Axillary lymphadenopathy: overview and more

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Axillary lymphadenopathy, also known as adenopathy, describes changes in the size and density of the lymph nodes in the armpit (axillary lymph nodes). It is not a disease in itself, but a symptom associated with a variety of diseases and conditions, from mild infections to breast cancer .

Axillary lymphadenopathy can be a concern, especially if you are not sure what is causing it. To help you decide when to visit your doctor, this article looks at possible causes and symptoms to look out for. Learn more about the different tests your healthcare provider may order to make a diagnosis below.

Lymphadenopathy caused by infection or other inflammatory conditions is called lymphadenitis . To prevent lymphadenopathy from spreading to other lymph nodes in your body, your doctor may prescribe antibiotics, antivirals, or antifungals.

Symptoms

Axillary lymphadenopathy is characterized by swelling and inflammation of one or more of the 20 to 40 axillary lymph nodes in each armpit. The swelling can affect one armpit, called unilateral, or both armpits, called bilateral.

Unilateral swelling is often (but not always) a symptom of an infection or disease on that side of the body. Bilateral edema usually indicates a systemic disease, that is, a disease that affects the entire body.

Enlarged axillary lymph nodes can range in size from a small pea to a large grape. They can appear porous or hard, like marble. They can also be accompanied by additional symptoms, including:

  • Heat in the lymph nodes and surrounding skin.
  • Redness of the lymph nodes and surrounding skin.
  • Painful or painful lymph nodes
  • Lymphedema (swelling of the affected arm)
  • Fever and chills
  • Fatigue
  • Discomfort
  • Joint or muscle pain
  • Night sweats
  • Unexplained weight loss
  • Splenomegaly (swollen spleen)

Causes

Lymph nodes are part of the lymphatic system, which play a central role in immune function, fluid balance, and the absorption of fat and fat-soluble nutrients. Other parts of the lymphatic system include the lymphatic fluid, lymphatic vessels, spleen, tonsils, and thymus .

Lymphadenopathy is a sign that the lymphatic system has triggered an immune response to defend itself against an invader, such as infection or disease. The immune response works like this:

  1. First, the invader enters the lymphatic vessels and lymphatic fluid.
  2. Lymph fluid travels to the lymph nodes for the immune system to control.
  3. Once the invader is detected, inflammatory proteins ( cytokines ) and protective white blood cells ( lymphocytes ) are released. Its task is to isolate and neutralize the invader in the lymph node.
  4. As a result, inflammation and fluid build-up in the lymph node causes swelling. We recognize this tumor as lymphadenopathy.

Axillary lymphadenopathy can occur on its own or at the same time as lymphadenopathy of the neck or chest. Generalized lymphadenopathy describes the development of lymphadenopathy throughout the body due to a systemic disease.

There are many possible causes of axillary lymphadenopathy, including:

  • Local infection: For example, streptococcal and staphylococcal skin infections or other infections localized to the arm, hand, chest, or shoulder.
  • Short-term swelling: for example, after a tattoo on the shoulder or arm.
  • Vaccines: Measles, smallpox, tuberculosis, and anthrax vaccines are associated with unilateral lymphadenopathy on the same side of the arm where the vaccine was injected.
  • Strep throat: can affect the axillary lymph nodes and the cervical lymph nodes.
  • Cat scratch fever: It is caused by a cat scratch on the arm or hand.
  • Sporotrichosis – A rare, localized fungal infection that causes nearby lymph nodes to swell.
  • Hidradenitis suppurativa: a painful skin condition of unknown cause that affects the sweat glands.
  • Tularemia: a rare infection that usually affects the skin, eyes, lymph nodes, and lungs.
  • HIV: The axillary and cervical lymph nodes are often affected early in infection.
  • Autoimmune lymphoproliferative syndrome: syndrome characterized by swollen lymph nodes in the armpit, neck, or groin.
  • Lymphoma: Cancer of the lymph nodes and lymph tissue that causes swollen lymph nodes, usually in the armpit, neck, or groin.
  • Regional cutaneous tuberculosis: A form of tuberculosis characterized by scaly and crusty skin lesions.
  • Breast cancer: Axillary lymphadenopathy usually occurs with locally advanced breast cancer or inflammatory breast cancer.

Cancers of the lung, thyroid, stomach, colon, pancreas, ovaries, kidneys, and skin can also sometimes metastasize (spread) to the armpits.

Diagnostics

Axillary lymphadenopathy is usually identified on physical examination. Your healthcare provider can find them during a routine checkup, even if you don't have symptoms. To determine the cause, they will look at several factors, including:

  • Lymph node size
  • Number of enlarged lymph nodes
  • Pain or tenderness
  • Location (one-way or two-way)
  • Consistency (hard or fluffy knots)
  • Mat (whether the knots are spliced or individual)
  • Mobility (if the nodes are mobile or stationary)

Together, these clues can point to some diagnoses and help exclude others.

Diagnostic indications to evaluate lymphadenopathy
Symptoms Alleged cause (s)
Acute joint pain and stiffness, muscle weakness, rash Autoimmune
Fever, chills, fatigue, malaise Infection
Enlarged spleen, unexplained weight loss of more than 10% Lymphoma, metastatic cancer
Many small knots that look like "buckshot" Viral infection
Solid, painless, or hard elastic mass that sets Cancer
Swollen lymph nodes a few days to weeks after intercourse. HIV

Healthcare providers tend to be concerned about lymph nodes if they develop for no apparent reason. In such cases, additional tests may be ordered to help identify the causes.

Laboratory tests and procedures

In addition to the physical exam, your healthcare provider will look at your medical history and symptoms, such as recent vaccinations, unexplained weight loss, recent sexual intercourse, or abnormal skin lesions. This information will help them determine which tests to include in their training, for example:

  • C-reactive protein levels: High levels in the blood indicate generalized inflammation.
  • Erythrocyte sedimentation rate (ESR): A blood test that detects inflammation in the body.
  • White blood cell count: increased numbers of lymphocytes in the blood may indicate an infection
  • Testing for infection: possibly for HIV, tuberculosis, or strep.
  • Immunological blood tests: to detect an autoimmune disease.
  • Skin biopsy: A procedure that can be done if there are skin lesions.
  • Diagnostic mammogram or breast ultrasound – to detect breast cancer
  • Imaging tests: such as x-rays, ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI)
  • Lymph node biopsy – to determine if an infection, autoimmune disease, or cancer is involved

Differential diagnosis

Lumps and masses in the armpit do not always indicate lymphadenopathy. Some of them may be benign or malignant neoplasms not associated with the lymphatic system, for example:

  • Lipomas: benign tumors made up of mature fat cells.
  • Epidermal Inclusion Cysts – Benign cysts usually found on the skin.
  • Fibroadenomas : painless, benign breast lumps that can spread to the armpit.
  • Schwannomas: benign tumors of the lining of nerves
  • Malignant neuroendocrine tumors: cancer that affects the cells of the nervous and endocrine systems, sometimes affecting the armpit.

These conditions can usually be differentiated by imaging and other procedures, such as fine needle aspiration .

Watch out

Lymphadenopathy is not a disease, but rather a symptom of a disease, an infection, or an abnormal immune response. Therefore, there is no specific treatment for axillary lymphadenopathy itself. Instead, it is addressed by treating the underlying condition.

Symptoms of lymphadenopathy can be treated with some over-the-counter or home remedies. A cold compress can ease inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Aleve (naproxen) and Advil (ibuprofen) can also relieve pain and inflammation. If there is an infection, rest is vital.

For advanced breast cancer, the axillary lymph nodes are removed as part of a radical or modified mastectomy .

Summary

When your body detects a foreign invader, be it a disease, infection, or even a vaccine, your lymphatic system triggers an immune response to protect itself from the perceived threat. When lymphocytes and cytokines attack the invader, your lymph nodes will swell and cause lymphadenopathy.

Sometimes axillary lymphadenopathy can be a sign of a serious medical condition, such as HIV, lymphoma, or breast cancer. You should make an appointment with your doctor if you are concerned or:

  • Your lymph nodes are swollen for no apparent reason.
  • The swelling does not go away in two to four weeks.
  • The swelling continues to get worse.
  • Your lymph nodes feel hard, irregular, or fixed in place
  • You have a fever, night sweats, or unexplained weight loss.

Get the word of drug information

An enlarged lymph node is not uncommon. But it should never be ignored if it is persistent, severe, or unexplained. When visiting your doctor, provide as much information as possible about what you were doing or experiencing before the lymphadenopathy started. The more your healthcare provider knows, the faster a diagnosis can be made.

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