Swollen Lymph Nodes

[rwb]

I am a married 40 year old male with two noticeable swollen lymph nodes.  The first is the left auxillary lymph node, which I just notice it being swollen.  It is the size of a breakfast sausage, and painless with no visible signs of infection in the armpit.  The second is the right inguinal node (groin) which my surgeon upon examination said it was "impressive in size", bigger than the previous one described.  I believe I just noticed this one day over a year ago being large when i exited the shower.  Upon examination of the right leg, the surgeon saw no other swollen lymph nodes.  But he did see a mole on my right ankle that he said was "unusual".  This mole may have been around as long as the swollen right inguinal lymph node (over a year).  I have chest x-rays that were taken about 5 days ago, but no results given to me yet.  My blood work came back normal except for a raised liver enzyme count which they said was nothing to worry about by itself.  I am in very good shape except for degenerative disc disease between L1 & L2.  This was operated on 10 years ago.  The disc was operated using a scope.  The last time I was really sick was 4 years ago.  I had a bout with bronchitis.  I was given augmentin xr by the first doctor I went to see about the swollen nodes (three weeks ago).  This medication had no results.  What can be happening here?  Can I assume mono or any other viral infection is not a player due to the fact that my blood work didn't show abnormal white blood cell counts and I haven't been sick? Even if mono or some other infection was thought to be the reason,wouldn't it have been test for when they took three vials of blood from me? Would an infection stay around this long (over a year)in the lymph nodes?  Could the two seperate lymph nodes be swollen for the same reason?  I believe I can rule out any type of infection in the groin area.  No STD's or anal infections.  I am scheduled for a biopsy to remove one of the lymph nodes in the right inguinal lymph node area.  I am really thinking about cancelling the biopsy because I can't get anyone to tell me what they think it can be and what might happen if I don't get the biopsy.  I just get the range of culprits from the logical to the bizarre for the reason of my swollen lymph nodes.  With the information given to you, can you answer the questions above?  Are there certain diseases/infections that can be ruled out or are strong contenders knowing the information presented?  The last pit of info that I forgot to tell the doctor was that when i was 7 or 8, I had a very enlarged thymus gland.  At that time, the doctors wanted to do some procedure on it but my parents declined.  Could this be of any consequence?  Can I assume the chest x-ray will pick up on this?

Thanks for your help.

[Kevin Pho, MD]

Most common cause for enlarged lymph nodes is infection.  It seems like your doctors thought the same thing and give you the Augmentin.  If the lymph nodes persist, then other causes should be considered.

The most serious would be lymphoma (cancer of the lymph nodes).  This certainly needs to be ruled out if they persist.  I would recommend that you stick with the biopsy, since this is the best way to evaluate for this.

Another would be HIV.  If the enlarged lymph nodes persist despite antibiotics, I would consider being tested (via a simple blood test) to ensure this isn't the case.  

Regarding the thymus gland - a plain film isn't very sensitive for this.  If this is a concern, a CT scan should be considered for further evaluation.  

I would discuss these options with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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