Enlarged Cervical Lymph Nodes : Causes, Symptoms, Diagnosis & Treatment

• Causes Of Enlarged Cervical Lymph Nodes
• Thyroid Cancer
• Organic Thyroid Disease
• Rubella And Measles
• Other Infectious Diseases
• Tumors Of The Head And Neck
• Systemic Lesions Of Lymphoid Tissue
• Survey
• Symptomatic Therapy

Enlargement of the cervical lymph nodes (cervical lymphadenopathy) is the presence on the lateral and posterior surface of the neck of formations of lymphoid tissue larger than 5 mm, having an elastic or dense texture. The symptom is observed with viral and bacterial infections of the upper respiratory tract, inflammatory processes in the oropharynx, tumor formations of the neck and head. To determine the cause of lymphadenopathy, ultrasound, puncture biopsy, lymphography, and laboratory tests are prescribed. Symptoms are relieved with non-steroidal anti-inflammatory drugs, analgesics, antiseptics.

Causes of enlarged cervical lymph nodes

This group of lymph nodes drains the head, neck, upper chest, proximal upper limbs. Accordingly, enlarged cervical nodes most often indicate the presence of thyroid diseases, inflammatory processes in the oropharynx, bacterial and viral infections. The symptom is pathognomonic for rubella, develops with measles, and can be detected with rarer infectious pathologies - ornithosis, Ebola and Marburg fever, mycoplasma infections.

thyroid cancer

Thyroid neoplasias account for about 1.5% of all malignant neoplasms and in most cases are asymptomatic. The most typical variant is papillary cancer. Follicular tumors are quite common. With these volumetric formations, there is always an increase in the cervical lymph nodes, which indicates an increased proliferation of malignant thyrocytes, metastasis of tumor cells. Usually the lymph node remains soft and mobile for a long time, since the process does not affect the capsule and surrounding tissues.

Patients usually go to the doctor about an incidentally discovered thyroid nodule when it reaches 1 cm or more. As the tumor grows, other manifestations join: cough, hoarseness associated with compression of neighboring anatomical structures. Large neoplasms can compress the airways, causing shortness of breath and suffocation. When cancer spreads beyond the capsule of the organ, an expansion of the subcutaneous venous network occurs, deformation of the contours of the neck. In elderly patients, cachexia increases.

Cervical lymphadenopathy is one of the signs of thyroid lymphoma, an aggressive neoplasia characterized by intensive growth and involvement of neighboring organs in the pathological process. The disease often develops against the background of autoimmune thyroiditis. The tumor grows rapidly, occupying a whole share of the organ. Patients themselves often find a woody density node, which is combined with an increase and compaction of the cervical lymph nodes on the side of the lesion. Compression of the surrounding tissues provokes dysphagia, paresis of the vocal cords, displaces the esophagus and trachea.

Organic thyroid disease

In other lesions of the endocrine gland, an increase in lymph nodes is due to an increase in blood flow by 10-15 times, increased production and differentiation of normal lymphocytes in response to stimulation with foreign antigens. The size of the lymph nodes is more than 1 cm, they are elastic, not soldered to the surrounding tissues, sometimes they are sensitive to palpation. The symptom is typical for acute inflammatory processes, but it also occurs with benign neoplasms, chronic autoimmune thyroiditis. Lead to cervical lymphadenopathy:

• Acute thyroiditis . The disease begins suddenly with a sharp pain in the thyroid gland, which radiates to the lower jaw, ear. Lymph nodes increase on both sides, become very painful, redness of the skin is noted. Purulent thyroiditis occurs with an increase in temperature to febrile numbers, severe symptoms of intoxication. There may be complaints of a feeling of pressure and fullness in the neck, an increase in symptoms when coughing.
• Nodes and cysts. According to statistics, various benign thyroid tumors are detected in 10% of the population, but more often they are asymptomatic. An increase in lymph nodes in the cervical region occurs with inflammation or suppuration of cysts, hormonally active neoplasia. Lymph nodes are elastic, almost painless, the skin over them is not changed. A detailed clinical picture of thyroid lesions is observed with hyperproduction of hormones - thyrotoxicosis.

Rubella and measles

Cervical lymphadenopathy involving the posterior cervical and occipital nodes is an important symptom of rubella. Lymph nodes are moderately enlarged, painless, not soldered to the surrounding skin. For children, the appearance of "buckshot" lymph nodes is typical - multiple small formations on the neck. Simultaneously with lymphadenopathy, a rash occurs - punctate or papular rashes are localized on the extensor surfaces of the limbs, in the region of the trunk and head. The rash disappears in a few days, leaving no peeling and pigmentation.

Lymphadenitis with an increase in the cervical lymph nodes develops in the catarrhal stage of measles. Lymphadenopathy is combined with rhinitis, conjunctivitis, hyperemia of the pharynx and puffiness of the face. In adults, the manifestations of the catarrhal period are less pronounced. The pathognomonic sign of measles is Belsky-Filatov-Koplik spots on the buccal mucosa. After 4-5 days, a second wave of fever begins, which coincides with the appearance of a maculopapular rash. On the 1st day, the rashes are located on the face and neck, by the end of the first day they spread to the trunk, on the third day the rash goes to the limbs.

Other infectious diseases

Cervical lymphadenopathy is detected in various infections occurring in the oral cavity, ENT organs. Possible manifestation of a symptom in systemic bacterial and protozoal lesions - anginal-bubonic form of tularemia, sleeping sickness, diphtheria. Enlargement of lymph nodes is associated with the primary penetration and reproduction of pathogenic microorganisms, intensive proliferation and accumulation of specific clones of lymphocytes in the follicular and paracortical zones. With the defeat of the cervical lymphoid formations proceed:

• Congenital listeriosis . Infectious pathology develops with transplacental or intranatal infection of the child and manifests itself in the first days after birth. The defeat of the cervical nodes is combined with febrile body temperature, roseolous or hemorrhagic rash, granulomas on the oral mucosa. The late form is accompanied by muscle tremor, convulsive syndrome, enlargement of the liver and spleen.
• syphilis . After entering the body, pale treponema multiplies in the regional lymph nodes, causing their increase. Cervical lymphadenopathy is often observed when the pathogen penetrates through the mucous membrane of the oral cavity or lips, where the primary affect is localized - hard chancre. A month later, the chancre disappears on its own, then a polymorphic rash appears, which indicates the generalization of the infection and the development of secondary syphilis.
• Brucellosis . In the prodromal period, patients complain of myalgia, arthralgia, and headaches. A fever then sets in, lasting from a few days to 3 weeks, alternating with profuse sweats. At the height of the temperature, there is hyperemia of the face, an increase in the cervical and axillary lymph nodes, which can be painful on palpation. In the acute form, small fibrous formations appear along the tendons.
• Inguinal lymphogranulomatosis . An increase in the lymph nodes of the neck and submandibular region is noted in the secondary period with the localization of the primary affect (ulcer) in the area of ​​the oral mucosa and pharynx. As the disease progresses, lymphoid formations turn into large-tuberous tumors and lose mobility. In the future, the nodes suppurate, fever, intoxication join, fistulas form.
• Tonsillitis, pharyngitis . The reaction of the cervical lymph nodes is detected with tonsillitis, which is due to increased antigenic stimulation of lymphoid formations. The symptom is accompanied by sore throat, reddening of the pharynx and tonsils, fever. On the surface of the tonsils, yellowish dots or widespread plaque can be seen. An increase in lymph nodes is also found in herpetic pharyngitis, which is characterized by a vesicular rash on the pharyngeal mucosa.

Severe cases of tonsillitis can be complicated by a retropharyngeal abscess - purulent inflammation of the pharyngeal tissue. In addition to lymphadenopathy of the upper cervical and occipital lymph nodes, the patient is concerned about sharp pains in the throat, difficulty swallowing, with a large abscess, respiratory disorders are possible. The general condition is disturbed, the body temperature rises to 39-40 ° C. An increase in lymph nodes, combined with damage to the jugular vein and septicemia, is pathognomonic for Lemierre's syndrome. In children, cervical lymphadenopathy often indicates adenoiditis.

Tumors of the head and neck

Lymph from the face and neck enters directly into the cervical lymph nodes, therefore, with various malignant tumors of this zone, they are a typical site of metastasis. Lymph nodes are usually woody in density, tightly connected to the skin and surrounding tissue, and are not painful. Lymphadenopathy in certain types of tumors is the initial sign of the disease, when the primary neoplasm does not yet cause clinical symptoms. An increase in lymph nodes is observed with such malignant neoplasia as:

• New growths of the jaws. The tumor may be characterized by exophytic growth with the formation of a protruding nodule with ulceration. It is possible to proceed as a long-term non-healing ulcer with purulent-sanitary discharge. Bone damage (osteosarcoma) is evidenced by shooting pains, loosening and loss of teeth. Lymph nodes are enlarged on both sides, have a stony density, soldered to the skin, subcutaneous tissue.
• Tongue cancer . Although with neoplasia of this localization, an increase in the submandibular lymph nodes is more often noted, sometimes metastasis also occurs in the cervical group. Neoplasia of the tongue looks like a diffuse thickening of the organ with the formation of ulcers or local outgrowth of tissue. Pain syndrome appears early, eating disorders are expressed, emaciation progresses.
• Neoplasms of ENT organs. Cervical lymphadenopathy is a symptom of epithelial tumors of the nasopharynx, which are also manifested by nosebleeds, difficulty breathing. The symptom is determined with esthesioneuroblastoma and is combined with anosmia, nasal congestion, mucous secretions. Sometimes a unilateral enlargement and induration of the lymph nodes indicates ear neoplasia (basaliomas, epitheliomas, sarcomas).
• Eye tumors. Enlarged nodes are observed at an advanced stage of conjunctival neoplasms, when malignant cells grow into the surrounding tissues, spread by lymphogenous and hematogenous routes. An increase in the lymph nodes of the submandibular region and neck occurs with melanoma of the eye - an aggressive neoplasm of pigment cells, which progresses rapidly with the development of distant metastases.
• Thymoma . An increase in cervical lymphoid structures is detected in benign and malignant tumors of the thymus gland. Invasive neoplasm growth causes a compression syndrome with intense retrosternal pain, dry cough, and difficulty breathing. With compression of the peripheral nerves, Horner's syndrome, hoarseness, and dysphagia occur. About 30% of cases of the disease are accompanied by myasthenia gravis.

Systemic lesions of lymphoid tissue

Enlarged lymph nodes in the neck can be the first sign of lymphogranulomatosis - malignant hyperplasia of the lymphoid tissue with the formation of specific granulomas. The disease is characterized by the appearance of dense painless nodes, which are arranged in the form of a chain. In the local form of the lesion, an increase in one group of lymph nodes occurs, in the generalized form, total lymphadenopathy develops with damage to the internal organs. Cervical lymph nodes are affected in chronic lymphocytic leukemia, autoimmune lymphoproliferative syndrome.

Survey

An increase in the cervical lymph nodes, which is not accompanied by other symptoms, is an indication for consulting a hematologist. With a combination of lymphadenopathy with signs of damage to the organs of the respiratory, digestive systems, consultations of other specialists may be required. Diagnosis involves assessing the state of pathologically altered lymph nodes and identifying the cause of the condition. The most valuable are:

• Ultrasound . Ultrasound of the lymph node is performed to study the morphological structure of the affected tissue, the method allows you to detect hyperechoic and hypoechoic zones. Thyroid ultrasonography and thymus sonography are additionally recommended to determine the underlying cause of lymphadenopathy.
• Blood tests . Infectious and hematological diseases, in which an increase in the cervical lymph nodes is possible, are characterized by changes in blood counts. Patients are prescribed a standard general analysis, a biochemical study, and the determination of the level of acute phase indicators.
• Biopsy of the lymph node. The sampling of cytological material from the affected organ with subsequent histological examination is recommended to verify the diagnosis. The method is mainly used for the differential diagnosis of malignant tumors of the lymphoid tissue and metastases with other diseases.
• Lymphography . A radionuclide study of the lymphatic system with the help of the introduction of a special radiopharmaceutical is prescribed to study the ways of lymphatic drainage and exclude oncopathology. The method is widely used for the neck area, since standard radiography is difficult.

A further list of studies is formed taking into account the patient's complaints. Often, an examination of the upper respiratory tract is required - pharyngoscopy, rhinoscopy, laryngoscopy. To confirm the infectious etiology of the process, specific serological reactions are performed (RIF, ELISA, PCR). If there is a suspicion of a connection between the defeat of the cervical lymphatic structures and the pathology of the thyroid gland, a blood test for triiodothyronine and thyroxine, scintigraphy with radioactive iodine is performed.

Symptomatic therapy

In infectious diseases with lesions of the pharynx, gargling with an antiseptic solution is recommended to relieve local symptoms, inhalations and plenty of warm drinking are useful. To relieve pain in the neck and ENT organs, non-steroidal anti-inflammatory drugs, analgesics are prescribed. Etiotropic treatment is selected only after consulting a specialist. With a combination of cervical lymphadenopathy with febrile fever, palpable formations of the head and neck, a rapid deterioration in the general condition, it is necessary to consult a doctor as soon as possible.