How many of us have experienced neck swelling?
At least once in our lifetime, we have noticed the appearance of small swellings at our neck when we are having sore throat. More often, children have multiple but tiny neck swellings at their neck and lower scalp area.
What causes the swelling?
Our body has a defence mechanism composed of the lymphatic system. Lymph node is part of this system. In presence of infection, cancer or other diseases- the node grows in size & becomes noticeable under the skin. Generally, we name this condition lymphadenopathy.
We have lymph nodes in the axilla (armpit), inguinal (groin crease) and abdomen as well, but I will be discussing on cervical (neck) lymph nodes. Below, I have provided few scenarios to illustrate the wide spectrum of diseases which can cause lymphadenopathy.
Patient 1:
A 5 year old boy came in with noticeable painful neck swelling at the front upper neck after having fever and sore throat for few days. Examination revealed enlarged tonsils with whitish spots and enlarged neck lymph nodes about 1 cm at both sides of his neck. Most likely diagnosis was tonsillitis with infection of the lymph nodes – which we call lymphadenitis.
Children are more common to have lymphadenitis. Sometimes it appears at the neck and lower scalp, usually less than 1 cm in size. It is prudent to look for possible underlying infection in the head & neck area- especially mouth, teeth, throat and scalp. The causes are usually viral or bacterial. Trial of antibiotics is sometimes given if the child is symptomatic for infection and if the cervical lymph node is large.
Tuberculosis (TB) of the lymph node (tuberculous lymphadenitis) is quite common in our region within any age group. Fine needle aspiration cytology (FNAC) is done, whereby a small needle is inserted into the swelling and the cells are aspirated on to glass slides, processed and examined under microscopy by the Pathologist. In many cases, 94% of diagnosis can be achieved with this method. On rare occasions, the tuberculous swelling may burst with pus.
Patient 2:
A 10 year old boy presented with progressive neck swelling on both sides of the neck for 1 month with intermittent fever (image 1 & 2). He did not have any oral or throat symptoms. He was investigated for tuberculosis, but all were negative. He had anopen incisional biopsy under general anaesthesia for confirmation of disease. His result revealed a final diagnosis of lymphoma.
Source: Dr. Ahmad Nordin
Source: Dr. Ahmad Nordin
Image 2: Right neck swelling of same boy with skin inflammation. Lymphoma also rarely has skin changes as in this case .The sutures at top of swelling are of previous incision biopsy at 6 days post-surgery.
Rarely and fortunately, cases which are similar to this, do not occur often. A neck swelling of a lymph origin, which is enlarging and painless, should be referred as early as possible for proper workup.
Patient 3:
A 50 year old gentleman came in complaining of left neck swelling for 3 months, which was painless and increasing in size. On further history, noted to have mild nosebleed 6 months earlier and gradual block of the left ear.
Examination of the neck revealed enlarged left neck lymph node measuring 3 cm in size. The right ear appeared to have otitis media (inflammation of the middle ear) with effusion, which is presence of fluid in middle ear space, behind the ear drum (image 3). Nasal endoscopy revealed a mass in nasopharynx (image 4). Unfortunately, this man has nasopharyngeal cancer, which I have discussed in my earlier articles.
Image 3: Left neck massive cervical lymphadenopathy
Image 4: endoscopic view of the ear canal showing the ear drum (tympanic membrane) which is sucked inwards due to otitis media with effusion caused by the cancer.
Source: Dr. Ahmad Nordin (with permission)
Image 5: Endoscopic view of the nose into the nasopharynx revealing a cauliflower like mass on the patient’s left nasopharynx (right side of the picture). Patient’s right nasopharynx appears normal
Nasopharyngeal Cancer (NPC) is one of the causes for lymphadenopathy in this region. Cancer of the head & neck region, and even the lung & gastrointestinal system may give rise to swelling at the neck through metastasis (The spread of a disease-producing agency (cancer cells) from the initial or primary site of disease t anohte rpart of the body).
In conclusion & to answer the question “Should I be worried if I have swollen lymph glands?”
There are many causes of lymphadenopathy. It is best to seek your nearest doctor for thorough check up, especially if the size of the neck swelling is larger than 1 cm. In most cases, it is due to a self-limiting infection. But do not let this be an excuse not to get treatment. An ENT (Ear, Nose, and Throat) referral should be made in any case which is out of the norm.
(Pictures are taken for internet display with permission from patients and/ or guardian and staff concerned. This article is also available in Bahasa Malaysia here).
Dr Ahmad Nordin is an ENT surgeon currently working in Sabah. Learn more about him at The Team page.
References:
- Cervical lymphadenopathy – diagnosis by F.N.A.C., a study of 219 cases, A. B. Pandav, P. P. Patil, D. N.Lanjewar Asian J Med Research, Jul-Sep 2012 Vol-1 Issue-3 79-83
- The Royal Children’s Hospital Melbourne Cervical Lymphadenopathy Clinical Practice Guidelines, Accessed 28 October 2013