Cervical lymphadenopathy Flashcards
What causes it?
INFLAMMATION
Bacterial causes: Acute causes include β-haemolytic streptococci and Staph aureus; chronic causes include TB.
Viral causes: Epstein-Barr virus, Herpes simplex virus, cytomegalovirus, and HIV
Parasitic: For example, toxoplasmosis and fungal infections
Non-infective causes include sarcoid and connective tissue disorders.
In children, benign reactive lymph nodes are the most likely cause of neck lump.
MALIGNANCY.
How does it present?
INFLAMMATORY: Usually as acute, painful, swelling of lymph nodes. There may be associated symptoms of tonsillitis, pharyngitis or glandular fever. Occasionally, and abscess can form if the lymph node become necrotic.
MALIGNANT LYMPHADENOPATHY presents a s a mass in the left supraventricular fossa (Virchow’s node) may indicate metastatic malignancy from a primary tumour below the clavicle (for example lung or upper GI). Leukaemia can present with generalised lymphadenopathy. Other features include pallor, fatigue, fever, persistent infection, bruising and bleeding.
Signs on examination?
Lymphoma can occur at any age and presents with painless, rubbery lymphadenopathy often in the posterior triangle, and sometimes nodes in the axillae and inguinal areas. Systemic symptoms such as fever, night sweats, fatigue and weight loss may occur, and hepatomegaly may be an associated finding.
Investigations
Lymph node examination.
If lymphadenopathy is unexplained, consider a very urgent FBC.
In people >40 with supraclavicular lymphadenopathy or persistent cervical lymphadenopathy, consider an urgent chest X-ray.
Treatment
If someone becomes systemically unwell with cervical lymphadenopathy thought to be secondary to a viral upper respiratory infection, then advise medical review. Consider antibiotics for viral, and if not gone in two weeks, urgently refer to ENT. I won’t start to go into the treatment for lymphoma, but would be an urgent referral.
Conditions that would present similarly
Normal structures. Skin infections. Benign tumours. Malignant primary tumours. Thyroid lumps. Salivary gland lumps, congenital and developmental lumps carotid body tumours and aneurysms, trauma.
