lymphatic disorders
heart and blood vessel disorders
Swollen Lymph Nodes
Not every person with swollen lymph nodes requires immediate evaluation by a doctor. The following information can help people decide when a doctor's evaluation is needed and help them know what to expect during the evaluation. In people with swollen lymph nodes, certain symptoms and characteristics are cause for concern. They include A node that is about 2 centimeters (almost an inch) or more in diameter A node that is draining pus A node that feels hard Risk factors for HIV infection (such as having been stuck with a needle used by another person or having engaged in high-risk sexual activities) or tuberculosis (such as living or working with a person who has tuberculosis or having recently moved from an area where tuberculosis is prevalent) Fever or unexplained weight loss If a lymph node is very painful or draining pus or other material, people should see a doctor right away. Other people should call their doctor. The doctor will decide how quickly they need to be seen based on the presence of warning signs and other symptoms. For people who have no warning signs and otherwise feel well, a delay of a week or so is not harmful. The doctor first asks questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the swollen lymph nodes and the tests that may need to be done (see table Some Causes and Features of Swollen Lymph Nodes ). Doctors ask Where the swollen nodes are located How long nodes have been swollen Whether the person has pain Whether the person has recently had an injury (particularly cat scratches and rat bites) Whether the person has an infection or symptoms of an infection (for example, a runny nose, cough, fever, sore throat, unexplained weight loss, or tooth or gum pain) Doctors then do a physical examination. Doctors check for fever and examine areas where lymph nodes are found. Doctors check the person for any signs of infection or lumps elsewhere in the body. People who have swollen lymph nodes throughout the body usually have a disorder that affects the entire body. However, people who have swollen lymph nodes in only one area may have a disorder that affects only that area (for example, an infection) or more widespread disease. Sometimes, the history and physical examination findings suggest the cause, as for example when the person has an upper respiratory infection or a dental infection. In other cases, findings do not point to a single cause. People with warning signs are more likely to have a serious disorder, but people with lymph node swelling and no other symptoms may also have a serious disorder. Nodes that are hard, very enlarged, and do not move when pushed may indicate cancer. Tenderness, redness, and warmth in a single enlarged lymph node may indicate an infection of the node. If doctors suspect a specific disorder (for example, mononucleosis in a young person with fever, sore throat and an enlarged spleen), initial testing is directed at that condition (see table). If history and physical examination do not show a likely cause, further testing depends on the nodes involved and the other findings present. People with warning signs and those with widespread lymph node swelling should have a complete blood count and chest x-ray. Doctors may also test for tuberculosis, HIV infection, and mononucleosis. Sometimes blood tests are needed to detect toxoplasmosis and syphilis. In people with joint pain or stiffness or a rash, blood tests are done for systemic lupus erythematosus (lupus). If doctors suspect cancer or lymphoma, the person has a lymph node biopsy. Biopsy may also be needed when widespread lymph node swelling does not resolve within 3 to 4 weeks. 