Clinical approach to lymphadenopathy

What it is

Cervical lymphadenopathy is swelling of lymph nodes in the neck. It sits among the other neck masses, which are grouped by where they lie. Central neck masses are thyroglossal cyst, thyroid mass, submental lymphadenopathy and cervical cleft. Anterior triangle masses are branchial cyst, submandibular abscess, thyroid nodule and laryngocele. Posterior triangle masses are cystic hygroma, clavicular tumor and cold abscess, an abscess lacking the usual inflammation such as a TB abscess. Lymphadenitis is the inflamed node itself, and it may be infectious or non-infectious. The other neck masses are separated by their own features. A thyroglossal cyst arises in the route of the thyroglossal duct, extending from the tongue at the foramen caecum to the thyroid gland, and lies at the midline below the hyoid bone, moves with swallowing and with tongue protrusion, and enlarges with URTI. A branchial cleft cyst is a smooth, painless, slowly enlarging lateral neck mass in the anterior triangle, often following a URTI. A cystic hygroma is a thin walled cyst that transilluminates in the posterior triangle, painless, soft and compressible, present by the age of 2 years, and infection causes a sudden increase in its size. A carotid body tumor is a slowly enlarging painless, firm rubbery pulsatile lump that moves from side to side, and a bruit can be heard over it. A salivary gland tumor is a painless rapidly growing mass that may invade the skin, with CN VII palsy, cervical lymphadenopathy and constitutional symptoms, and 80% of salivary gland tumors are benign, the pleomorphic adenoma.