Acute Cervical

Lymphadenopathy
Dr Eishal Arshad
 Cervical lymphadenopathy
Lymphatic cells are present in the whole body
with cells of the hemopoetic sy
In some tissues higher concentration-
lymhonodes, tonsills, spleen, bone, marrow
Basic function-mechanical filter

-immunological barrier
In ENT area-submental, submandibular, pre-and
retroauricular, before and behind
sternocledomast.muscle, occopital, nuchal,
supra-and infraclavicular lnn.
 Causes
Very wide
Basic division: Acute <2weeks

Chronic >2 weeks

1.Inflammatory a.Non specific
b.Specific
2.Neoplastic lymphadenopathy
 Infective:
Age < 10years
Painful lump jus below the angle of jaw
Child may snore at night, Difficulty in breathing,
Nasal speech, Recurrent chest infections
Systemic Effects: Feels ill sore throat pyrexia
and doesnt want to eat
Malnourished child, Cold, damp houses
 Infective: Acute Causes
Both anterior and posterior cervical lymph nodes
are frequently involved when associated with
pharyngitis or tonsillitis
Large (2-3 cm) solitary, tender, unilateral cervical
lymph nodes that rapidly enlarge in the preschool
age child are commonly due to bacterial infection.
The most commonly involved lymph nodes in
decreasing order of frequency are the
submandibular, upper cervical, submental,
occipital, and lower cervical nodes.
 Infective: Acute Causes
(adeniditis)
Acute bacterial adenitis is characterised by larger
nodes >10mm, tender and fluctuant, in the anterior
part of the neck.
Associated with fever and warm, erythematous
overlying skin.
Caused by Staphylococcus Aureus or Group A
Streptococcus (Strep pyogenes). A
site of entry may be found e.g. mouth or scalp.
Anaerobic bacteria may be associated with dental
disease in older children.
 Infective: Acute Causes (viral)
Acute viral associated cervical lymphadenitis typically
develops following an upper respiratory tract infection
bilateral, multiple, and relatively small, without warmth
or erythema of the overlying skin.
resolves spontaneously
reactive hyperplasia
fever, conjunctivitis, pharyngitis, and other upper
respiratory tract symptoms. Rashes and
hepatosplenomegaly may also be present, particularly
in CMV
Infective: Acute Causes: Others
cervical lymphadenitis due to anaerobic
infections frequently is associated with dental
caries or periodontal disease.
Acute cervical adenitis due to Pasteurella
multocida can occur following animal bites or
scratches on the head, neck, or upper chest,
acute cervical lymphadenitis due to Yersinia
pestis is associated with flea bites in west
United states
 Subacute and chronic
lymphadenitis
Failure to resolve or improve despite a 2-
to 4-week period of appropriate therapy, or
the presence of generalized
lymphadenopathy should prompt further
diagnostic testing.
A variety of organisms can result in
generalized or persistent
lymphadenopathy
 Tuberculous

lymphadenitis:
Children, young and elderly
Lump with gradual appearance, With or without
pain
Neck movement and swallowing painful
Anorexia and weight loss
If breaks down into abscess it increases in size,
become painful, discoloration of overlying skin
BCG vaccination
Any Family member has TB
Poor socioeconomic status
 Primary
Reticuloses:
Common in children and young adults
Painless lump which Grow slowly
Systemic:
Malaise, weight loss and pallor
Itching of the skin (unexplained but distinct)
Periodic fever and rigors
Pains in bones
Venous congestion in the neck ( large lymph gland mass
occlude superior vena cava)
 Metastatic
lymphadenopath
Occur in patients > 50 years
Painless lump
Grow slowly and new lumps may appear
Symptoms of Primary lesion
In the head and neck: sore tongue; hoarse voice
In the chest: cough; haemoptysis
In the abdomen: dyspepsia; abdominal pain
Head and neck cancers do not cause anorexia or
weight loss
Division of the lymph nodes
CT
 1b.Specific Lymphadenopathy
TB
Sarcoidosis(Bocks disease)
Lupus erytematodes
Toxoplasmosis
Cat scratch fever
Tularemia
Anthrax
Syphyllis
Lyme disease
Brucelosis, Actinomycisis, Listeriosis, Leishmaniosis
Non Specific Lymhadenopathy I
Very often
Acute painfull swelling
Possible fluctuation
Angina, CMV,Boreliosis,Rubeola
virus,Adenovirus
Revmatoid artritis
Fatigue disease
Dermatopoetic lymphadenopathy
Lymphadenopathy due to drug hypersensitivity
 Child with
lymphadenopathy

Lymphadenopathy in
acute tonsillitis
 Non Specific Lymphadenopathy II
Benign angiofollicular
lymhoma(Castleman)
Collagenosis
Monocutaneous
lymphadenopathy(Kawasaki)
Sjogrens disease
Non malignant idiopatic histiocytosis
Disturbances of lipid metabolism(Niemann-
Picks disease)
Cat scratch fever
 TB

Tularemia
HIV Lymphadenopathy
 2.Neoplastic Lymhadenopathy
A. Metastases
B.Lymphomas

Differentialdiagnosis
Medial and lateral cysts, laryngocele, diseases
of thyreoid gland, chemodectoma(carotic body
tumor), neurogenic tumor, cervical lipoma,
hemangioma, lymhangioma(cystic hygroma),
cystadenolymhoma or other tu of salivary
glands,malignant tumours of soft tissues
Hodgkin's Lymphoma
 2a.Lymph nodes metastases
Carcinomatous cells reach the peripheral
sinus of the lymph nodes via the afferent
vessels
Loss of mobility and adherence to
sorrounding tissue due to malignant
infiltration of the capsulae-worse prognosis
Irregularly spreading of metastases due to
obstructed lymph nodes
Malignant lymhoma
 TNM classification
NO-regional lymph nodes are not palpable
N1-mobile, homolateral enlarged lymph
nodes
N2-mobile, bilateral or contralateral lymph
nodes
N3-fixed lymph nodes
 Stage grouping based on TNM
classification for malignant tumors
 Basic investigation
Case history
Somatic investigation
Ivestigation of the other organs according
to location of lnn.
Auxiliary laboratory tests
 Case history
Age
Job
Sweating
Fewer
Loss of weigh
Local or general infection
Trauma
Itching of the skin
Pain of the joins
Using of the drugs
Contact with animals
Time of enlargment
 Somatic investigation of lymph
nodes
Size
Consistence(abscess, fluctuation, stiffnes,
elasticity)
Mobility or adherence
Changes of the skin
Sensitivity for palpation
 Consequence

Liver and spleen

Inflammation in the areas from tibutary
tissues
Marks of the symstemic disease(join ts)
Investigation of the nasopharynx,pharynx,
larynx, tonsils, ear investigation
Changes of the skin
 Laboratory tests
Blood count
LFT and RFTs
Serology(HIV, IM,CMV,borrelia, syphillis,
toxoplasmosis)
Microbiology(culture from suspected
areas,haemocolture, TB tests)
X ray of lungs, mediastinum, ultrasound, CT
Diagnostic biopsy of cerv. Lnn
Histology
Other auxiliary tests(revmatoid factor,HIV antib., LE
cells, ANF..)
 Treatment
depends on
underlying cause

Melanoma

Neck cancer
Thank you