Unilateral swollen lymph nodes
Lymph node swelling can occur on both sides as well as on one side. In the case of unilateral swelling, this may indicate a unilateral infection or inflammation of the tissue supplied by the corresponding lymph node. To confirm the suspicion of an inflammatory disease, blood tests are performed to check the inflammation parameters and antibodies against any pathogens.
If no focus of inflammation is found and there is a swelling of the lymph node even after several days, which may become even larger, a biopsy (surgical removal of a tissue sample) should be performed immediately. A malignant tumor, for example a lymphoma, can be responsible for the enlargement of the lymph node. If a metastasis has developed in the lymph node, the primary tumor must be searched for in the area of care. In principle, however, a malignant disease should not be assumed immediately after a lymph node swelling is detected. A physician should always be consulted in the case of new swellings that increase particularly quickly or persist for a long time.
How can lymph nodes be palpated?
In general, only superficial lymph nodes can be palpated. Deep lymph nodes, e.g. in the abdomen, cannot be detected this way. Lymph nodes can be palpated by palpating the skin and underlying fatty tissue with light pressure with the fingertips.
Swollen lymph nodes in the neck, under the armpit and in the groin are easy to palpate. The consistency, the mobility in the skin and any pain caused by pressure are assessed. Lymph nodes are suspect if they are enlarged and hardened.
A pressure painful, bulging elastic lymph node is a sign of infection and inflammation. Painless, hard lymph nodes that do not move against the skin are more likely to be suspected of serious diseases and require close examination. For superficial lymph nodes, palpation is the first and most important diagnostic procedure.
First the size is estimated by the doctor, then the painfulness and mobility is tested, distinguishing between movable and non-displaceable lymph nodes. This means whether the lymph node can be easily moved and shifted by pressure or whether it remains in place as if it were baked. The former is normal and therefore no indication of disease, the latter can be a sign of a tumor and possible malignancy.
In addition, the tactile findings are described (the consistency, for example, as hard or soft, the surface, among other things, as smooth or bumpy). Indications of a reactive (caused by infection) swelling are also given by the inflammation parameters in a blood test, as well as the patient’s medical history and other symptoms.Furthermore, ultrasound is suitable for the examination of the superficial and somewhat deeper lymph nodes. Very few lymph nodes can be palpated, however, so that the deeper lymph node swellings are often noticed late and due to other symptoms.
The deeper the lymph nodes are located in the body, the better the resolution of the examination procedure must be in order to display them, so that computer and magnetic resonance imaging is used. To determine the cause of lymphadenopathy (when acute infection is unlikely), it is often necessary to take a sample (biopsy) of the affected lymph node. This sample is processed in histology and pathology and the cells can be stained and thus visualized.
In this way, the pathologist can lead the way in clarifying the etiology (cause) between benign and malignant diseases. Occasionally, suspicious lymph nodes as a whole are surgically removed and sent to the pathology department for tissue examination. This is often done during breast cancer surgery, for example, to find out whether the tumor has already spread into surrounding lymph nodes. For this purpose, the first lymph node (sentinel lymph node, sentinel lymph node), which is located after the tumor and into which the tumor would first scatter, is “marked” with a dye or with the help of radioactive marking, removed and then histologically examined. The presence of a lymph node metastasis influences the patient’s prognosis.
