessible lymph nodes. Begin with a visual inspection of the area, looking for asymmetry or erythema. All major lymph node chains should be evaluated in a systematic fashion. The extent and location of lymphadenopathy are important in determining and providing diagnostic clues to the cause of lymphadenopathy. Matted nodes or nodes fixed to underlying structures should raise the question of malignancy or infection freely movable nodes are more likely to occur in benign conditions. Tender nodes are suggestive of an inflammatory process. Enlarged lymph nodes that have an irregular shape and a rubbery, hard consistency may be infiltrated by malignant cells. Lymph nodes that are smooth and relatively soft, but slightly enlarged, may be normal and reveal only hyperplasia when biopsied. Particular attention should be directed to the size, shape, and consistency of enlarged nodes. Lymph nodes can also enlarge due to cancer in the lymphatic system, such as Hodgkin disease.In searching for lymph nodes, one must be gentle otherwise, lymph nodes that are only minimally enlarged or embedded in tissue may not be apparent. Sometimes, the lymph nodes themselves can become inflamed and enlarged, a condition called lymphadenitis. However, the lymphadenopathy may be generalized, with lymph node enlargement in more than one area, which is typical of a viral illness. Swollen lymph nodes around the jaw may be due to an infection in the teeth or mouth. For example, an infant with a scalp infection may have enlarged lymph nodes at the back of the neck. Since enlarged lymph nodes are often near the source of infection, their location can help determine the cause. Bacterial infections, such as strep throat caused by the streptococcus bacterium, can also cause lymphadenopathy. Nearly all children will develop lymphadenopathy at some time, as the condition commonly occurs in response to an infection from a virus, such as an upper respiratory infection. As infection-fighting cells and fluid accumulate, the lymph nodes enlarge to many times their normal size. The lymphatic system is part of the immune system and functions to fight disease and infections.

Difference between swollen and shotty lymph nodes