What could be causing my enlarged lymph nodes, difficulty breathing, chest pain, night sweats, and leg weakness?

Urgent Evaluation for Lymphoma is Required

Your constellation of symptoms—multiple hard lymph nodes in different regions (axillary, cervical, popliteal), night sweats, unexplained weight loss (implied by weakness), and respiratory symptoms—strongly suggests lymphoma until proven otherwise, and you need immediate medical evaluation with imaging and likely biopsy. 1

Critical Red Flags Present

Your presentation contains multiple concerning features that mandate urgent investigation:

• Hard, non-tender lymph nodes in multiple sites (axillary, posterior cervical, popliteal) persisting for 3 months—this pattern is highly suspicious for malignancy rather than infection 2, 3
• Night sweats combined with lymphadenopathy is a classic "B symptom" of lymphoma 1
• Systemic symptoms including leg weakness (suggesting possible systemic involvement or paraneoplastic effects) 1, 3
• Respiratory symptoms with chest pain that may indicate mediastinal lymph node involvement or pulmonary complications 1

The American College of Chest Physicians guidelines emphasize that unexplained weight loss, fevers, night sweats, and/or the presence of lymphadenopathy must trigger further investigation for lymphoma 1. Hard lymph nodes (as opposed to soft, mobile, tender nodes seen in infection) are particularly concerning 2.

Immediate Diagnostic Workup Required

First-Line Imaging

• High-resolution CT (HRCT) chest scan is more appropriate than a simple chest X-ray given your respiratory symptoms and concern for lymphoproliferative disease 1
• CT imaging of neck, chest, abdomen, and pelvis to evaluate all lymph node regions involved 1

Advanced Imaging

• PET scan should be considered for pulmonary lesions (nodules >8mm, consolidations, or lymphadenopathy) when neoplasm is suspected 1
• This is particularly important given your multiple-site lymphadenopathy and systemic symptoms 1

Tissue Diagnosis

• Biopsy is recommended for lymphadenopathy with your clinical presentation 1
• The guidelines state that in patients with lymphadenopathy, growing lung nodules, and/or progressive disease, biopsy should be performed 1

Respiratory Symptom Evaluation

Your difficulty breathing after meals with chest/breast pain radiating to the back requires consideration of:

• Mediastinal lymphadenopathy causing compression of airways or esophagus 1
• Pleural involvement from lymphoma, which can cause chest pain and dyspnea 1, 3
• Pulmonary lymphoproliferative disease, which can present as consolidations, nodules, or lymphadenopathy 1

The chest pain pattern you describe (right-sided, radiating to back, under breast/rib area) could represent pleural involvement or chest wall invasion, both of which occur with thoracic malignancies 3, 4.

Why This Cannot Wait

The guidelines are explicit: lymphoma must be further investigated in patients with unexplained weight loss, fevers, night sweats, and/or the presence of lymphadenopathy 1. The combination of:

1. Multiple hard lymph node sites (not just one region)
2. Duration of 3 months without resolution
3. Constitutional symptoms (night sweats, weakness)
4. Respiratory compromise

...creates a high-probability scenario for lymphoproliferative disease that requires multidisciplinary review involving primary care physician, pulmonologist, pathologist, radiologist, and hematologist/oncologist 1.

Common Pitfall to Avoid

Do not accept reassurance that "lymph nodes can be normal" or "wait and see" at this point. Painless, hard, or persistent lymph nodes require imaging studies and possible biopsy 2. The 3-month duration far exceeds the typical 2-4 week timeframe for reactive lymphadenopathy from infection 5. Hard texture specifically suggests malignancy rather than inflammatory causes 2.

Next Steps

1. Seek immediate medical attention (within days, not weeks)
2. Request CT imaging of chest, neck, abdomen, and pelvis
3. Expect referral to hematology/oncology for biopsy planning
4. Do not delay—lymphomas are treatable but require prompt diagnosis and staging

Your symptom complex does not fit benign reactive lymphadenopathy, and the respiratory symptoms suggest possible thoracic involvement requiring urgent evaluation 1, 3.