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What causes enlarged lymph nodes?

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Posted on Fri, 18 Jul 2014
Question: Hi!

I*m a 24 year old female, non-smoker, no medication.

For the past about 7months I've been sick on and off with the flu (about 5 times past 6months) and had all sorts of infections which I've never ever experienced before (pneumonia, ear infections on both ears with ruptured eardrums, UTI, an eye infection). While suffering from the pneumonia ja ear infections in the beginning of April, I noticed a lump on the left side of my neck. Thought at the time it was enlarged because I was very sick at the time.
Also had some chest discomfort and trouble breathing about litle over a month ago, went to the ER and nothing was found that could've caused my feelings of discomfort.

The lump is still there (so been there for almost 3months now) and is accompanied by swollen supraclavicular node on the right side (size 8mm), one node in the right axillary area about 1cm and bilateral epitrochlear nodes about 1cm. Some sort of a lump is also palpable on chest, above the right breast. So these palpable nodes keep popping up like every few weeks.
I went to have an ultrasound few weeks ago and it showed bilateral enlarged nodes in the upper jugular region, size ranging from 1,8 to 2,3cm and 8mm right supraclavicular node. The radiologist said that all the nodes appeard benign. Also had an x-ray done, just to control my lungs after the pneumonia, nothing suspicious was seen on that.

But, I'm still kind of questioning whats causing all this, since more and more nodes keep swelling up.. Altough their size isn't all that concerning (besides the big ones on my neck), but the more rare location of some of the nodes (supraclavicular, epitrochlear).
Went to see my GP on friday and he didn't seem to be very used to palpating nodes in the areas noted and I had to show him where to find these swollen nodes. He said he wouldn't be too concerned since many of the nodes are somewhat small, but just in case he ordered some blood test, results from those are ready next tuesday.

So, what could be causing my lymph nodes to swell up in these rare places? How reliable ultrasound is in judging if nodes are swollen because of a bening or malign reason? What on earth could cause palpable epitrochlear lymph nodes? Would highly appreciate someones thoughts about my situation!
doctor
Answered by Dr. Grzegorz Stanko (12 hours later)
Brief Answer:
detailed below

Detailed Answer:
Hello.

Thank you for the query.

As you are able to palpate this lymph nodes you need to assume that this nodes are enlarged. No doubt in that.
Enlarged lymph nodes can be caused by an inflammation or cancer (including lymphoma).
Telling you that an ultrasound can determine if the nodes are benign or malignant is a hudge lie. Ultrasound can not do that. This is what histopathologist can do.
Chest x-ray is a test good for pneumonia detection. But not for possible cancer detection. Chest CT is the test which can do that.
So in my opinion you are not diagnosed well.
I suggest you to:
-have complete blood count and consult hematologist with this results
-lymph nodes should be collected and tested by a histopathologist
- chest CT should be done

Hope this will help. Feel free to ask further questions.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko (7 hours later)
Thank you so very much for your reply!

Funny how the doctors here in Finland seem to think that ultrasound can rule out malignacy, I understand it might help in that, but should'nt be 100% trusted on.

I know that enlarged nodes in the epitrochlear area are very unusual and I think that they may be so unusual that the GP had no idea what to think of them. And since they are relatively small (although big to be normal in that area), he thought nothing of them.

Once I get the results from my blood tests I will try to push for some more tests. If there is something wrong in my blood, it's probably going to fairly easy to get some more tests done, but if nothing points to something being seriously wrong, it might be a struggle to get things done. Then I might consult a private hematologist to see what he thinks of my situation.
But isn't it true that lymphoma may not show up in blood tests?

Lymphoma is obviously on top of the things I fear to have right now, so I want to be 100% sure I don't have that, or have a 100% sure diagnosis for that or something else.
Being worried about my health and not knowing the reason for any of this, is very frustrating.

But truly, thank you for you response, it gave me confidece to push for this to be thoroughly examined!
doctor
Answered by Dr. Grzegorz Stanko (35 minutes later)
Brief Answer:
.

Detailed Answer:
Its true, lymphoma can give no changes in blood work. However usually elevated WBC are present. For sure it needs to be done as a first test.
And as neither ultrasound or CBC wont rule lymphoma out, one of lymph nodes should be tested by a histopathologist. This is the right test to be 100% sure. And it is not so complicated to prevent your doctor from doing it. It seems your doctors simply ignore the symptoms.
Epitrochlear lymph nodes are really unusual location, but this only should force the doctors to keep searching for the reason.


Hope this will help.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko (43 hours later)
Went to see a doctor today since the results from the blood tests were already in. Different doctor this time, she also had trouble locating the epitrochlear nodes, which makes it even more obvious that those are not very commonly palpable. Although she said that nodes can be palpable all over, for no apparent reason, is that the case with the epitrochlear nodes also?
I just have trouble understanding why I'd have palpable nodes in places I've never ever felt lymph nodes before..

She felt my lymph nodes and said that "with 20 years of experience as a doctor, I wouldn't be worried".

When it came to my blood work, doctor said that all appeared to be quite normal (except for elevated eosinophils and monocytes), I'll put the results here with results from same test done before.

(reference value EOS 0.010-0.060, MONO 0.020-0.100)

27.6.2014 EOS 0.090 MONO 0.112
14.04.2014 EOS 0.043 MONO 0.058
29.08.2013 EOS 0.066 MONO 0.070

She thought nothing of those values, even though both seem to have doubled since April! She just said that, oh it's nothing since they're so slightly elevated, but I'm thinking it's not normal that they're so different compared with the tests done previously. Everything else have stayed just the same.
Your thoughts about this?

Should I just stop worrying or maybe schedule an appointment with a specialist?
doctor
Answered by Dr. Grzegorz Stanko (10 hours later)
Brief Answer:
.

Detailed Answer:
Lymph nodes can be palpable in the groins, armpits, neck and cervix. Small nodes in this area CAN be normal thing.
But supraclavicular nodes and for sure epitrochlear nodes are not palpable in normal conditions. No doubt in that.
As you have had this nodes palpable from some time (not since you have been born) this simply means that during this 7 months this nodes become larger than before. No doubt in that as well.
The doctor "would not be worried" as it is not about her. No diagnosis can be based on someones experience especially in that matter. Please note that every person is different and so are symptoms.
Elevated esynophils can be present with parasites in digestive tract or with lymphoma (Hodgins lymphoma for example).
Another thing is that you wont get comfortable as long as you wont get this lymph nodes diagnosed. This is completely understandable. So you wont be able to live your life without ruling out lymphoma. This is another reason to do not ignore it.
I do not say that you have lymphoma or any other cancer. Most likely you do not. But enlarged lymph nodes at young age along with chest discomfort, breathing problems and recurring infections CAN NOT BE IGNORED.
That is why I suggest you to consult hematologist even if your doctor does not seem to be worried. Lymph node biopsy or lymph node removal and histopathology test seems to be the key for your comfort of living.

Hope this will help.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko (42 minutes later)
Thank you so very much for your reply, once again!
doctor
Answered by Dr. Grzegorz Stanko (14 minutes later)
Brief Answer:
.

Detailed Answer:
You are welcome. Hope you will get well soon.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Grzegorz Stanko

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What causes enlarged lymph nodes?

Brief Answer: detailed below Detailed Answer: Hello. Thank you for the query. As you are able to palpate this lymph nodes you need to assume that this nodes are enlarged. No doubt in that. Enlarged lymph nodes can be caused by an inflammation or cancer (including lymphoma). Telling you that an ultrasound can determine if the nodes are benign or malignant is a hudge lie. Ultrasound can not do that. This is what histopathologist can do. Chest x-ray is a test good for pneumonia detection. But not for possible cancer detection. Chest CT is the test which can do that. So in my opinion you are not diagnosed well. I suggest you to: -have complete blood count and consult hematologist with this results -lymph nodes should be collected and tested by a histopathologist - chest CT should be done Hope this will help. Feel free to ask further questions. Regards