Anatomy, Head and Neck, Supraclavicular Lymph Node – StatPearls

Introduction

The lymphatic system consists of a collection of lymphatic vessels connected to lymph nodes which filter lymph fluid that gets collected throughout the body. Lymph nodes filter lymph via specialized white blood cells that destroy and remove microorganisms, malignant cells, damaged cells, and foreign particles.  The lymphatic vessels and lymph nodes, along with the thymus, tonsils, and spleen, serve a vital function for the removal of interstitial fluid from tissue and development and maintenance of the immune response. Lymph fluid ultimately returns to the venous circulation. 

Lymph nodes are present throughout the body.  The head and neck region contains over 300 lymph nodes, of which include the supraclavicular lymph nodes.[1] This paper will focus on the supraclavicular lymph nodes and their anatomical relations, drainage, physiological variations, surgical considerations, and clinical significance in the context of malignancy and other pathology.

Structure and Function

Classification

There have been several ways to classify cervical lymph nodes, which can become quickly confusing for students.[2] Based on a Roman numeral “level” system classification (from IA, IB, II, III, IV, V, VI) by the American Joint Committee on Cancer (AJCC), the supraclavicular lymph nodes belong to sublevel Vb: the posterior triangle group. This level is bounded:

• Superiorly by the horizontal line defined by the lower border of the cricoid cartilage

• Inferiorly by the clavicle

• Medially (anteriorly) by the sternocleidomastoid (SCM) muscle or sensory branches of cervical plexus

• Posteriorly (laterally) by the anterior border of the trapezius muscle

The Virchow node (VN), named in honor of the German pathologist Rudolf Virchow, is an end node or the most proximal of left supraclavicular lymph nodes. Unlike the rest of the left supraclavicular lymph nodes, it belongs to the IV level which is near the jugulo-subclavian venous confluence and, usually, lying on the scalenus anterior muscle and posterior to the platysma and the sternocleidomastoid muscles. [3][4] If classified by region, the supraclavicular lymph nodes would qualify as inferior deep cervical nodes.

Anatomical boundaries

The supraclavicular lymph node chains have an investing fat pad, which is bounded by the following structures[5]:

• Posteriorly: by the scalene muscles; hence, which leads to their reference as scalene nodes in some texts

• Anteriorly: by the sternocleidomastoid muscle

• Medially: by the common carotid artery and internal jugular vein

• Laterally by lateral edge of the sternocleidomastoid

Drainage

Generally speaking, both right and left supraclavicular lymph nodes drain the neck via efferent lymphatic vessels coming from the accessory nerve lymph node chains, which belong to sublevel Va.[1] However, these nodes mainly drain structures in the thorax and abdomen. More specifically, the right supraclavicular lymph nodes drain the breast, lung and upper esophagus, while the left supraclavicular lymph nodes have more extensive drainage sites and drain distant regions which include but are not limited to the kidney, cervix, testis, and pancreas through various and complicated lymphatic pathways which are out of the scope of this text. The right supraclavicular lymph nodes then drain into the right lymphatic duct, while the left supraclavicular lymph nodes drain into the thoracic duct.[6]

Blood Supply and Lymphatics

The skin flap in which the supraclavicular nodes lie within is mainly supplied by the supraclavicular vessels, which usually branch from the transverse cervical artery. When harvesting the lymph nodes without the skin paddle, they primarily receive blood supply the transverse cervical vessels. The transverse cervical artery originates from the thyrocervical trunk of the subclavian artery. After that, it courses transversely under the inferior belly of the omohyoid muscle and anterior to scalene muscle and the phrenic nerve as it reaches the levator scapulae muscle to give its branches. The transverse cervical artery offers various branches that pass through the supraclavicular nodes and supply them.[7]

Nerves

The significant nerves which are related to the supraclavicular lymph nodes are the phrenic and the vagus nerves which lie lateral and medial to the internal jugular vein, respectively. [7]

The phrenic nerve arises from the ventral rami of roots (C3-C4-C5) and receives a contribution from the cervical sympathetic ganglia. The nerve forms at the superior lateral border of the anterior scalene muscle and then descends obliquely towards the medial side of the anterior scalene muscle (staying deep to the prevertebral fascia, the supraclavicular lymph nodes and the transverse cervical vessels). As the nerve approaches the root of the neck, it usually traverses between the subclavian artery and vein and descends to the mediastinum to supply the diaphragm muscle.[8]

The vagus nerve takes its origin in the medulla oblongata from various nuclei which are out of the scope of the text. The vagus nerve then exits the skull via the jugular foramen and descends inside the carotid sheath posterior and lateral to the common and internal carotid arteries and medial to the internal jugular vein. The right and left vagal nerves then descend anterior to the subclavian arteries to the thorax and the abdomen. [9] 

Physiologic Variants

The exact number of the supraclavicular lymph nodes, including the Virchow node, and their distance from anatomical boundaries surrounding it can vary to an extent.

In a study done to provide a detailed description of the surgical anatomy of the supraclavicular lymph node flap for free vascularized lymph node transfer, a surgical method to treat lymphedema, dissections on fresh cadavers showed variation in the number of lymph nodes between the right (average of 1.5 +/- 1.85) and left supraclavicular lymph nodes (average of 3 +/- 2.26). In four out of nine cases, no right supraclavicular lymph nodes were present on the right side while in one out of nine cases, no left supraclavicular lymph nodes were present. Researchers also noted a variation in their mean distance from the jugular notch in the right (8.29 +/- 2.15) and left sides (6.10 +/- 1.21).[10]

Studies have also noted variations in the location of the Virchow node and its histological anatomy relative to the thoracic duct. A study done on five cadavers found that the Virchow node was attached to the dorsal aspect of the carotid sheath (two out of five cadavers) or on the scalenus anterior muscle (three out of five). The study noted different numbers of collaterals coming from the thoracic duct and their communication pattern with the Virchow node. It is also noteworthy that the Virchow node is not always present at the terminal of the thoracic duct (only present in 27% of Japanese subjects).[3]

Surgical Considerations

Investigations of supraclavicular lymph nodes masses include imaging techniques such as computed tomography (CT) or positron emission tomography (PET) followed by ultrasound-guided fine needle aspiration cytology (FNAC).[11][12] Although rapid, painless, inexpensive, safe and does not require anesthetic or hospital admission, FNAC comes with its disadvantages, which include the inability to provide the cellular architecture required for accurate subtyping of lymphomas. Thus, invasive procedures that provide a greater volume of tissue such as an open biopsy of the supraclavicular lymph nodes are an option when the FNAC is nondiagnostic.  Despite excisional biopsy being the gold standard in lymphoma cases, a core needle biopsy should be performed alternatively, as it provides adequate results and is less invasive.[13] According to the latest guidelines set by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), an open biopsy is only necessary if FNAC, core needle biopsy, physical examinations, and other ancillary test prove to be undiagnostic.[14]

As with any surgical procedure, procedures involving the supraclavicular lymph node require a firm grasp of the critical structures and anatomy that surround it. Complications that could arise from procedures such as supraclavicular lymph node harvest or biopsies include but are not limited to[15][14]:

• Carotid and subclavian artery bleeding

• Chylous fistulas, the leaking of lymph from lymphatic vessels, caused by damage to lymphatics such as the thoracic duct

  • Chylous fistulas are preventable by asking the patient to cough; this will compress the intrathoracic lymphatics leading to distension of lymphatic vessels outside the thorax, resulting in a jet of chyle leaking from places of the defect, allowing their localization and ligation before closing the wound.

• Damage to the phrenic nerve, which could lead to dyspnea as the phrenic nerve supplies the diaphragm

• Wound infection

• Tumor seeding in cases of human papillomavirus-positive head and neck squamous cell carcinoma (HPV-positive HNSCC)

Clinical Significance

Generally speaking, most neck masses in children are of infectious etiology. In adults, however, neck masses in patients who are greater than or equal to 18 years old should always be considered to be malignant until proven otherwise. Thus, the clinical approach to neck masses for adults vs. children vary greatly. It is crucial to keep in mind that cancers of the head and neck, such as squamous cell carcinoma (HNSCC), lymphoma, thyroid, or salivary gland, can present initially as asymptomatic masses.[16][14] Because of this, young adults presenting with an asymptomatic neck mass and an insignificant history may have their diagnosis for underlying malignancies such as mucosal HPV-positive HNSCC delayed.

The differential diagnosis for lymphadenopathy is extensive. It generally categorizes as neoplastic, infectious, inflammatory, reactive, and nondiagnostic. Researchers performed a retrospective 5-year study in a large hospital on 309 supraclavicular masses diagnosed with fine needle aspiration. Results showed that the majority of masses (55%) were malignant, with secondary (metastatic spread) being far more frequent than primary lymphomas (47% vs. 8%, respectively). The most common metastatic malignancies were of lung, breast, uterine, and esophageal origin.[17]

Enlargement of VN, a significant clinical finding termed Troisier sign, can indicate advanced stage 4 gastrointestinal metastasis, which is associated with a 5-year survival of 4%.[6] Other etiologies include, but are not limited to, lymphoma, breast, esophageal, pelvic and testicular cancers.[18] Because of its anatomical relations to critical structures such as the phrenic nerve, the subclavian vessels, and the brachial plexus, enlargement of this node can compress these structures and cause various pathologies such as unilateral phrenic neuropathy, which might lead to dyspnea, vascular and neurogenic thoracic outlet syndromes, and Horner syndrome. Horner syndrome is due to the compression of the lower part of the brachial plexus (C8-T1), leading to the disruption of sympathetic innervation of the eye and usually manifests as four key clinical signs on the ipsilateral side: miosis (constricted pupil), ptosis (droopy eyelid), anhydrosis (decreased sweating) and enophthalmos (sunken eyes). Thus, the presence of a Troisier sign should be kept in consideration when any of these pathologies are present.[19][20]

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Figure

Illustration of the lymph nodes of the head and neck. Contributed by Chelsea Rowe

References

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Koroulakis A, Jamal Z, Agarwal M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Dec 11, 2022. Anatomy, Head and Neck, Lymph Nodes. [PubMed: 30020689]

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Benninger B, Barrett R. A head and neck lymph node classification using an anatomical grid system while maintaining clinical relevance. J Oral Maxillofac Surg. 2011 Oct;69(10):2670-3. [PubMed: 21723019]

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Mizutani M, Nawata S, Hirai I, Murakami G, Kimura W. Anatomy and histology of Virchow’s node. Anat Sci Int. 2005 Dec;80(4):193-8. [PubMed: 16333915]

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Robbins KT, Clayman G, Levine PA, Medina J, Sessions R, Shaha A, Som P, Wolf GT., American Head and Neck Society. American Academy of Otolaryngology–Head and Neck Surgery. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. Arch Otolaryngol Head Neck Surg. 2002 Jul;128(7):751-8. [PubMed: 12117328]

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Burke TW, Heller PB, Hoskins WJ, Weiser EB, Nash JD, Park RC. Evaluation of the scalene lymph nodes in primary and recurrent cervical carcinoma. Gynecol Oncol. 1987 Nov;28(3):312-7. [PubMed: 3678980]

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López F, Rodrigo JP, Silver CE, Haigentz M, Bishop JA, Strojan P, Hartl DM, Bradley PJ, Mendenhall WM, Suárez C, Takes RP, Hamoir M, Robbins KT, Shaha AR, Werner JA, Rinaldo A, Ferlito A. Cervical lymph node metastases from remote primary tumor sites. Head Neck. 2016 Apr;38 Suppl 1(Suppl 1):E2374-85. [PMC free article: PMC4991634] [PubMed: 26713674]

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Ooi AS, Chang DW. 5-step harvest of supraclavicular lymph nodes as vascularized free tissue transfer for treatment of lymphedema. J Surg Oncol. 2017 Jan;115(1):63-67. [PubMed: 28114742]

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El-Boghdadly K, Chin KJ, Chan VWS. Phrenic Nerve Palsy and Regional Anesthesia for Shoulder Surgery: Anatomical, Physiologic, and Clinical Considerations. Anesthesiology. 2017 Jul;127(1):173-191. [PubMed: 28514241]

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Kenny BJ, Bordoni B. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Nov 7, 2022. Neuroanatomy, Cranial Nerve 10 (Vagus Nerve) [PubMed: 30725856]

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Steinbacher J, Tinhofer IE, Meng S, Reissig LF, Placheta E, Roka-Palkovits J, Rath T, Cheng MH, Weninger WJ, Tzou CH. The surgical anatomy of the supraclavicular lymph node flap: A basis for the free vascularized lymph node transfer. J Surg Oncol. 2017 Jan;115(1):60-62. [PubMed: 27353521]

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Awwad A, Tiwari S, Sovani V, Baldwin DR, Kumaran M. Reliable EGFR mutation testing in ultrasound-guided supraclavicular lymph node fine-needle aspirates: a cohort study with diagnostic performance analysis. BMJ Open Respir Res. 2015;2(1):e000075. [PMC free article: PMC4488608] [PubMed: 26175906]

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Duguay S, Wagner JM, Zheng W, Ling J, Zhao LC, Allen KS, North JC, Deb SJ. Ultrasound-Guided Needle Biopsy of Neck Lymph Nodes in Patients With Suspected Lung Cancer: Are the Specimens Sufficient for Complete Pathologic Evaluation to Guide Patient Management? Ultrasound Q. 2017 Jun;33(2):133-138. [PubMed: 27984516]

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Morris-Stiff G, Cheang P, Key S, Verghese A, Havard TJ. Does the surgeon still have a role to play in the diagnosis and management of lymphomas? World J Surg Oncol. 2008 Feb 04;6:13. [PMC free article: PMC2254406] [PubMed: 18248683]

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Pynnonen MA, Gillespie MB, Roman B, Rosenfeld RM, Tunkel DE, Bontempo L, Brook I, Chick DA, Colandrea M, Finestone SA, Fowler JC, Griffith CC, Henson Z, Levine C, Mehta V, Salama A, Scharpf J, Shatzkes DR, Stern WB, Youngerman JS, Corrigan MD. Clinical Practice Guideline: Evaluation of the Neck Mass in Adults. Otolaryngol Head Neck Surg. 2017 Sep;157(2_suppl):S1-S30. [PubMed: 28891406]

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Wertheimer M, Hughes RK. Scalene lymph node biopsy, Prevention of postoperative chylous fistula. Am J Surg. 1971 Jul;122(1):121-2. [PubMed: 5091843]

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Unsal O, Soytas P, Hascicek SO, Coskun BU. Clinical approach to pediatric neck masses: Retrospective analysis of 98 cases. North Clin Istanb. 2017;4(3):225-232. [PMC free article: PMC5724916] [PubMed: 29270570]

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Ellison E, LaPuerta P, Martin SE. Supraclavicular masses: results of a series of 309 cases biopsied by fine needle aspiration. Head Neck. 1999 May;21(3):239-46. [PubMed: 10208667]

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Sundriyal D, Kumar N, Dubey SK, Walia M. Virchow’s node. BMJ Case Rep. 2013 Sep 12;2013 [PMC free article: PMC3794256] [PubMed: 24031077]

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Zdilla MJ, Aldawood AM, Plata A, Vos JA, Lambert HW. Troisier sign and Virchow node: the anatomy and pathology of pulmonary adenocarcinoma metastasis to a supraclavicular lymph node. Autops Case Rep. 2019 Jan-Mar;9(1):e2018053. [PMC free article: PMC6394356] [PubMed: 30863728]

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Maslovsky I, Gefel D. Virchow’s node and Horner’s syndrome. Am J Med. 2006 Feb;119(2):180-1. [PubMed: 16443433]

Disclosure: Fayadh Banjar declares no relevant financial relationships with ineligible companies.

Disclosure: Allecia Wilson declares no relevant financial relationships with ineligible companies.

The Adult Neck Mass | AAFP

ERIC SCHWETSCHENAU, M.D., AND DANIEL J. KELLEY, M.D.

Family physicians frequently encounter neck masses in adult patients. A careful medical history should be obtained, and a thorough physical examination should be performed. The patient’s age and the location, size, and duration of the mass are important pieces of information. Inflammatory and infectious causes of neck masses, such as cervical adenitis and cat-scratch disease, are common in young adults. Congenital masses, such as branchial anomalies and thyroglossal duct cysts, must be considered in the differential diagnosis. Neoplasms (benign and malignant) are more likely to be present in older adults. Fine-needle aspiration and biopsy and contrast-enhanced computed tomographic scanning are the best techniques for evaluating these masses. An otolaryngology consultation for endoscopy and possible excisional biopsy should be obtained when a neck mass persists beyond four to six weeks after a single course of a broad-spectrum antibiotic.

When an adult patient presents with a neck mass, malignancy is the greatest concern. Although differentiating benign and malignant masses can be difficult, a methodical approach will usually result in an accurate diagnosis and appropriate treatment. This article reviews the differential diagnosis of neck masses in adults and provides a framework for clinical decision-making.

Normal Anatomy

Accurate diagnosis of a neck mass requires a knowledge of normal structures. With practice and experience, normal variations in anatomy can be distinguished from true pathology without the need for additional diagnostic testing or subspecialist consultation.

The hyoid bone, thyroid cartilage, and cricoid cartilages are located within the central portion of the neck. The thyroid gland is usually palpable in the midline below the thyroid cartilage. Carotid arteries are pulsatile and can be quite prominent if atherosclerotic disease is present. The sternocleidomastoid muscles should be palpated along their entirety, with careful attention given to deep jugular lymph nodes.

The parotid glands are located in the preauricular area on each side in the lateral neck. The tail of each parotid gland extends below the angle of the mandible, inferior to the ear-lobe. The submandibular glands are located within a triangle bounded by the sternocleidomastoid muscle, the posterior belly of the digastric muscle, and the body of the mandible. In older patients, these glands may become ptotic and appear more prominent.

Lymph nodes are located throughout the head and neck region and are the most common sites of neck masses. Fixed, firm, or matted lymph nodes and nodes larger than 1.5 cm require further evaluation.

History

A careful medical history can provide important clues to the diagnosis of a neck mass.¹ The patient’s age and the size and duration of the mass are the most significant predictors of neoplasia.¹ The patient’s age is most important, because the risk of malignancy becomes greater with increasing age.²

The occurrence of symptoms and their duration must also be determined. Acute symptoms, such as fever, sore throat, and cough, suggest adenopathy resulting from an upper respiratory tract infection. Chronic symptoms of sore throat, dysphagia, change in voice quality, or hoarseness are often associated with anatomic or functional alterations in the pharynx or larynx.

Recent travel, trauma to the head and neck, insect bites, or exposure to pets or farm animals suggests an inflammatory or infectious cause for a neck mass. A history of smoking, heavy alcohol use, or previous radiation treatment increases the likelihood of malignancy.

A review of associated medical conditions and previous treatments is useful in narrowing the differential diagnosis and formulating an appropriate treatment plan.

Physical Examination

The skin on the head and neck should be inspected for premalignant or malignant lesions resulting from chronic sun exposure. The otologic examination may show a sinus or fistula associated with a branchial anomaly. Evidence of chronic sinusitis or pharyngitis suggests reactive adenopathy as the most likely cause of a neck mass.

The physician should pay particular attention to mucosal surfaces. For examination of the mucosa, dentures or other dental appliances may need to be removed. Palpation of the tongue, including the base of the tongue, can reveal occult lesions. Attention should be paid to ulcerations, submucosal swelling, or asymmetry, particularly in the tonsillar fossa.

Examination of the larynx and pharynx is accomplished by indirect or flexible laryngoscopy. Palpation during swallowing or during a Valsalva’s maneuver may identify pathology within the larynx and thyroid gland. Rotation of the head in both flexion and extension aids examination of the posterior triangle of the neck.

For initial assessment and serial examination, the size of the mass may be measured using calipers or a tape measure.

Differential Diagnosis

CONGENITAL ANOMALIES

Although congenital anomalies of the neck are more common in children, they also should be considered in the differential diagnosis of neck masses in adults.

Lateral Neck

Branchial anomalies are the most common congenital masses in the lateral neck. These masses, which include cysts, sinuses, and fistulae, may be present anywhere along the sternocleidomastoid muscle.³ The masses are typically soft, slow-growing, and painless. A history of infection, spontaneous discharge, and previous incision and drainage is not uncommon.

Computed tomographic (CT) scanning can usually demonstrate cystic masses medial to the sternocleidomastoid muscle at the level of the hyoid bone in the neck. Treatment is complete surgical excision, with preparation and examination of frozen sections to exclude malignancy. Fine-needle aspiration and biopsy should be performed before excision because of the possibility of cystic metastases from squamous cell carcinoma within Waldeyer’s tonsillar ring.⁴

Other congenital anomalies of the lateral neck include cystic hygromas (lymphangiomas) and dermoids.

Central Neck

The thyroglossal duct cyst is the most common congenital anomaly of the central portion of the neck (Figure 1). This anomaly is caused by a tract of thyroid tissue along the pathway of embryologic migration of the thyroid gland from the base of the tongue to the neck. The thyroglossal duct cyst is intimately related to the central portion of the hyoid bone and usually elevates along with the larynx during swallowing. It may contain the patient’s only thyroid tissue.⁵ Thyroid carcinoma has been reported within thyroglossal duct cysts.

With regard to thyroglossal duct cysts, the extent of preoperative assessment is controversial and ranges from physical examination to serologic testing and diagnostic imaging.^6,7 If serum thyroid function test results are abnormal, thyroid scanning should be performed to determine the amount of thyroid tissue in the neck. Some investigators advocate routine ultrasonography or nuclear scanning to avoid permanent hypothyroidism. As with branchial cysts, a history of infection, spontaneous discharge, and previous incision and drainage is not uncommon.

The treatment of choice is the Sistrunk procedure, which involves complete excision of the thyroglossal duct cyst, including the central portion of the hyoid bone. If necessary, excision extends to the base of the tongue.

Other congenital midline neck masses include thymic rests and dermoids.

INFLAMMATORY AND INFECTIOUS CONDITIONS

Inflammation

Lymph node groups in the neck include the submandibular nodes within the submandibular triangle, the jugular chain of nodes located along the internal jugular vein, and the posterior-triangle nodes located between the sternocleidomastoid and trapezius musculature.

Inflammatory lymphadenopathy is typically self-limited and resolves spontaneously over a period of weeks. Chronic sialadenitis as a result of salivary stones or duct stenosis can result in gland hypertrophy and fibrosis.⁸ Chronic inflammation may result in a mass within the submandibular or parotid glands. Treatment is usually conservative unless pain is severe enough to justify surgical excision.

Cervical adenitis is probably the most common cause of an inflammatory mass in the neck. This condition is characterized by painful enlargement of normal lymph nodes in response to infection or inflammation.⁹

Infection

Both bacterial and viral infections can cause neck masses. Occasionally, the lymph node becomes necrotic, and an abscess forms. Staphylococcus and Streptococcus species are the organisms most commonly cultured from neck abscesses.¹⁰ In many instances, however, the infection is polymicrobial. A neck abscess usually requires intravenous antibiotic therapy, and surgical drainage may be necessary.

Typical and atypical mycobacterial infections are less common infectious causes of neck masses. Mycobacterial infection generally presents as a single enlarged node that is rarely tender or painful. Tuberculous infection generally presents in older patients with a history of tuberculosis exposure and a positive purified protein derivative (PPD) tuberculin skin test. Therapy with antituberculous antibiotics for six to 12 months is the treatment of choice.¹¹

Atypical mycobacterial infection is usually found in children with a nonreactive PPD skin test and no exposure history. Left untreated, the lymph node may drain spontaneously, leading to a chronic fistula. Surgical removal with curettage is the standard treatment. Antibiotic therapy is generally reserved for recurrent disease.¹²

In recent years, the incidence of typical mycobacterial infections has increased in adults who test positive for the human immunodeficiency virus (HIV) and in children who test negative for the virus.^13,14 HIV infection should be considered in any adult with cervical adenopathy, and appropriate serologic testing is indicated. HIV-positive adult patients with a nontuberculous mycobacterial infection involving cervical lymph nodes are typically treated with clarithromycin (Biaxin). Surgical intervention is reserved for use in patients with resistant or unresponsive disease. ¹⁵

Cat-scratch disease is another less common cause of neck masses. Accurate diagnosis may be difficult because the adenopathy can appear days to months after the original injury. The etiologic agent in cat-scratch disease (Bartonella henselae) was recently identified.¹⁶ In general, only one lymph node is enlarged, and the node returns to normal size without treatment.

Toxoplasmosis sometimes causes neck masses. This infection generally presents as a single enlarged node in the posterior triangle.¹⁷ The clinical course is benign, and antibiotic therapy is not needed.¹⁸

Infectious mononucleosis usually presents with acute pharyngitis, cervical adenopathy, and an elevated Epstein-Barr virus titer.

Fungal infections such as actinomycosis can also cause neck masses.

TRAUMA

Neck masses resulting from trauma have a characteristic history and physical findings. Although new or organized hematomas generally resolve, they may persist as firm masses because of fibrosis.

Pseudoaneurysm or an arteriovenous fistula of a major arterial vessel in the neck is rare and is usually associated with the shearing effects of major blunt-force trauma, such as occurs in an automobile accident.¹⁹ If the injury is not recognized at the time of initial trauma, the patient may present later with a pulsatile, soft, fixed mass over which a thrill or bruit can generally be auscultated.

METABOLIC, IDIOPATHIC, AND AUTOIMMUNE CONDITIONS

Metabolic disorders are rare causes of neck masses. Gout and tumoral calcium pyrophosphate dihydrate deposition disease have been reported to present as neck masses.^20,21

Idiopathic conditions, such as inflammatory pseudotumor, Kimura’s disease, and Castleman’s disease, can also present with a neck mass.^22–24 A neck mass may also be the presenting symptom of sarcoidosis.²⁵

Kimura’s disease is an uncommon chronic inflammatory condition involving subcutaneous tissue. The etiology is unknown. The disease presents as a tumor-like lesion with a predilection for the head and neck region.

Castleman’s disease is a benign lympho-proliferative disorder that most frequently involves the mediastinal lymph nodes. It typically presents in the head and neck as cervical adenopathy of unknown etiology. Multiple biopsies showing florid lymphoid hyperplasia are frequently required to establish the diagnosis.

NEOPLASM

Benign Masses

Lipomas, hemangiomas, neuromas, and fibromas are benign neoplasms that occur in the neck. They are all characterized by slow growth and lack of invasion. Lipomas are soft masses that are isodense with a fat signal on magnetic resonance imaging. Hemangiomas typically occur with cutaneous manifestations and are relatively easy to recognize. Neuromas may arise from nerves in the neck and rarely present with sensory or motor deficits. Most of these benign masses are diagnosed at the time of surgical excision.²⁶

Malignant Masses

Retrospective studies of open biopsies have shown high rates of malignancy for neck masses in adults. ²⁷ A malignant neoplasm in the neck can arise as a primary tumor or as metastasis from the upper aerodigestive tract or a distant site.

Thyroid cancer, salivary gland cancer, lymphomas, and sarcomas are examples of primary malignancies.²⁸ The most common presentation for thyroid or salivary gland cancer is an asymptomatic nodule within the gland. Further diagnostic evaluation and management of the nodule is always indicated.²⁹

Risk factors for mucosal head and neck cancer (oral cavity, larynx, pharynx) include chronic sun exposure, tobacco and alcohol use, poor dentition, industrial or environmental exposures, and family history.³⁰ Symptoms include a nonhealing ulcer within the oral cavity or oropharynx, persistent sore throat, dysphagia, change in voice, and recent weight loss.

Metastatic disease to lymph nodes of the neck from a head-and-neck primary site usually follows well-defined patterns^31,32(Figure 2). For example, cancers of the oral cavity typically metastasize to the submandibular triangle (Figure 3), whereas cancers from most other sites in the head and neck spread to the lateral neck. Patients with palpable lymphadenopathy in the supraclavicular fossa should be evaluated for malignancy below the clavicles (e.g., lung cancer).

Management

Many inflammatory lymph nodes resolve with no treatment, although close observation is required. A single course of therapy with a broad-spectrum antibiotic and reassessment in one to two weeks is a reasonable treatment choice when a patient with a neck mass has signs and symptoms of an inflammatory process (i.e., fever, painful mass, erythema) or a history of recent infection.

Thyroid and salivary gland nodules should undergo fine-needle aspiration and biopsy. This diagnostic procedure should also be performed when a neck mass persists beyond four to six weeks. In experienced hands, the sensitivity and specificity of fine-needle aspiration and biopsy exceed 90 percent. ³³

Local recurrences have been reported following stereotactic core-needle biopsy of solid tumors, including breast, liver, colon, pancreas, and lung cancers.^34,35 The use of large-diameter needles has been associated with the seeding of head and neck carcinomas.^36,37 However, no cases of seeding or dissemination have been reported with the use of fine-needle aspiration, and the risk of tumor seeding of the biopsy site is considered to be exceedingly low. Fine-needle aspiration and biopsy are typically indicated when no cause for a neck mass is found on the initial evaluation.³⁸

Contrast-enhanced CT scanning is the best imaging technique for evaluating a neck mass. This modality should be used whenever the diagnosis is unclear. Assessment of a neck mass also requires a recent chest radiograph. Routine serologic tests can exclude metabolic disorders and other uncommon causes of neck masses in the vast majority of patients.

Cytopathologic differentiation of benign and malignant adenopathy can be difficult. Cytologic or radiographic evidence of conditions other than reactive lymphadenopathy warrants consultation with an otolaryngologist for endoscopic evaluation, with possible excisional biopsy or neck dissection.

Biopsy should be considered for neck masses with progressive growth, location within the supraclavicular fossa, or size greater than 3 cm. Biopsy also should be considered if a patient with a neck mass develops symptoms associated with lymphoma. Frozen-section examination of the mass followed by neck dissection should be performed if the mass proves to be metastatic carcinoma.

An algorithm for the evaluation and management of a neck mass in an adult patient is provided in Figure 4.

Why there is inflammation of the lymph nodes in the neck: causes, symptoms, treatment

Contents

• 1 Causes and treatment of inflammation of the lymph nodes in the neck: how to get rid of unpleasant symptoms?
  • 1.1 Causes of inflammation of the lymph nodes in the neck
    • 1. 1.1 Infections
    • 1.1.2 Dental problems
    • 1.1.3 Skin lesions
    • 1.1.4 Oncology
  • 1.2 Symptoms of inflammation of the lymph nodes in the neck
    • 1.2.1 General information
    • 1.2.2 Symptoms of swollen lymph nodes in the neck
    • 1.2.3 When should I see a doctor?
  • 1.3 Diagnosis of inflammation of the lymph nodes in the neck
    • 1.3.1 Medical history
    • 1.3.2 Examination
    • 1.3.3 Laboratory and instrumental studies
    • 1. 3.4 Biopsy
  • 1.4 Treatment of inflammation of the lymph nodes in the neck
    • 1.4.1 General principles of treatment
    • 1.4.2 Treatment of swollen lymph nodes in the neck in children
    • 1.4.3 Treatment of inflammation of the lymph nodes in the neck with lymphadenitis
  • 1.5 How to avoid inflammation of the lymph nodes in the neck?
  • 1.6 Inflammation of the lymph nodes in children
    • 1. 6.1 Causes
    • 1.6.2 Symptoms
    • 1.6.3 Treatment
    • 1.6.4 Prevention
  • 1.7 When should you see a doctor for swollen lymph nodes in your neck?
  • 1.8 Association between swollen lymph nodes in the neck and cancer
  • 1.9 Other causes of swollen lymph nodes in the neck
  • 1.10 Conclusions
  • 1.11 Related videos:
  • 1.12 Q&A:
    • • 1.12.0.1 What are lymph nodes and why do the body need them?
      • 1.12.0.2 What causes inflammation of the lymph nodes in the neck?
      • 1.12.0.3 How is inflammation of the lymph nodes in the neck diagnosed?
      • 1.12.0.4 How is swollen lymph nodes in the neck treated?
      • 1.12.0.5 Can swollen lymph nodes in the neck go away on their own?
      • 1.12.0.6 How can inflammation of the lymph nodes in the neck be prevented?

Find out the main causes of inflammation of the lymph nodes in the neck and how they can be treated to restore health and improve well-being. Read the article on our website and do not put off taking care of your health!

Lymph nodes are part of the body’s lymphatic system that perform an important protective function. They act as a barrier that prevents the penetration of infections and harmful substances into the tissues and organs of the human body. However, sometimes the lymph nodes themselves can become the site of infection or stress conditions, causing inflammation and enlargement.

Especially often the lymph nodes become inflamed in the neck, where a large number of lymph nodes are located. The causes of inflammation can be diseases of the upper respiratory tract (throat, nose), teeth, ulcers, colds. Also, inflammation of the lymph nodes in the neck can be a sign of serious diseases – tumors, infections, tuberculosis.

To identify inflammation of the lymph nodes and determine the causes of its occurrence, it is necessary to conduct a diagnosis and consult a specialist. Depending on the circumstances, treatment may include the use of antibiotics, anti-inflammatory and anti-tuberculosis drugs, recommendations to strengthen the immune system and prevent possible diseases.

Causes of inflammation of the lymph nodes in the neck

Infections

Inflammation of the lymph nodes in the neck can be caused by various infections. For example, it can be the flu, SARS, tonsillitis, runny nose, chicken pox, streptococcal infection and others. During the body’s fight against infection, the lymph nodes increase in size and become inflamed, which signals that the body is fighting the infection.

Dental problems

Inflammation of the lymph nodes in the neck can be associated with diseases of the teeth and gums, such as caries, gingivitis, periodontitis. In this case, the inflammation of the lymph nodes is the body’s response to the bacteria that cause the disease.

Skin lesions

Injuries and various injuries to the scalp and neck can also lead to inflammation of the lymph nodes in the neck. Lymph nodes become inflamed to help the body fight infection that can occur as a result of skin damage.

Oncology

It is possible that inflammation of the lymph nodes in the neck may be associated with various cancers, such as lymphoma or head and neck cancer. In such cases, the inflammation of the lymph nodes does not go away, but increases with time, so it is important to consult a doctor to rule out oncology.

Symptoms of inflammation of the lymph nodes in the neck

General information

Inflammation of the lymph nodes in the neck is often a sign of an infection in the body. The lymph nodes in the neck are close to the surface of the skin and their inflammation can lead to pain and discomfort.

Symptoms of inflammation of the lymph nodes in the neck

The main symptoms of inflammation of the lymph nodes in the neck are:

• Hypersensitivity in the area of ​​the lymph nodes;
• Soreness when touching lymph nodes;
• Enlarged lymph nodes. Depending on the cause of inflammation of the lymph nodes, they may increase in size to varying degrees;
• Swelling of surrounding tissues in the area of ​​inflammation of the lymph nodes;
• Headache, fever, fatigue, general malaise.

When should I see a doctor?

If you notice swelling and tenderness of the lymph nodes in your neck, be sure to seek medical attention. The doctor will conduct the necessary examination and find out the cause of the inflammation of the lymph nodes and prescribe an effective treatment.

Diagnosis of inflammation of the lymph nodes in the neck

Medical history

The first step in the diagnosis of inflammation of the lymph nodes in the neck is to take an anamnesis of the disease. The doctor should ask the patient about the presence of symptoms such as sore throat, runny nose, cough, fever. It is also necessary to find out if the patient has had similar symptoms before and how they were treated.

Examination

After taking the medical history, the patient is examined. The doctor checks for swelling and redness in the neck. He also palpates the lymph nodes and determines their size and condition. If a tumor is present, the doctor may recommend a more detailed examination.

Laboratory and instrumental research

Laboratory and instrumental research methods are used to diagnose inflammation of the lymph nodes in the neck. Blood is taken for general analysis and detection of inflammatory processes in the body. You can also prescribe an ultrasound to more accurately identify the condition of the lymph nodes and determine the presence of tumors.

Biopsy

In some cases, a biopsy may be ordered to determine the cause of swollen lymph nodes in the neck. During a biopsy, a small sample of lymph node tissue is taken and examined under a microscope. This allows you to identify the presence of infectious agents or tumors.

Treatment of inflammation of the lymph nodes in the neck

General principles of treatment

Treatment of inflammation of the lymph nodes in the neck depends on its cause. However, there are general principles of treatment:

1. Prescription of antiviral, antibacterial or antifungal drugs;
2. Use of anti-inflammatory and analgesic drugs;
3. Completeness and correctness of nutrition;
4. Physiotherapy.

A few days before the start of treatment, it is recommended to avoid smoking, drinking alcohol and fatigue.

Treatment of swollen lymph nodes in the neck in children

In case of swollen lymph nodes in the neck of children, a pediatrician should be consulted. The purpose of treatment depends on the cause of the inflammation. However, there are general principles of treatment:

• Carrying out hygiene procedures;
• Use of anti-inflammatory drugs, certain antibiotics or antimycotic drugs;
• Completeness and correctness of nutrition.

Treatment of inflammation of the lymph nodes in the neck with lymphadenitis

Lymphadenitis is an acute form of inflammation of the lymph nodes in the neck, which can lead to complications. For lymphadenitis, along with the standard treatment needed for other forms of inflammation of the lymph nodes in the neck, local therapy is carried out:

• Use of antibiotics;
• Washing the inflamed area;
• Use of medical dressings or application of a medical compress;
• Occasionally, surgery may be required to remove pus deposits.

In case of lymphadenitis, it is not recommended to prescribe treatment on your own, you should consult an infectologist or otolaryngologist.

How to avoid inflammation of the lymph nodes in the neck?

Lymph nodes in the neck are part of our immune system that protects us from infection and disease. They may enlarge due to inflammation, also known as lymphadenitis.

To prevent inflammation of the lymph nodes, it is recommended:

• Take care of hygiene – Wash your hands regularly and practice basic hygiene. This helps prevent infection and the spread of bacteria and infections.
• Avoid possible sources of infection – Avoid contact with people who have infectious diseases such as influenza or SARS.
• Support the immune system – Try to maintain a healthy lifestyle, including proper nutrition and physical activity. It strengthens the immune system and helps fight viral and bacterial infections.

If you have signs of swollen lymph nodes, such as soreness or redness in your neck, seek medical attention. Don’t try to treat yourself, as this can make the problem worse.

Inflammation of the lymph nodes in children

Causes

Inflammation of the lymph nodes is a signal that disease processes are occurring in the child’s body. It can be caused by infectious diseases such as SARS, influenza or tonsillitis, as well as a number of other acute diseases. In addition, the lymph nodes can become inflamed as a result of allergic reactions to food, medicines, or other allergens.

Symptoms

Symptoms of swollen lymph nodes in children may vary depending on the cause of the disease. Usually, swollen lymph nodes in the neck cause pain and discomfort, as well as an increase in their size. The child may experience weakness, dizziness, low body temperature, fever and other symptoms that are characteristic of a disease that causes inflammation of the lymph nodes.

Treatment

Treatment of inflammation of the lymph nodes in children should be directed to the treatment of the underlying disease. If the inflammation is caused by a bacterial infection, the doctor may prescribe antibiotics. In the event of an allergic reaction, it is necessary to identify the allergen and eliminate it from the child’s diet. In most cases, inflamed lymph nodes go away on their own after the treatment of the underlying disease. However, if necessary, the doctor may prescribe anti-inflammatory or pain medication.

Prevention

• Avoid contact between the child and sick people;
• Strengthen your child’s immune system: maintain a healthy lifestyle, eat right, spend a lot of time outdoors;
• Wash your hands regularly and teach your child to do the same;
• Take care of your child’s oral hygiene: brush your teeth, use dental floss and mouth water;
• Get all the necessary vaccinations, if necessary, to boost your child’s immune system.

When should you see a doctor for swollen lymph nodes in your neck?

Inflammation of the lymph nodes in the neck can be a sign of various diseases. In most cases, it is caused by an infection, but it can also be a sign of a more serious condition, such as cancer. Therefore, it is very important to see a doctor if you experience the following symptoms:

• Swollen lymph nodes: If you notice swollen lymph nodes in your neck, this may indicate an infection or tumor. If the lymph nodes have become longer for a long time, be sure to visit a doctor.
• Pain: If you feel pain on palpation of the lymph nodes or if they become tender, this may indicate an infection or inflammation. However, it can also be a sign of a more serious illness. In any case, this requires the attention of a doctor.
• Bitterness in the mouth: If you feel that you have a bitter taste in your mouth after eating, this may be a sign of swollen lymph nodes. Consult a doctor to clarify the diagnosis.
• High temperature: If you have other symptoms associated with inflammation of the lymph nodes, as well as fever, this may indicate more serious diseases, such as viral and bacterial infections.

Association between swollen lymph nodes in the neck and cancer

Swollen lymph nodes in the neck can be caused by many factors, one of which is cancer. Cancer occurs in tissues, which are made up of cells that grow and divide rapidly. When these cells begin to grow and multiply in an uncontrolled way, they form a tumor. This tumor can spread to nearby tissues, including lymph nodes.

However, inflammation of the lymph nodes in the neck is not always associated with cancer. There are many other causes such as infections, allergies, or diseases that can cause swollen lymph nodes in the neck. Therefore, if you find an inflamed lymph node, do not panic and consult a doctor to establish the correct diagnosis.

In any case, if you suspect cancer, you should see an oncologist for diagnosis and treatment. Cancer is a serious disease that requires complex treatment, including surgery, chemotherapy and radiation therapy.

In conclusion, swollen lymph nodes in the neck may be associated with cancer, but not always. Therefore, if you find an inflamed lymph node, do not waste time and contact a specialist to establish an accurate diagnosis and prescribe the correct treatment.

Other causes of inflammation of the lymph nodes in the neck

Although the most common cause of inflammation of the lymph nodes in the neck is associated with infectious diseases, there are other causes of this condition. For example, some types of cancer can lead to swollen lymph nodes, which can also cause inflammation. Blood diseases such as lymphoma and leukemia can also cause swollen lymph nodes.

Inflammation of the lymph nodes in the neck can also be caused by certain drugs. For example, antibiotics and antidepressants can cause a reaction in the body, which manifests itself in the form of inflammation of the lymph nodes. Some causes of inflammation, such as thrombophilia and metastatic cancer, can also lead to swollen lymph nodes in the neck.

• Reminder: If the lymph nodes in the neck are enlarged and do not go away for more than two weeks, it is necessary to see a doctor for diagnosis and treatment.

Conclusions

As a result of the study, we can draw the following conclusions:

• Inflammation of the lymph nodes in the neck is a fairly common disease . It can cause discomfort and pain in the neck, as well as act as a symptom of other diseases, such as influenza or SARS.
• There are several types of lymph nodes in the neck, all of which can be inflamed . This can be determined by a doctor during examination and palpation of the throat and neck.
• Inflammation of the lymph nodes in the neck can occur due to various causes such as bacterial or viral infections, autoimmune diseases or cancer. Each of these causes may require its own treatment.
• Treatment of inflammation of the lymph nodes in the neck depends on its cause . This may include medication, physical therapy, or even surgery if malignant tumors are found.
• To prevent inflammation of the lymph nodes in the neck, you need to pay attention to your health , strengthen the immune system, observe hygiene and disease prevention.

In general, inflammation of the lymph nodes in the neck is not a dangerous disease, but requires careful attention and timely treatment. At the first symptoms, you should consult a doctor to diagnose and determine the correct treatment.

Related videos:

Q&A:

What are lymph nodes and why do the body need them?

Lymph nodes are small organs of the lymphatic system that play an important role in protecting the body from infection and disease. They filter the lymph, remove bacteria, viruses and other impurities from it, and also produce lymphocytes – cells that develop immune responses to diseases.

What causes inflammation of the lymph nodes in the neck?

Inflammation of the lymph nodes in the neck can be caused by various causes, such as infectious diseases (influenza, SARS, tonsillitis), viruses (HIV, herpes), bacteria (staphylococcus aureus, streptococcus), cancer, allergic reactions, as well as reactions to drugs or vaccinations.

How is inflammation of the lymph nodes in the neck diagnosed?

Diagnosis of inflammation of the lymph nodes in the neck begins with a visual examination and palpation of the lymph nodes. Further, ultrasound, computed tomography, magnetic resonance imaging, biopsy and other research methods may be prescribed to determine the cause of inflammation.

How is inflammation of the lymph nodes in the neck treated?

Treatment of inflammation of the lymph nodes in the neck depends on the cause that caused the inflammation. Antibiotics are commonly used to treat infectious diseases, antiviral drugs for viral diseases, and antihistamines for allergic reactions. In cases of cancer, surgery, chemotherapy, and radiation therapy may be prescribed.

Can swollen lymph nodes in the neck go away on their own?

Yes, swollen lymph nodes in the neck can go away on their own if they were caused by an infectious disease and the body has coped with the disease. However, if the inflammation does not go away within a few weeks or other symptoms appear, it is necessary to see a doctor for diagnosis and treatment.

How can inflammation of the lymph nodes in the neck be prevented?

To prevent inflammation of the lymph nodes in the neck, it is necessary to practice good hygiene, wash your hands regularly and avoid contact with sick people. It is also recommended to strengthen the immune system, eat right, lead an active lifestyle and avoid stressful situations.

Submandibular lymph node enlargement – causes, symptoms, who treats

Submandibular lymph node enlargement – causes, symptoms, who treats

What should be done to diagnose and treat submandibular lymph node enlargement ? To solve this problem, the first step for the patient is to make an appointment with a lymphologist. After the initial examination, the doctor may prescribe additional tests:

• Ultrasound of the lymph nodes of the neck
• CT of neck lymph nodes
• MRI of lymph nodes
• Laboratory tests.

Swollen lymph nodes usually result from an infection caused by bacteria or viruses. In rare cases, the increase is caused by cancer. Lymph nodes, also called lymph glands, play a vital role in the body’s ability to fight infections. They work like filters, trapping viruses, bacteria, and other causes of disease. Typically, swollen lymph nodes can be found in the neck, under the chin, in the armpits, and in the groin. In some cases, only time and warm compresses are enough to treat swollen lymph nodes. If the disease is caused by an infection, treatment depends on the cause.

Symptoms of enlarged submandibular lymph nodes

Enlarged submandibular lymph nodes are a sign that something is wrong in the body. When the lymph nodes swell for the first time, you may notice:

• heaviness and pain in the lymph nodes
• swelling, which may be the size of a pea.

Depending on the cause of the swollen lymph nodes, there may be other symptoms:

• runny nose, sore throat, fever and other signs of an upper respiratory infection
• general enlargement of lymph nodes throughout the body. This may indicate an infection, such as HIV or mononucleosis, or an immune system disorder, such as lupus or rheumatoid arthritis
• hard, immobile, rapidly growing nodules indicating possible cancer or lymphoma
• fever
• night sweats.

Which doctor diagnoses and treats enlarged submandibular lymph nodes

Sometimes swollen lymph nodes return to normal when the underlying disease, such as a minor infection, resolves. See a doctor if you are concerned or if swollen lymph nodes:

• appear for no apparent reason
• continue to increase or remain so for 2-4 weeks
• hard or rubbery to the touch or do not move when pressed
• are accompanied by persistent fever, night sweats, or unexplained weight loss.

Seek immediate medical attention if you have difficulty swallowing or breathing.

Causes of enlarged submandibular lymph nodes

The most common cause of enlarged submandibular lymph nodes is an infection, especially a viral one, such as a cold. Other possible causes include:

• common infections
• strep throat
• measles
• ear infections
• abscess
• mononucleosis
• infections of the skin or wounds, such as cellulitis
• human immunodeficiency virus – the virus that causes AIDS
• unusual infections
• tuberculosis
• certain sexually transmitted infections such as syphilis
• Toxoplasmosis is a parasitic infection resulting from contact with the faeces of an infected cat or eating undercooked meat
• cat-scratch fever is a bacterial infection resulting from a scratch or bite from a cat
• disorders of the immune system
• lupus is a chronic inflammatory disease affecting the joints, skin, kidneys, blood cells, heart and lungs
• rheumatoid arthritis is a chronic inflammatory disease affecting the tissue lining the joints
• cancers
• lymphoma – cancer that occurs in your lymphatic system
• leukemia – cancer of the blood-forming tissue of your body, including the bone marrow and lymphatic system
• other cancers that have spread to the lymph nodes.

Other possible but rare causes include certain drugs, such as the anti-seizure drug phenytoin and malaria prophylactic drugs.

How a doctor diagnoses swollen submandibular lymph nodes

To diagnose the cause of swollen lymph nodes, a lymphologist may need to:

• medical history. The doctor will find out how the enlarged submandibular lymph nodes appeared and if there are any other symptoms
• physical examination. The doctor will check the lymph nodes near the surface of the skin for size, tenderness, redness and texture
• blood tests. Some blood tests confirm or rule out an underlying disorder. Specific tests depend on the suspected cause, but will most likely include a complete blood count. This test helps assess overall health and detect a range of conditions, including infections and leukemia
• imaging studies. Ultrasound or computed tomography of the affected area helps to identify potential sources of infection or find tumors
• lymph node biopsy. To clarify the diagnosis, the doctor may prescribe a biopsy. He will take a sample from a lymph node or the entire lymph node for microscopic examination.

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