Where are the lymph nodes in the neck and how to check their condition, knowing their location? Local examination: peripheral lymph nodes

IN initial examination many diseases ( malignant neoplasms, infectious, inflammatory processes) palpation is of great importance lymph nodes. IN healthy condition Not only are they not visualized, but they are also not highlighted. But with some pathological processes that occur in our body, they can increase, hurt and be released.

Examination of the lymph nodes allows you to determine their consistency, soreness, and degree of enlargement. It must take place in conjunction with general diagnostics. You can perform a digital examination of peripheral nodes. Of the internal ones, only mesenteric (mesenteric) are available.

Functions of lymph nodes

Lymph nodes are round formations up to 22 mm in size, resembling beans or peas. The consistency of healthy nodes is soft, small and difficult to palpate. In a child of the first year of life, they may increase in size and number. In some children, enlarged nodes may occur after past illness. Therefore, you need to find out whether this is a normal condition or requires urgent treatment.

In our body, lymph nodes perform the following functions:

• Immunological
• Filters and retains viruses and bacteria
• Produce white blood cells
• Take part in lymph outflow
• Participate in metabolism and regulation of digestion

Lymph node examination techniques

The point of the technique is to study those parts of the body where lymph nodes can be palpated. Places of greater accumulation of nodes are usually palpated: the ear, occipital, parotid region, axillary, elbow, groin areas.

What is usually determined during examination:

• Lymph node size in centimeters
• Coloring: both the node itself and the skin on its surface. IN in good condition it should be of normal color, without damage or redness
• Integrity of the skin (no fistulas, scars, wounds)
• Number of nodes (multiple or single)
• Soreness, mobility
• Consistency (soft, dense)

What is the palpation technique?

• The doctor is in front of the patient, with the exception of examining the popliteal fossae.
• Examine with the second and fifth fingers of both hands.
• They begin to palpate from top to bottom.
• The fingertips are pressed tightly against the skin.
• Feel the entire area in a circular motion.
• The position of the fingers should be parallel to the surface of the skin.

Each lymph node has its own palpation characteristics. In children, palpation is carried out according to the same algorithm as in adults.

Lymph nodes of the head

When examining the occipital nodes, fingers are probed above and below the back of the head.

Lymph nodes located behind the ear are probed from the beginning of the auricle and above the temporal bone.

Palpation of the parotid nodes is carried out from the base of the ear, cheekbones and to the jaw in a straight direction.

To palpate the nodes under the lower jaw, the head is tilted forward or straight. The phalanges of the fingers, in a semi-bent state, are placed in the area of ​​the chin on the surface of the neck, with slight pressure on the skin. Then, move towards the jaw. If there are inflamed nodes, they pass between the fingers. Since they are located one behind the other, they are palpated sequentially: from the corner of the jaw, in the middle and at the edge. In case of pathology, more than 9 of them are felt. The nodes under the chin are examined right hand, and the left one supports the patient’s head and the area from the chin to the edge of the jaw. The head is slightly turned and tilted forward.

In all cases, normal nodes should not be highlighted.

Cervical nodes

You need to feel them first on one side of the neck, then on the other. When examining the neck from the front, two fingers are placed along the muscles. They begin to feel with their index and middle fingers from lower jaw along the muscle. The phalanges of the fingers extend more towards the spine than the larynx. The nodes at the jaw edge are especially noticeable.

The sides of the neck are examined with straight fingers, which are placed parallel to the skin. They probe two sides at once, or in turn, from posterior muscles to the collarbone. Finger movements should be circular, sliding, without bending or pressing hard. Nodes up to 5 mm can be detected, this is considered normal.

Axillary nodes

The patient, while palpating the nodes under the armpit, should spread the upper limbs to the sides (about 30 degrees). The doctor's hands are placed, with phalanges slightly bent, in the armpit, along the shoulder. The patient lowers his hands, and the doctor moves down 6 centimeters lower with sliding movements. The movements are repeated twice and the condition of the palpated nodes is assessed. Normally, their number should be from 5 to 10.

Supraclavicular and subclavian lymph nodes

The surface is palpated from the neck muscles to the collarbone. They are palpated in the supraclavicular and subclavian fossae. Inspect using one index or middle finger.

The pits under the collarbone are probed by lowering the fingers deeply towards the deltoid muscles.

Cubital (ulnar) nodes

The patient's arm is held below the shoulder and palpated on each side in turn. The doctor examines the entire arm up to the armpit. Normally, the nodes should also not protrude.

Inguinal nodes

When palpating these nodes, the patient is either in a lying or standing position. Examining upper area thighs below the crease of the groin. Some of the enlarged nodes can go in a row near the fold, others along the thigh. The groin area is palpated one by one: first they look along the groin, then in the opposite direction. The fingers are placed parallel to the groin, the skin is slightly stretched towards the abdomen. The lymph node is detected using sliding, circular movements. Do it twice. In normal conditions they are found in numbers up to 15 and 20 mm in size.

Popliteal nodes

During examination, the patient lies horizontally. These nodes are located in the popliteal fossa. During the examination, the doctor holds the lower leg, bends and straightens the patient's knee. The lymph nodes under the knee are felt first with the leg straight, then with the knee bent. Afterwards, inspect the surface of the shin.

Palpation of the mesentery

Of all the internal ones, they are only available for palpation, since greatest number lymph nodes are found in this area. Inflammation may be noticed at its base. It should be palpated according to the rule of palpating the abdomen.

The palm, with slightly bent phalanges, is held parallel to the surface of the abdominal muscles. The fingers are buried three centimeters below the navel. As you inhale, the phalanges move upward. As you exhale, press on the stomach and move down five centimeters in a circular motion, then remove your hands. This is repeated several times.

This procedure, in a healthy state, is painless and the nodes cannot be felt. If during the examination pain appears and nodes are detected, then this is a symptom of inflammation. This may indicate diseases such as lymphogranulomatosis. Also, an infiltrate can be detected; purulent mesadenitis (inflammation) is already possible here.

Enlargement of nodes simultaneously in several places at once, occurs with some infectious processes(brucellosis, mononucleosis, toxoplasmosis).

Lymph nodes are part of the lymphatic system; through them, drainage of certain anatomical zones is carried out. Lymph nodes perform barrier and immune functions.

Lymph nodes in children - studies

Anatomical and physiological features of lymph nodes

Peripheral lymph nodes in children are round or oval formations of various sizes, usually located at the confluence of lymphatic vessels. The final formation of lymph nodes occurs in the postnatal period. In newborns, the capsule of the lymph nodes is very thin and delicate, the trabeculae are underdeveloped. Lymph nodes are small and soft in consistency, so palpation is difficult. The size and number of lymph nodes increase towards the end of the first half of life. In newborns and children of the first years of life, the lymph nodes have a characteristic clear-shaped pattern due to constrictions in the area of ​​​​the valves that are not fully formed.

By the age of 1 year, lymph nodes in children can already be palpated in most children. Together with gradual increase volume, their further differentiation occurs.

By 3 years of life, the thin connective tissue capsule is well defined and contains slowly growing reticular cells. By the age of 7-8 years, trabeculae gradually begin to form in a lymph node with a pronounced reticular stroma, growing in certain directions and forming the skeleton of the node. By the age of 12-13 years, the lymph node has a complete structure: a well-developed connective tissue capsule, trabeculae, follicles, narrower sinuses and less abundant reticular tissue, a mature valve apparatus. In children, lymph nodes located nearby are connected to each other by numerous lymphatic vessels.

During puberty, the growth of lymph nodes stops and they partially undergo reverse development. Maximum amount lymph nodes are counted by 10 years. An adult has more than 400 lymph nodes, their weight is about 1% of body weight (500-1000 g).

The reaction of lymph nodes to various (most often infectious) agents is detected in children starting from the 3rd month of life. At 1-2 years barrier function lymph nodes is low, which explains the frequent generalization of infection at this age.

In the pre-school period, lymph nodes can already serve as a mechanical barrier and respond to the presence of pathogens of infectious diseases with an inflammatory reaction. Children of this age often develop lymphadenitis, including purulent and caseous (with tuberculosis).

By 7-8 years, it becomes possible to suppress the infection within the lymph node. At this age and in older children, pathogenic microorganisms enter the lymph nodes, but do not cause suppuration or other specific changes.

Lymph nodes in children - examination

Questioning and examining the child

The child or his parents may themselves notice a pronounced enlargement of the lymph nodes; with lymphadenitis, there may be complaints of pain, swelling or redness in the area where the lymph nodes are located.

Upon examination, only significantly enlarged and superficially located lymph nodes can be detected. With lymphadenitis, hyperemia of the skin and swelling of the subcutaneous fatty tissue above the inflamed lymph node are detected.

Lymph nodes in children - palpation

The following groups of peripheral lymph nodes are available for palpation (the first 7 groups listed below are combined under common name"cervical lymph nodes"):

Occipital, located on the tuberosity of the occipital bone; lymph is collected from the scalp and back of the neck.

Mastoid, located behind the ears in the area of ​​the mastoid process, and parotid, localized in front of the ear on the parotid salivary gland; collect lymph from the middle ear, from the skin surrounding the ear, ears and outdoor ear canal.

Submandibular, located under the branches of the lower jaw; collect lymph from the skin of the face and mucous membrane of the gums.

The mental muscles (usually one on each side) collect lymph from the skin lower lip, mucous membrane of the gums and the area of ​​the lower incisors.

Anterior cervical, located in front of the armor. sternocleidomastoideus, mainly in the upper cervical triangle; lymph is collected from the skin of the face, from the parotid gland, mucous membranes of the nose, pharynx and mouth.

Posterior cervical, located along the posterior edge of the lats. sternocleidomastoideus and in front of the trapezius muscle, mainly in the lower cervical triangle; lymph is collected from the skin of the neck and part of the larynx.

Supraclavicular, located in the area of ​​the supraclavicular fossa; lymph is collected from the skin of the upper chest, pleura and apexes of the lungs.

Subclavian, located in the subclavian areas; lymph is collected from the skin of the chest and pleura.

Axillary, located in the armpits; collect lymph from the skin upper limbs, with the exception of the III, IV, V fingers and the inner surface of the hand.

Thoracic, located inside from the lats. axillaris, anterior under the lower edge of the lat. pectoralis major, collect lymph from the skin of the chest, parietal pleura, partly from the lungs and mammary glands.

Ulnar, or cubital, located in the sulcus bicipitalis (groove of the biceps muscle); lymph is collected from the skin of the third, fourth, fifth fingers and the inner surface of the hand.

Inguinal, located along the inguinal ligament; collect lymph from the skin lower limbs, lower abdomen, buttocks, perineum, genitals and anus.

Popliteal, located in the popliteal fossa; collect lymph from the skin of the foot.

Knowledge of the location of the lymph nodes and the direction of the lymphatic vessels that drain and lead lymph helps in determining the entrance gates of infection and the source of focal lesions, since sometimes no changes are found at the site of introduction of the pathological agent, while regional lymph nodes are enlarged and painful.

Palpation of lymph nodes

When palpating the lymph nodes, pay attention to the following parameters:

Size (normally, the diameter of the lymph nodes does not exceed 0.5 cm, i.e. not larger size peas). The following sizes of lymph nodes are distinguished:

• with millet grain (I degree),
• with lentils (II degree),
• about a pea ( III degree),
• with bob (IV degree),
• with hazelnut (V degree),
• with a pigeon egg (VI degree).

Enlargement of the lymph nodes can be symmetrical, widespread or isolated and reach such an extent that they become visible upon examination.

Quantity (no more than three palpable nodes in a group - single lymph nodes, more than three - multiple).

Consistency (soft, elastic, dense), largely dependent on the duration of the pathology; at chronic course of the process, the nodes are dense, in the acute phase they are soft.

Mobility (normally the nodes are mobile).

Relation to the skin, subcutaneous fatty tissue and to each other (normally not welded together).

Sensitivity and pain on palpation (normally insensitive and painless), indicating an acute inflammatory process.

Palpation of symmetrical groups of lymph nodes (with the exception of the elbow) is carried out simultaneously, with both hands. Usually healthy children You can palpate no more than three groups of lymph nodes (cervical, axillary, inguinal). Normally, the mental, subclavian, thoracic, cubital and popliteal lymph nodes are not palpable. The condition of the lymph nodes is normal if they are less than the size of a pea, single, soft-elastic consistency, mobile, not fused to the skin or to each other, and painless.

Except clinical trial lymph nodes, more if necessary accurate diagnosis the nature of their lesions are performed by puncture, biopsy and lymphography.

Lesions of lymph nodes in children

Terminology and semiotics of lymph node lesions:

Polyadenia- increase in the number of lymph nodes.

Lymphadenopathy- an increase in the size of lymph nodes, observed during infectious, inflammatory and neoplastic processes. In this case, an increase is possible both due to reactive hyperplasia as a result of the immune response to infection, and as a result of involvement of the lymph nodes directly in the inflammatory or tumor process.

Lymphadenitis- inflammation of the lymph node, manifested by pain on palpation, swelling of surrounding tissues (periadenitis) and redness of the skin over it. The nodes themselves become dense, and when purulent melts, fluctuate. When the surrounding subcutaneous tissue is involved in the process, adenophlegmon develops. Lymphadenitis can be acute or chronic, local or diffuse, caused by a general disease or local infection. If regional lymphadenitis has developed due to an inflammatory focus in the underlying part of the limb, then on its skin you can sometimes detect a narrow strip of hyperemia (lymphangitis) running from the site of inflammation to the node.

Violation of displacement lymph node occurs when it becomes inflamed and adheres to the underlying tissues, as well as when a tumor grows into it.

Local (regional) increase lymph nodes are noted in purulent skin processes: folliculitis, pyoderma, furunculosis, multiple miliary abscesses, infected wound, hidradenitis, etc.

With tonsillitis, diphtheria and scarlet fever, enlargement and tenderness of the anterior cervical lymph nodes are detected.

Rubella is characterized by significant enlargement and tenderness of the occipital lymph nodes.

At mumps First of all, the pre-auricular lymph nodes enlarge.

Cat scratch disease (felinosis) is accompanied by a long-lasting reaction of the cubital or axillary lymph nodes.

Tuberculosis of peripheral lymph nodes most often occurs in the cervical group. In this case, the nodes are a significant size, dense, painless package with a tendency to caseous disintegration and the formation of fistulas, after which uneven retracted scars remain. The nodes are fused to each other, to the skin and subcutaneous tissue. Similar changes are observed with actinomycosis lymphadenitis.

Non-communicable diseases, for example lymphosarcoma, can be clinically manifested by an increase in one group of lymph nodes (cervical or supraclavicular). In this case, the nodes are usually very dense, painless, without local inflammatory changes.

Generalized lymphadenopathy occurs in many infectious and non-infectious diseases, but in some of them it has certain diagnostically significant features.

Generalized lymphadenopathy is one of the characteristic and early signs of HIV infection. The lymph nodes are of moderate density, sensitive or slightly painful on palpation, are not fused to each other or to the surrounding tissues, and have smooth contours.

At infectious mononucleosis All groups of lymph nodes increase, but most significantly - the posterior cervical ones. They are often visible upon examination, especially when turning the head to the side. The development of lymphostasis and the appearance of puffiness of the face are possible.

With measles, generalized lymphadenopathy occurs, mostly affecting the cervical, occipital and axillary lymph nodes.

At adenovirus infection and parainfluenza, the posterior cervical, anterior cervical and occipital lymph nodes are moderately enlarged.

In chronic tuberculosis intoxication, almost all groups of lymph nodes are palpated; they are multiple, small and dense (“pebbles”).

With toxoplasmosis, the lymph nodes (usually cervical, axillary and inguinal) are enlarged to hazelnut, sometimes form packets, but each lymph node can be palpated in them. The nodes in this disease are painless and do not suppurate.

With plague and tularemia, there is a significant increase in lymph nodes in the form of large conglomerates - buboes, fused with brightly hyperemic and hot skin.

Lymphogranulomatosis usually begins with an increase in certain groups of peripheral lymph nodes, most often cervical and submandibular. Gradually, the lymph nodes enlarge and merge into large conglomerates. Their consistency is elastic, their quantity is increased, there is no pain, they resemble a “bag of potatoes” to the touch. Of decisive importance when carrying out differential diagnosis is histological examination biopsy samples of enlarged lymph nodes and detection of Berezovsky-Sternberg cells in them.

In acute lymphoblastic leukemia lymph nodes of all groups quickly increase in size, are juicy and painless.

Before you begin to palpate the lymph nodes, you need to remember their anatomical location.

Location of lymph nodes

It is known that there are more than 300 lymph nodes in the neck area alone. Superficial lymph nodes The heads and necks form two main groups - horizontal and vertical. The first group drains lymph from the scalp and neck. It is formed by the chin, submandibular, ear, and occipital lymph nodes. The vertical group of nodes predominantly drains lymph from internal structures head and neck. Its deep chain runs along the inner jugular vein(in the thickness of the sternocleidomastoid muscle), and the superficial one - along the external jugular vein, where lymph flows from the salivary glands and the auditory canal. Lymph from the very tip of the tongue drains into the mental nodes, from its anterior two-thirds into the mental and submandibular nodes, and from the posterior third into the deep lymph nodes of the neck. The lymphatic vessels of the arm and hand drain into the axillary and subclavian nodes. The ulnar lymph nodes are an intermediate group.

Lymph from the mammary glands drains medially into the internal thoracic chain, and laterally into the axillary lymph nodes. Lymph from the parietal pleura also comes here (which is why this group of lymph nodes must be palpated during examination of the respiratory organs!). Lymphatic vessels of the lower extremities drain into the popliteal and vertical chain inguinal lymph nodes. Lymph from the skin of the perineum, external genitalia and lower back drains into the horizontal chain of inguinal nodes, located primarily below the inguinal ligament. From the testicles, lymph drains mainly into the para-aortic lymph nodes, and from the genitals - into the pelvic, lower abdominal and para-aortic chains.

Lymph node examination

Lymph node examination involves examining and palpating the lymph nodes.

Progress of palpation of lymph nodes

If they are inflamed (lymphadenitis), then they become painful when palpating the lymph nodes, and the skin over them turns red. Sometimes small reddish stripes of inflamed lymphatic vessels (lymphangitis) are visible on the skin. Palpation of the lymph nodes is carried out with the pads of the fingers, in a circular motion. If the lymph nodes are enlarged, it is necessary to estimate their size (about the size of a pea, Walnut and the like), consistency, soreness, mobility, their adhesion to tissues. Lymph nodes of the head and neck can be examined from a position in front or behind the patient. Palpation of the lymph nodes is recommended on both sides simultaneously. First they palpate parotid lymph nodes, then tonsillar (at the angle of the lower jaw), submandibular (along the edge of the jaw) and mental groups of nodes. At the next stage, the doctor palpates the lymph nodes of the back of the head and posterior cervical triangle. The anterior group of lymph nodes in the neck is palpated along the edge of the sternocleidomastoid muscle. Palpation of the lymph nodes ends by palpating the supraclavicular nodes on both sides. Note that it is easier to palpate them at the moment take a deep breath sick.

To palpate the lymph nodes of the elbow, the patient's arm is moved to the side. Holding the hand in this position, palpate the ulnar nodes between the tendons of the biceps and triceps muscles, proximally medial condyle humerus. Axillary lymph nodes form several groups, of which three should be examined: the anterior ones - along the edge of the large pectoral muscle, rear - along the anterior edge of the latissimus muscle and upper axillary - at the very head of the humerus. IN the latter case The palpating fingertips should be directed towards the patient's head of the humerus. It is recommended to examine the lymph nodes of the lower extremities by palpation in the supine position. Superficial inguinal nodes form two chains. First, the horizontal chain of lymph nodes below the inguinal ligament is palpated, and then the vertical chain along the saphenous vein of the leg. Then, bending the patient's leg in knee joint, popliteal lymph nodes are palpated. At the same time, they clasp the knee with both hands so that the tips of the palpating fingers are in the depths of the popliteal fossa. It should be noted that the liver and also belong to lymphatic system and can increase with its pathology.

Enlarged lymph nodes may be clearly visible. It is always important to carefully examine the areas drained by enlarged lymph nodes, since their enlargement may be due to local pathological process, For example infected wound. In each case, the nature of lymphadenopathy (local or generalized) is clarified. In the latter case, it is necessary to exclude leukemia and lymphosarcoma. With tumor infiltration, the lymph nodes are usually painless on palpation. At the same time, they can reach significant sizes, become very dense, uneven and welded together with each other and surrounding tissues. If dense axillary nodes are detected, first of all, it is necessary to exclude or pleura. In lung cancer, the supraclavicular nodes are most often affected. With tuberculous lymphadenitis, caseous discharge from the lymph nodes (scrofula or scrofula) may be observed.

Sometimes during an examination, the doctor discovers 1-2 small, mobile and painless lymph nodes in the patient. In this case, it is recommended to re-examine them after a short period of time. If they do not increase in size and the patient does not develop new symptoms, then most likely their enlargement is not a serious problem.

Causes of enlarged lymph nodes

Causes of local lymphadenopathy

• local infections
• tumor metastases
• lymphogranulomatosis

Causes of generalized lymphadenopathy

• lymphomas and leukemias
• viral infections (HIV, mononucleosis)
• bacterial infections (tuberculosis, brucellosis, syphilis)
• toxoplasmosis
• sarcoidosis
• serum sickness

Structure of the lymphatic system

Organs of the lymphatic system include lymph vessels, lymph nodes, spleen, tonsils, thymus ( thymus gland). Lymphoid tissue also found in terminal Peyer's patches ileum, V lung tissue and liver. A network of lymphatic vessels seems to accompany the bloodstream. Through them, lymph, which is a white opalescent liquid, enters the lymph nodes. Lymph from certain regions is drained into each group of nodes. Small lymphatic vessels gather into large ones and, finally, into two main lymphatic trunks. Lymph from the upper right half of the body collects into the right lymphatic trunk, and then into the right subclavian vein. From other regions of the body lymph through the chest lymphatic duct drains into the left subclavian vein. Fats from the small intestine, bypassing the portal bloodstream, also enter the thoracic lymphatic duct, pulmonary vessels, and then into the systemic circulation through the mesenteric lymphatic vessels. The lymph nodes contain lymphocytic follicles and sinuses lined with reticuloendothelial cells (histiocytes and macrophages). The follicles of the cortical layer have a special germinal center rich in B-lymphocytes and macrophages. Each such center is surrounded by a muff of T-lymphocytes. Various antigens travel through the lymphatic vessels to the lymph nodes, where in response lymphocytes proliferate with the formation of antibody-producing B lymphocytes (plasma cells) and antigen-specific T lymphocytes.

It is usually believed that healthy person lymph nodes are not visible and cannot be palpated. This rule, which is fair in most cases, should be accepted only with certain reservations. Thus, given the widespread prevalence among the population various diseases teeth (caries, periodontitis, periodontal disease, etc.), we have to take into account the fact that many people manage without special labor palpate the submandibular lymph nodes. In practically healthy people, due to minor, sometimes unnoticeable injuries to the skin of the lower extremities, small (pea-sized) inguinal lymph nodes can be detected by palpation. According to a number of authors, detection of single small axillary nodes during palpation may also not be any serious diagnostic sign. Nevertheless, it should be emphasized once again that a more significant enlargement of the lymph nodes, especially in cases where it is detected already during examination, always serves as a symptom of one or another disease, sometimes very serious.

When examining different groups of lymph nodes, the data obtained must be compared with the results of examination and palpation of the same (symmetrical) group of lymph nodes on the other side.

Palpation of lymph nodes

During palpation, they determine first of all the size of the lymph nodes, which are usually compared with the size of some round objects (the size of a millet grain, a lentil, a small (medium, large) pea, a hazelnut, with a pigeon egg", "with a walnut", "with egg" etc.).

Clarify number enlarged lymph nodes, their consistency(doughy, soft-elastic, dense); pay attention to mobility lymph nodes, soreness upon palpation (a sign of inflammatory processes), cohesion with each other into conglomerates and adhesion to surrounding tissues, the presence of edema of the surrounding subcutaneous tissue and hyperemia of the corresponding skin area, formation fistula tracts and cicatricial changes (for example, with tuberculous lymphadenitis). In this case, the lesion may affect individual lymph nodes, their regional group (in case of inflammation, malignant tumors) or can be systemic, manifesting itself as a generalized enlargement of lymph nodes of various groups (for example, with leukemia, lymphogranulomatosis).

Palpation of the lymph nodes is carried out with the tips of slightly bent fingers (usually the second - fifth fingers of both hands), carefully, carefully, with light, sliding movements (as if “rolling” through the lymph nodes). In this case, a certain sequence is observed in the examination of lymph nodes.

First they palpate occipital lymph nodes, which are located in the area of ​​attachment of the muscles of the head and neck to the occipital bone. Then they move on to feeling behind the ear lymph nodes, which are located behind the auricle on the mastoid process of the temporal bone. In the parotid area salivary gland palpate parotid lymph nodes. Mandibular (submandibular) lymph nodes, which increase during various inflammatory processes in the oral cavity, are palpable in subcutaneous tissue on the body of the lower jaw behind the masticatory muscles (during palpation, these lymph nodes are pressed against the lower jaw). The mental lymph nodes are determined by moving the fingers from back to front close up midline chin area.

Superficial cervical lymph nodes palpated in the lateral and anterior areas of the neck, respectively, along the posterior and anterior edges of the sternocleidomastoid muscles. Long term increase cervical lymph nodes, sometimes reaching significant sizes, are observed in tuberculous lymphadenitis and lymphogranulomatosis. However, even in patients chronic tonsillitis Along the anterior edges of the sternocleidomastoid muscles, chains of small dense lymph nodes can often be found.

For gastric cancer in the supraclavicular region (in the triangle between the legs of the sternocleidomastoid muscle and the upper edge of the clavicle), a dense lymph node (“Virchow’s gland” or “Virchow-Troisier’s gland”) can be detected, which is a tumor metastasis.

On palpation axillary lymph nodes slightly move the patient's arms to the sides. The fingers of the palpating hand are inserted as deep as possible into the armpit (for hygienic reasons, the patient’s T-shirt or shirt is taken into the palpating hand). The patient's abducted arm returns to its original position; in this case, the patient should not press it tightly to the body. Palpation of the axillary lymph nodes is carried out by moving the palpating fingers in the direction from top to bottom, which slide along the lateral surface of the patient's chest. Enlargement of the axillary lymph nodes is observed with metastases of breast cancer, as well as with any inflammatory processes in the upper extremities.

On palpation ulnar lymph nodes Grab the lower third of the forearm of the patient's arm being examined with your own hand and bend it at the elbow joint at a right or obtuse angle. Then, with the index and middle fingers of the other hand, with sliding longitudinal movements, they probe the sulci bicipitales lateralis et medialis just above the epicondyle of the shoulder (the latter are the medial and lateral grooves formed by the biceps tendon).

Inguinal lymph nodes palpate in the area of ​​the inguinal triangle (fossa inguinalis) in a direction transverse to the pupart ligament. Enlargement of the inguinal lymph nodes can be observed in various inflammatory processes in the lower extremities, anus, external genitalia. Finally, popliteal lymph nodes palpated in the popliteal fossa with the leg slightly bent at the knee joint.

Enlargement of regional lymph nodes, for example in the neck, as well as in other areas, is sometimes the main complaint of patients, leading them to the doctor. In this case, it is rarely possible to see enlarged lymph nodes that deform the corresponding part of the body. The main method of examining lymph nodes is palpation. It is advisable to palpate the lymph nodes in a certain order, starting with the occipital, parotid, submandibular, submental, then supraclavicular, subclavian, axillary, cubital, inguinal.

Enlarged lymph nodes are observed in lymphoproliferative diseases (lymphogranulomatosis), systemic diseases connective tissue, for tumors (metastases). To clarify the cause of enlarged lymph nodes, in addition to general clinical and laboratory studies, a biopsy (or removal) of the node is performed for its morphological examination. Musculoskeletal system(joints, muscles, bones) is examined after the lymph nodes. In this case, the study begins with the identification of complaints, most often about pain or limitation of movements in the joints, then inspection and palpation are performed.

How to check the lymph nodes in the neck and what could their enlargement indicate? Before answering these questions, let us clarify what function these small organs perform in the human body.

General characteristics of lymph nodes

Lymph nodes are unique filters that check the lymph flowing through them for the presence of pathogenic microorganisms, modified cells and toxins. Positioned one after another along the neck, they screen out dangerous agents, isolate them and give a signal to turn on the protection. However, the capabilities of the lymph nodes are not limited to this.

Without waiting for a response from their central organs, they send lymphocytes to the source of the problem, trying to cope with it on their own. The stronger the attack harmful substances, the greater the load on the lymph nodes. It is in this situation that their increase occurs. When the body copes with the disease, the size of the lymph nodes will become the same.

Where does that same lymph come from? This is a transparent substance consisting of intercellular fluid. Lymph nodes filter lymph coming from organs. Along with them, the lymphatic system also includes the tonsils, spleen and follicles.

Consequently, by where the affected lymph node is located and from which part of the body the lymph comes to it, it is possible to determine the location of the source of the disease. And according to the results of a better examination, information obtained during professional palpation, as well as some associated symptoms- the type of illness itself.

Visual inspection

The first thing you need to do when you detect a swelling in the neck is to make sure that it is a lymph node. To do this, a visual inspection is carried out.

The cervical lymph nodes are located on the sides of the sternomastoclavicular muscle. From the very bottom edge of the neck to the very top. If you tilt your head slightly to the side and strain your neck, this muscle will begin to bulge.

If one or more lymph nodes in this area are enlarged, you should pay attention to the following indicators:

1. size;
2. the color of the skin surrounding the lymph node;
3. and its integrity - the presence of scars.

In a healthy person, the lymph nodes of the neck are not noticeable because they are located deep in the subcutaneous tissue. But if they are enlarged - more than 2 cm - it will not be difficult to detect them.

If the skin around the affected lymph node turns red, this is a sign of an inflammatory process. Scars or fistulas are an inflammatory process with suppuration that has passed or is currently occurring.

Most informative way examination of lymph nodes. Its principle is to find the lymph nodes in the area under study, press with your fingertips to the dense area and, making circular movements, determine:

• shape;
• elasticity;
• mobility;
• temperature in the study area;
• soreness;
• adhesion to the skin;
• the presence of fluctuations - pus, blood.

The palpation technique is different for different areas neck. The only constant condition is that the doctor is in front of the patient. Therefore, to examine your lymph nodes, it is better to ask someone close to you for help.

Lymph nodes in the neck can be felt on both sides, along the location of the largest and most convex muscle. First they check the back, then the front.

Palpation of the posterior part is carried out with four fingers at once. It is necessary to press the skin under the muscle, as it were, since the lymph nodes are hidden in the depths of the tissue underneath it.

To palpate the lymph nodes on the front of the neck, use two fingers - the index and middle. Palpation begins from the angle of the lower jaw and moves along the entire front side of the sternocleidomastoid muscle. The fingers are pressed to the spine - not to the larynx.

There are a number of other lymph nodes in the neck area:

1. occipital;
2. behind the ear;
3. chin;
4. subclavian;
5. parotid;
6. submandibular;
7. supraclavicular.

Along with the cervical ones, all these groups of lymph nodes ensure the full functioning of the immune system in the upper part of the human body. In medicine, it is customary to classify them separately from each other, but at the everyday level it is quite normal to consider them as a single system of lymph nodes located in the neck.

Therefore, let’s look at how these groups of lymph nodes are palpated:

• Occipital – place your palms on the sides of the neck, and use your fingers to feel the area under and above the occipital bone. Ideally, such lymph nodes should not be palpable.
• Behind-the-ear - place both hands, palms down, near the ears, and with your fingers, feel the entire behind-the-ear area, starting at the base of the ears and along the mastoid processes. Healthy lymph nodes cannot be palpated.
• Parotid - with four fingers, feel the area from the zygomatic arches to the edge of the lower jaw. Only the inflamed lymph nodes are felt.
• Submandibular - tilt your head forward, plunge four half-bent fingers of one hand deep into submandibular region. The next step is to make a scooping motion towards the edge of the jaw, which will allow the lymph nodes to slip under your fingers and press against the jawbone. Since the lymph nodes are located along the entire edge of the jaw, palpation is performed sequentially - in the extreme corners of the jaw, in the center, on the sides.
• Chin - you need to tilt your head slightly forward, this will help relax the muscles. The doctor, with one hand with bent fingers, probes the entire area of ​​the chin - from the hyoid bone to the end of the jaw. And with the other hand he holds his head so that it does not tip back.

Associated symptoms

Along with symptoms directly related to the lymph nodes, secondary symptoms that appear in certain diseases may also be observed.

Among them are:

• weakness;
• elevated temperature;
• all the signs of a cold and infectious diseases– sore throat, runny nose, cough;
• headache;
• pain when swallowing;
• increased sweating

Medical examination

If you find swollen lymph nodes in the neck area, you should contact your GP. To identify the cause of this phenomenon, he will conduct an examination and palpation.

He may also prescribe the following tests:

1. A blood test can help detect infection and leukemia.
2. Ultrasound is a necessary step to identify a tumor, cyst or inflammation.
3. Lymph node biopsy - performed if there is suspicion of cancer. A biopsy is a microscopic examination of a tissue sample taken from the area being examined.
4. Chest X-ray – to determine infection or tumor in chest. All organs in the human body are interconnected, and lymph nodes can become inflamed due to pathogenic processes occurring in nearby organs.

Causes of enlarged cervical lymph nodes

Depending on the pain of the enlarged lymph node, there are:

• Lymphadenopathy – painless enlargement, signaling that a disease is occurring in nearby tissues.
• Lymphadenitis is a disease in which an enlarged lymph node hurts. This is a sign of inflammation of the lymph node itself.

Most often, the cervical lymph nodes become inflamed due to a cold or sore throat, especially in young children. However, an adult may experience this phenomenon due to the development of a tumor or an immune disease. Therefore, you should not neglect professional medical help.

With the help of information obtained from examination and palpation, we can assume what kind of disease we are talking about:

• The lymph nodes are slightly enlarged, do not hurt, move when pressed, not just one lymph node is inflamed, but several at once. Most likely, the reason lies in impaired immunity. The doctor you should contact is an infectious disease specialist.
• A motionless and painless formation that has an uneven contour and resembles a “bump” is a sign of a serious and possibly dangerous disease. It is necessary to visit an oncologist as quickly as possible and undergo the necessary examination.
• Too painful swelling, hot, indicates a purulent process inside the lymph node. Urgently see a surgeon!
• A painful, palpable lymph node, the pain intensifies with pressure, the ball rolls slightly under the fingers. These symptoms indicate inflammatory process in the throat, neck or mouth. Visit an ENT doctor or therapist. If you have problems with your teeth, you may need to see a dentist.
• If several lymph nodes are enlarged at once, and even more so, if, along with the cervical ones, lymph nodes in other areas of the body are inflamed, it is necessary to urgently visit a doctor. This phenomenon may be a sign of the development of a viral or bacterial infection, which covered the entire body. And even a sign of blood cancer.
• Red skin over a swollen lymph node? Often we're talking about about suppuration. It is dangerous to postpone a trip to the surgeon, as pus can break through and get into the surrounding tissues.

It is often possible to determine the disease due to which the cervical lymph nodes have increased in size using ordinary palpation. However, even the slightest negligence can lead to a diagnostic error.

Feeling the cervical lymph nodes is not such a simple process. In addition, many systemic and immune disorders affect lymph nodes in several places in the body, which makes it even more difficult to identify the source of the pathology. Therefore, you should not engage in self-diagnosis and self-medication!

Entrust your health to specialists.