Cervical lymphadenopathy is the swelling of the lymph nodes in the cervical region. It can be localized or generalized, depending on the involvement of other lymph nodes. The cause can be diagnosed by history taking, clinical examination, and various laboratory tests. Causes include infection, malignancy, autoimmune disease and rare diseases. Biopsy can be done to rule out malignancy. If it is due to malignancy, check for any metastatic lesions which can be done by CT scan.
KEYWORDS: Lymphadenitis, nodes, swelling
The lymphatic system consists of a collection of lymphatic vessels connected to lymphatic node which filter lymph fluid that gets collected throughout the body. Lymph nodes are present throughout the body. The head and neck region contains over 300 lymph nodes. It contains lymphocytes and works to protect the body against microbes, maintain adequate fluid levels, absorb nutrients, and remove certain waste products.
Cervical lymphadenopathy refers to the swelling of lymph nodes located in the neck. Lymphadenopathy is classified as localised or generalised lymphadenopathy. Localized lymphadenopathy should be evaluated with etiologies typically associated with the region that is involved according to lymphatic drainage system. When more than one area of lymph nodes is swollen it is called generalised lymphadenopathy. Some infections, certain medicines, immune system diseases and cancers like leukemia and lymphoma can cause this kind of swelling.
Classification of cervical lymph nodes:
- Level IA: Submandibular lymph nodes, Level IB: Sub mental lymph nodes
- Level II: Upper internal jugular lymph nodes
- Level III: Middle jugular lymph nodes
- Level IV: Lower jugular lymph nodes
- Level V: Posterior triangle
- Level VI: Central compartment
- Level VII: Superior mediastinal nodes
1. Infections: Physical signs include fever and pain. CBC reports show higher WBC than normal. In acute infection (bacterial), neutrophils are elevated. In viral infections, lymphocytes are mainly targeted. Monocytes are increased in tuberculosis, chronic inflammatory disease. Eosinophils are increased in allergic reactions and parasitic infections. FNAC and culture also aids in diagnosis of type of infection. Eg: Infectious mononucleosis, HIV, Cellulitis, measles.
2. Malignancies: Physical signs include no pain, loss of weight, fatigue, rapid increase in size of cervical lymph nodes. CBC report shows RBCs and platelets lower than normal, higher counts of WBC (100,000-4,00,000). Tumour markers, CA125 test, CT scan, MRI, Ultrasound, biopsy also helps in detection of malignancies and their metastasis. Eg: Lymphoma, leukemia.
3. Autoimmune Disorders: Physical signs include fatigue, skin rashes, numbness and tingling in the hands and feet. CBC shows increase in WBC. Antinuclear antibody test (ANA) helps in diagnosis of autoimmune disorders. Eg: SLE, Rheumatoid arthritis, Sjogrens syndromes.
4. Rare Diseases: Castleman disease is a disorder that involves an overgrowth of cells. Kikuchi's-Fujimoto disease. Rosai-Dorfman disease.
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- https://www.mayoclinic.org/diseases-conditions/swollen-lymph-nodes/symptoms-causes/syc-20353902
- Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis): report of a case with other autoimmune manifestations - Tina Mahajan, Richard C. Merriman, and Marvin J. Stone.
- Rosai Dorfman disease - Juan Rosai - National Organisation for Rare Disorders.