Glands in the neck and elsewhere      

Introduction

Lymph glands, like fever, help us fight infection.

Symptoms

Tiny pea sized glands may be seen behind or in front of the  neck, and also in other parts of the body like the groin and armpit in young children. They are not painful or tender. The child is otherwise normal. These glands do not increase in size, but once noticed, remain for months without causing any harm to the child.  They are often secondary to a minor infection in the head, arms or legs. Your doctor will probably not ask for any test in such cases and will just reassure you. Notice is to be taken of glands have suddenly appeared in different parts of the body in a younger infant, especially if he also looks pale and sickly.

Serious attention also needs to given if  there is rapid enlargement of a gland or glands or if a 'big pea sized' or still bigger gland remains persistently enlarged.

Common Causes

• Local Causes
• Systemic illness

Local Causes

A sore throat due to a viral  or bacterial infection, or infection of the teeth and gums can cause enlargement of the glands in front of the neck. Infection of the scalp over the head like like boils and infection secondary  to scratching due to  lice , dandruff or chickenpox can cause swollen glands behind the neck. Small tender glands in this region can also be seen in viral infections like German measles and big non-tender glands due to glandular fever(also called  infectious Mononucleosis)

Glands in the armpits and groin can be enlarged due to a local infection (injury, boils, cat scratch or chickenpox).

A gland just above the collarbone, should be taken more seriously It could be due to infection in the lungs and more rarely due to a tumour in the chest. Sometimes, ot can follow vaccination with B.C.G.

Tuberculosis can also present as a glandular swelling in different parts of the body. In tuberculosis, there is a significant enlargement of the glands. The swelling often gets adhered to the overlying skin. Sometimes more than one gland is enlarged in the same region and these glands appear to get matted (stuck) to each other.

Systemic illness

Viral infections accompanied by a rash(German Measles, glandular fever) can result in enlargement of glands  in different parts of the body.

Tuberculosis can present as  a localized glandular swelling or as a more generalized disease.

Rare Causes

Malignant disorders like leukemia and lymphomas and infections like AIDS are to be kept in mind in any persistent glandular swelling, especially if associated with unexplained fever, severe anemia, tenderness in the bones,  and bleeding from any part of the body.

Management

In any persistent or significant enlargement of glands, the doctor will probably ask for the blood test, a skin test (montoux test), and a chest X-ray. If required, an ultrasonography of the abdomen may be asked for. If no definite cause is found, a biopsy of gland or FNAC fine needle aspiration of the gland may be undertaken.

Most glands secondary to local causes or glands due to viral infections get better on their own. Sometimes antibiotics may be required to treat the local cause. Occasionally,the gland become severely inflamed with redness being noticed on the overlying skin. It is painful and the child has fever. Besides antibiotics, such children may need hot fomentation and even surgery.

Common Causes

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