Cervical lymph

adenopathy
Prepared by: Jamal Q Ahmed
Supervised by: Prof. Dr. Ali Al
Zubaidi
Neck lumps
 The tonsil is lymphoid tissue and there is
similar material in posterior aspect of the
tongue and posterior wall of pharynx.
These three areas form a ring of lymphoid
tissue ( Waldeyer’s ring ).Over ¼ of the
lymph nodes in the body are connected
with cervical lymph nodes situated in the
head and neck region.
Characteristics of cervical lymph nodes in
different pathological situations
 Lymph nodes that are tender may be inflammatory
 In acute infections nodes are tender, soft & discrete
 In chronic infections nodes are firm and may even be calcified
like in TB
 Nodes that are increasing in size and are hard, or fixed to
adjacent tissues may be malignant.
 Nodes that are enlarged and firm and matted or rubbery may
be due to leukemia
 In lymphoma the nodes are rubbery , matted together and
fixed to deeper structures.
 In systemic infective disorders the nodes are firm, discrete,
tender and mobile
Causes of cervical lymph node
enlargement
 Infections
 Viral upper respiratory tract: an enlarged jugulodigastric
(tonsillar) lymph node is common
 Oral or local in drainage area ( dental, scalp, ear, nose or
throat): including cat-scratch fever and staphylococcal and
mycobactrial lymphadenitis
 Systemic infections
 Viral (infectious mononucleosis, cytomegalovirus virus, HIV)
 Bacterial like TB, syphilis, brucellosis
 Fungal like histoplasmosis
 Parasitic like toxoplasmosis, leishmaniasis, tularaemia
cont
 Malignant diseases
 Oral or in the drainage area ( usually oral, scalp, ear, nose or
throat and rarely thyroid)
 Lymphoreticular ( leukemia, lymphoma )
 Langerhans histocytosis
 Others
 Drugs
 Mucocutaneous lymph node syndrome ( kawasaki disease)
 Connective tissue diseases
Most common causes of swellings in
the neck at different ages
 Child
 Lymphadenitis due to a viral respiratory tract infection (RTI)
 Kawasaki disease
 Adolescent and teenager
 Lymphadenitis due to viral RTI
 Bacterial infections
 Glandular fever syndromes
 HIV infections
 Toxoplasmosis
Cont

 Adult ( third and fourth decades)

 Lymph adenitis
 Glandular fever syndromes
 HIV infection
 Malignancy
 After fourth decade
 Lymphadenitis
 malignancy
Diagnosis
 It is important to consider the whole body when
dealing with lymph node swellings; examination of
other sites particularly liver and spleen may be
necessary
 The main complaint is swelling (glands in neck)
 History should include date of onset, details of
any swelling such as duration, character, surface
texture and any detail of pain experienced
cont
 Most diseases is detected in nodes in anterior
triangle of neck
 Lymph in this site drains most of the head and
neck except of occiput and back of the neck
 Lymph adenopathy in anterior triangle of the neck
alone is often due to local disease, specially if
nodes enlarged in one side.
CONTD
 Alone enlargement of lymph nodes is due to immune
response to an infectious agent in the area of drainage
of nodes and nodes are firm, discrete and tender but
are mobile.
 Enlargement of cervical lymph nodes alone may also
be due to reactive hyperplasia in the drainage region
or metastatic infiltration, in which the nodes are
distinctly hard, fixed ,and in advanced cases may
ulcerate through skin
Generalized lymph node enlargement
including cervical lymph nodes
 Systemic infections, such as glandular fever syndromes
caused by EBV, cytomegalovirus, toxoplasmosis, and HIV
infection. lymphadenitis in TB may lead to neck swelling
( scrofula) and suppuration ( cold abscess)

 Idiopathic lesions such as sarcoidosis and kawasaki disease

 Neoplasms of lymphoreticular system, such as lymphomas

and leukemias
 Hepatospleenomegaly and LN enlargement in neck, groin, axilla.
Infective inflammatory conditions
 Viral infections with predominantly upper respiratory
and oral manifestations
 Usually several anterior triangle nodes specially
jugulodigastric nodes are enlarged often bilaterally, no
posterior nodes enlargement, no generalized LN
enlargement, no hepatospleenomegaly
 Any viral respiratory disease can be responsible from
common cold to viral tonsillitis
 Most of these viral infections also produce oral ulceration like
 Herpes simplex virus, herpangina, herpes zoster
Acute non specific bacterial infections
 Usually one or two nodes are involved
 Often unilaterally and in anterior triangle
 How ever lesion in back of scalp or neck may
cause posterior nodes enlargement
 Any bacterial infections in the drainage area
like dental abscess, pericoronitis, sinusitis, or
a boil in the nose can cause anterior cervical
LN enlargement
Acute specific bacterial infections
 Particularly in young children acute
lymphadenitis caused by staphylococcus
aureus in the absence of any detectable
point of entry of organism
 Usually submandibular LN
 Treated by antibiotics, if lesion is fluctuant
surgical drainage is necessary
Non-bacterial infections with multiple
systemic manifestations
 Several anterior and often posterior node
enlarged, with generalized enlargement and
in some instances hepatospleenomegaly.
such as :
 Hand , foot, mouth disease
 Viral exanthemata ( chicken pox, measles, rubella)
 Glandular fever syndromes, EBV, cytomegalovirus
infections, toxoplasmosis and HIV
Chronic bacterial infections
 Generalized lymphadenopathy is atypical
finding of secondary syphilis
 FNA of the cervical nodes is the most
reliable diagnostic method for tuberculosis
 Brucellosis
 Cat-scratch disease
Chronic granulomatous diseases
 CGD is a rare genetic immune defect of
leukocyte function in which neutrophils and
macrophages fail to kill catalase positive
bacteria such as staphylococci.
 Patients suffering from recurrent pyogenic
infections and may develop suppuring
cervical lymph nodes showing granulomas
on biopsy
Other conditions
 Toxoplasmosis
 By toxoplasma gondi
 Like glandular fever syndromes
 Kawasaki disease
 Non infective inflammatory conditions
 Sarcoidosis
 Crohn’s disease
 Connective tissue disorders like rhematuid arthritis and
lupus erythematous
 Drug induced ; phenytoin
Neoplastic
 Neoplasms that usually metastasis to CLN
 Oral squamous carcinoma
 Tonsillar cancer, the most common cause of metastasis in a cervical
node of unidentified origin
 Nasopharyngeal carcinoma
 Thyroid tumours
 Other metastatic neoplasms ( other than lymphoid )
 Metastasis from stomach or even testicular tumours to the lower
cervical lymph nodes specially supraclavicular nodes
 Lymphoid malignancies
 Swelling both ant. And post. triangles together with generalized lymph
node enlargement and often hepatosplenomegaly