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Are palpable lymph nodes a normal finding?
Dec 24, 2001

Hi Bruce -

You recently answered a question for someone regarding what a "normal" size of a lymph node would be.

Your answers made sense, but I'm still confused and concerned -- hoping you could clarify.

I have noticed recently that I have what I would call "palpable" nodes in my neck region (collarbone, under jaw, etc). They do not feel swollen or enlarged, but I DO feel them as pea shapes under my skin. They are not rock hard. They are however somewhat hard, like a buckshot, and I can feel them if I look for them. Maybe this is what they call "shotty nodes"???

They are not protruding (i.e. - don't look swollen just by looking at my neck). They aren't abnormal or oddly placed nor are they tender. They are symmetrical it seems and they seem to be consistent in their location on my neck.

I guess I'm wondering if these are just plain and simply my lymph nodes/lymphatic system that I'm feeling, or if this is what is considered "enlarged" or "swollen" lymph nodes. Can you feel your nodes if your body isn't fighting an infection?

Obviously, I know you can't diagnose over the internet, I'm just going a little nuts over worried about my unknown HIV status after a low risk exposure 3 months ago(performing oral sex on an anonymous partner) and know that swollen nodes are common in HIV'ers.

I guess I'm curious if lymph nodes present themselves in this way in HIV infection or if these are just normal pea-sized nodes and I can just so happen to feel them because I'm skinny?

When nodes are referred to as "swollen" or "enlarged", does it literally mean just that?? (i.e. -Larger/more abnormal than a pea??) Or do these terms also refer to being able to acutally feel nodes in your neck, groin, etc.

Any thoughts you have would be great! I am going to get tested soon, but would love to put my mind at some sort of ease if I can until then. Thanks for reading -- sorry this is so long!

Response from Dr. Dezube

I've dealt with the issue of palpable lymph nodes on many other queries. I won't go over them again in great detail, but I do want to answer one of your queries.

Are palpable nodes a normal finding?? This is a reasonable question, but the answer is not necessarily straight-forward. The answer depends on how you define the word normal. In an HIV-negative person who is enjoying totally good health, then lymph nodes are typically not palpable (i.e. you can not feel them). However, in a particularly skinny person, then perhaps they might stand out. About 10-20% of healthy people will have lymph nodes which are palpable; are these normal or are these folks having some type of low grade infection which they are unaware of. No one really knows.

In HIV'ers, palpable lymph nodes are the rule, not the exception. This is the body's attempt to fight off infection. Often these lymph nodes are quite small and are refered to a "shotty". The shotty lymph nodes are sooooooo common that I usually tell my patients they are "normal". What I mean by that is that these lymph nodes are what is to be expected and they are not worrisome.

So rather than go back and forth with a discussion of whether or not palpable nodes are "normal" or not, it is more important to worry about lymph nodes which are clearly abnormal; these would be lymph nodes which are unusually large, or those that occur in the setting of systemic illness (fevers, chills, night sweats, weight loss). I hope I managed to clarify, and not confuse, the situation. BD.


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