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Lymph nodes are an important part of the lymphatic system, which is a component of the immune system in humans. The lymph nodes are located throughout the body. They are responsible for protecting the body against diseases and infections. They often become swollen and tender due to infection, and later return to the normal size after the underlying condition has been successfully treated.

It may be noted that occasionally the lymph nodes tend to remain permanently enlarged after an infection. Such enlarged lymph nodes have a rubber-like consistency, non-tender, and less than one cm. Also, they do not possess any features which may indicate infection or malignancies. Such enlarged lymph nodes are called shotty lymph nodes.

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The clinical importance and size of lymph nodes

Lymph nodes are termed to be normal when they are less than one centimeter in diameter. It may however be noted that inguinal nodes which are larger than 1.5 cm, and epitrochlear nodes which are bigger than half a centimeter are often considered abnormal.

It is also important to note that specific diagnosis is hard to be determined on the basis of lymph node size alone. However, a study conducted on lymphadenopathy patients has revealed that patients with lymph nodes smaller than one square cm did not have cancer, while 8 percent of the patients with lymph node size varying between 1 to 2.25 cm2, as well as 38 percent of patients with lymph node larger than 2.25 cm2 had cancer. The studies though cannot be applied in primary care settings as they were conducted in referral centers.

It may also be noted that nodes that regress in size is a good thing, while continuously growing lymph nodes are a cause for alarm. Shotty lymph nodes are however considered as normal.

The consistency

The presence of stony hard nodes is an indication of metastasized malignancies. Shotty lymph nodes are generally soft. Rubbery or very firm lymph nodes may indicate lymphoma. Unlike cancers, infections or inflammatory disorders typically feature softer nodes. Shotty lymph nodes is a term that is used to describe the presence of larger than usual nodes which feel like buckshot below the skin. They are comparable to the cervical nodes present in children affected by viral diseases.

The tenderness and pain

Lymph nodes are enclosed within a capsule of connective tissue. When the lymph nodes swell up, then the capsule stretches, thereby causing pain and tenderness. Pain is generally caused due to suppuration or due to the inflammatory processes. It can also be caused due to hemorrhage of the necrotic center of a cancerous lymph node. Tenderness alone cannot be used to determine the presence or absence of cancerous nodes.

The matting

A cluster of nodes which feel bound together and appear to move as a single unit is considered to be matted. Shotty lymph nodes are not matted. Lymph nodes which experience matting can be cancerous or benign.

Other factors

It may also be noted that shotty lymph nodes are not accompanied by other symptoms such as fever, fatigue, weight loss, etc. which are characteristics of infected or malignant lymph nodes.

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