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Forum Name: Dermatology Topics

Question: Lump on the back of the head


 Linzb7 - Fri Feb 04, 2005 12:04 am

In the past couple of weeks I have noticed a small, walnut sized lump on the lower left had side of the back of my head. It is about an inch above the hair line. I have been suffering from headaches in that region also. When I touch it it hurts and is tender. Also I always feel a sort of tingling sensation in the region surrounding it. I didn't know if it was a swollen lymph node, but I've had those before and they weren't sore like this. Just wondering ... thanks.
 Kathy C, RN - Sun Feb 06, 2005 9:38 am

Hi Lindsay, Here is some information on lymph nodes. Of course seeing your physician is a must....

All of us have hundreds of lymph nodes scattered throughout our bodies as a critical part of our immune systems. This network of nodes functions as a powerful, intelligent filtration system to keep the insides of our bodies clean and healthy.

Tiny vessels called lymph vessels carry germs, foreign particles, and unhealthy or malignant cells to the lymph nodes, where they are trapped. Active lymph nodes enlarge as they attempt to destroy the unwelcome material.

The lymph nodes also function as schools. Lymphocytes, a type of white blood cell, study the foreign material so that they can produce antibodies, killer cells, and other substances to protect the body from the threat.

Sometimes the lymph nodes are overwhelmed in the process. Our defenders can be taken over by a cancer or an infection. These enlarged nodes can become a refuge where the invaders can hide and proliferate.

When evaluating enlarged lymph nodes the first consideration is whether these nodes are localized (in one or two adjacent regions of the body) or generalized (spread throughout the body, often including the spleen -- the largest lymph node -- which is found just under the rib cage in the left upper part of the abdomen). Generalized enlarged lymph nodes suggest that the body is responding to a whole-body problem, such as an infection (bacterial, viral, or fungal), an autoimmune disease (arthritis or lupus), a drug reaction, or a malignancy such as leukemia. The infection might be very mild, or might be as serious as HIV.

Localized enlarged lymph nodes are responding to events in the part of the body filtered by those nodes. A scratch on the finger can produce swollen nodes at the elbow and /or the armpit. Minor trauma to the foot is filtered by nodes behind the knee and in the groin.

localized nodes are most often noticed around the head and neck. They frequently grow in response either to respiratory infections of all kinds (ear infections, colds, sinus infections, etc.) -- or, to some combination of these.

Much less commonly, head and neck nodes can grow from cat-scratch-fever, tuberculosis, drinking unpasteurized milk (mycobacterial infections), or eating undercooked meat (toxoplasmosis). They can also grow from an isolated malignancy, such as a lymphoma.

Many people have a sunny attitude toward "swollen glands," not believing they will really be serious. Others believe these lumps to be harbingers of doom. The truth is somewhere in between. Most of these situations turn out to be fine, but enlarged lymph nodes should be respected.

When should you be concerned?

Location -- enlarged lymph nodes just above the collar bone often indicate serious disease.
Character -- nodes that are hard, non-tender, and irregular are very suspicious. Normal nodes are mobile beneath the skin. Fixed nodes, those that are firmly attached either to the skin or to deeper tissues, are often malignant. Nodes that are tender, inflamed, or rubbery in consistency usually represent an infection.
Growth -- enlarged nodes that continue to enlarge rapidly should be evaluated rapidly.
Associated symptoms -- fever, night sweats, or weight loss accompanying enlarged lymph nodes should be investigated thoroughly.
Size -- size does matter!
If lymph nodes remain truly enlarged for more than 2 weeks, or if other worrisome signs are present, then the next steps of evaluation include a complete blood count (CBC).

Other simple tests include a sedimentation rate (a general blood test that indicates whether something significant might be going on in the body as a whole), blood chemistries (LDH is often elevated in malignancies, AST and ALT are often elevated in infections that cause enlarged lymph nodes), and a tuberculosis skin test. Depending on the results, other studies might include tests for specific illnesses (mono or HIV), and an x-ray or an ultrasound to get a better picture of what is going on.

If the node remains enlarged , or continues to grow after 2 weeks, then a biopsy of the lymph node is indicated, unless the physical exam and lab tests are convincingly reassuring. At least half of the time, a biopsy does not reveal a definite cause for the enlargement, but the biopsy can rule out cancer and other serious problems.

Hope this helps.

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