Everything you need to know about swollen lymph nodes in the neck

Introduction

Lymph nodes are small glands, the size of beans, which filter lymph circulating through the lymphatic system. They store white blood cells that are responsible for the body’s immunity. Therefore, it’s an important part of the immune system. In fact, those glands trap invading organisms to stop them from infecting other parts of the body. Those nodes can become swollen as a result of infections from bacteria or viruses, though rarely of tumors. Lymph nodes are located everywhere throughout the body mainly on the neck, the armpits and the fold of the groin. They can swell in response to infections in the areas where they are located.

In this article, we are going to focus on swollen neck lymph nodes or cervical lymphadenopathy which are classed as one of the most common lymphadenitis.

Anatomical consideration

The lymph nodes collect and filter fluids, waste products, and potentially hazardous pathogens. There are hundreds of lymph nodes in the human body. The following are the primary lymph nodes that individuals may see or feel:

Under the jaw
On each side of the neck
Under the armpits
On either side of the groin

Lymph fluid circulates throughout the body, entering and exiting lymph nodes before returning to the chest. It catches and traps hazardous materials such as germs, viruses, and body waste products while doing so. The lymph nodes filter the fluid and reintroduce it into the circulation, along with salts and proteins.

Lymph nodes also include immune cells, which aid in the fight against illness by destroying bacteria that have collected in the body's lymph fluid. When a person gets a brief infection, the lymph nodes may enlarge. The swelling is caused by immune cell activation in the lymph nodes.

The location of the swelling is frequently related to the afflicted region. An ear infection, for example, may result in swollen lymph nodes in the ear, but an upper respiratory tract infection may result in swollen lymph nodes in the neck.

Classification of the cervical LNs

Level IA: Submental Region

These LNs are located within a triangle formed by the anterior belly of the digastric muscles (on both sides) and the hyoid bone on the inferior side.

Level IB: Submandibular Region

These LNs are located within the triangle formed by the anterior and posterior bellies of the digastric muscle on the inferior side and the body of the mandible on the superior side. It should be highlighted that if the LNs at this level are excised, the submandibular gland should be included in the resected material.

Level IIA and IIB: Upper Jugular Group

These are the LNs that surround the internal jugular vein's upper part (IJV). They expand from the base of the skull superiorly to the level of the hyoid bone's inferior border inferiorly. It is bordered anteriorly by the sternohyoid and stylohyoid muscles' lateral borders. It is restricted posteriorly by the sternocleidomastoid (SCM) muscle's posterior border.

The level IIA LNs are located anterior to the vertical plane of the spinal accessory nerve, whereas the level IIB LNs are located posterior to this plane. The vertical plane at the posterior portion of the submandibular gland separates level IB and level IIA LNs radiographically.

Level III: Middle Jugular Group

This level is positioned in the middle third of the IJV and spans from the inferior border of the hyoid bone superiorly to the inferior border of the cricoid cartilage inferiorly. Again, the anterior boundary is represented by the sternohyoid muscle's lateral border, while the posterior limit is represented by the SCM's posterior border. This category includes the jugulo-omohyoid LN.

Level IV: Lower Jugular Group

These LNs go from the cricoid cartilage's bottom border to the collarbone and are found around the lower third of the IJV. This group is bordered anteriorly by the sternohyoid muscle's lateral boundary and posteriorly by the SCM's posterior border. It should be noticed that the "Virchow" LN falls inside this category.

Levels VA and VB: Posterior Triangle Group

The top boundary of this group is established by the convergence of the trapezius and SCM muscles, while the lower boundary is formed by the clavicle. The anterior boundary is established by the posterior border of the SCM, while the posterior boundary is formed by the anterior border of the trapezius muscle.

Level VA LNs and VB LNs are divided by an imagined horizontal plane that marks the bottom boundary of the cricoid cartilage. Level VA LNs contain the spinal auxiliary LNs, whereas Level VB LNs comprise the LNs situated around the transverse cervical vessels and the supraclavicular LNs.

Level VI: Central Compartment Group

This level contains pretracheal, paratracheal, precricoid (Delphian), and peri-thyroidal LNs (including LNs located along the recurrent laryngeal nerves). This area stretches from the hyoid bone superiorly to the suprasternal notch inferiorly. Laterally, it is confined by the common carotid arteries (CCAs).

Pathophysiology

Lymph nodes are part of the reticuloendothelial system, which also includes blood monocytes, connective tissue macrophages, the thymus, the spleen, bone marrow, bone, mucosa-associated lymphoid tissue of visceral organs, lymphatic veins, and lymphatic fluid found in interstitial fluid.

Lymphatic fluid circulates throughout the lymphatic system, passing from organs through lymphatic capillaries, lymphatic arteries, and eventually lymph nodes for antigen filtering. Foreign substances are given to lymphoid cells, causing them to proliferate and expand. Cellular growth in lymphoid follicles can be seen as multiple mitotic figures under a microscope. Patients may develop localized soreness when lymphatic capsules expand as a result of increased exercise.

B-cell development begins with pluripotent stem cells from the bone marrow. B cells that effectively construct their immunoglobulin heavy chains move to germinal centers, allowing for antibody diversity through somatic hypermutation. B-cell lymphomas are thought to be caused by changes in somatic hypermutation and chromosomal translocations.

T-cell development also begins with pluripotent stem cells, which mature in the thymic cortex. T cells initiate particular rearrangements at the T-cell receptor whilst in the thymic cortex. T-cell lymphomagenesis is thought to be caused by chromosomal translocations at the level of T-cell receptors.

Lymph node follicle necrosis can develop as a result of a variety of illnesses, including inflammatory, infectious, and malignant disorders. The prevalence of neutrophilic infiltrates denotes bacterial illness, whereas the predominance of lymphocytic infiltrates may indicate a viral infection. However, doctors must keep in mind that etiologies differ; lymphomas, leukemias, TB, or even systemic lupus may be more suitable diagnoses in the right clinical setting.

What causes swollen lymph nodes in the neck?

Generally, swollen lymph nodes in the neck are a sign that your immune system is fighting off to protect your body from an illness caused by a foreign agent such as a virus, a parasite, or bacteria. Swollen neck lymph nodes are commonly caused by illnesses affecting organs near the neck such as an infected tooth, cold, flu, tonsillitis, ear or throat infection, angina, and cellulitis.

Many other conditions can cause swollen lymph nodes in the neck:

Viral infections:

Are the most frequent cause:

A viral upper respiratory infection such as cold or flu
Human immunodeficiency virus: HIV
Herpes simplex virus
Adenovirus
Mononucleosis caused by Epstein Bar Virus
Cytomegalovirus

Bacterial infections:

Infection caused by bacteria such as:

Strep throat caused by streptococcus
Tuberculosis
Staphylococcus
Syphilis (a sexually transmitted infection)
Cat scratch disease

Parasitic infections:

Toxoplasmosis
Leishmaniosis

More serious diseases can also cause the lymph nodes throughout the body to swell.

Autoimmune diseases:

Cancers:

Sometimes swollen lymph nodes in the neck may be a sign of cancer that has spread to the lymph glands:

Cancer can be suspected if the swollen neck lymph node is persistent, gets bigger over time, is painless, and is hard to move. A knowledgeable doctor will help you obtain the proper diagnosis.

Occasionally, some medicines can cause swollen lymph nodes in the neck including typhoid immunization.

What are the symptoms of Swollen neck lymph nodes?

Symptoms are widely varied and are often related to an underlying disease that causes the neck swollen lymph nodes. They can include:

Localized pain
High fever
Increasing swelling
Warmth in the involved area
Tenderness
Swallowing, breathing, or moving difficulties
Night sweats
Fatigue

All aspects of a full history and physical examination must be remembered at all times. The following events can be discovered in history:

History of Presenting Illness: location, pain - if so intensity, quality, onset, precipitating factors, alleviating factors
Past Medical History: It is critical to understand the patient's past medical history, since this may provide insight into the cause of lymphadenopathy (e.g., HIV/AIDS, distant history of non- Hodgkin's lymphoma).
Medications: Some medications can cause reversible lymphadenopathy (i.e., cephalosporins, phenytoin)
Social History: It is critical to understand living conditions, chemical exposures, alcohol, cigarette, and recreational drug usage, pets, animal exposures, and recent travel.
Sexual History: It is necessary to know the number of sexual partners, whether they are sexually active with men, females, or both; the usage of protection, a history of sexually transmitted infections, and partners who have known sexually transmitted illnesses.
Surgical History: Inquire about which procedures were performed and when they happened, as well as how quickly the lymphadenopathy developed (i.e., post-operative lymphadenopathy)
Family History: It is critical to determine whether there is a cancer family history.

Physical examination involves the following:

Vital signs: Temperature, blood pressure, heart rate, respiratory rate, and oxygen saturation are all important in determining whether or not a patient is hemodynamically stable. This can help distinguish sepsis from other illnesses.
A complete physical examination must be performed, including an examination of the head, ears, nose, throat, and thyroid gland. Lung and heart auscultation, as well as palpation for splenomegaly and hepatomegaly A thorough examination of the skin should be performed, including palpation where required, to search for rashes, lesions, and nodules.
When palpating lymphadenopathy, keep location, size, stiffness, and discomfort in mind.

Location:

The sternocleidomastoid muscle is superior and inferior to the anterior cervical lymph nodes. The lymph nodes in the posterior cervical region are located behind the sternocleidomastoid muscle.
In addition, bilaterally check for supraclavicular, axillary, and inguinal lymphadenopathy.
Local lymphadenopathy denotes a more confined illness than extensive lymphadenopathy.

1. Size:

Cervical lymph nodes and axillary nodes are uncommon if they are larger than 1 cm, as opposed to supraclavicular nodes that are larger than 0.5 cm and inguinal nodes that are larger than 1.5 cm.

2. Firmness:

In general, a lymph node that is easily moveable is less worrying for malignant disease.

3. Pain:

Pain can be an indication of inflammation or acute response to an infection, but it is less problematic in the case of a malignant process.

However, sometimes a swollen lymph node in the neck can also be asymptomatic without any sign other than the swelling.

How is a Swollen neck lymph node diagnosed?

Besides the medical history and a precise physical examination, the physician will evaluate the characteristics of the node:

Its size
Its consistency
Whether it is painful
The matting
Its shape
Tenderness
Warmth
Texture

You have to disclose all details to your doctor in order to get the best results: have you been recently scratched by a cat or a dog? Do you eat undercooked meat? Have you traveled recently? Have you had risky sexual behavior? Responding to all these questions honestly is an important step in determining the right diagnosis rapidly. Also, some extra tests may be necessary to help to identify the cause such as:

Blood tests: that will help evaluate your general health and detect some undiscovered illnesses
Imaging studies: like scans and ultrasound scans that will help detect tumors or infection sources
Biopsy: a biopsy may be needed in order to confirm or exclude a diagnosis. It consists on making a small cut and removing a small sample from the swollen neck lymph node in order to perform a microscopic examination in a laboratory.

How to detect a swollen neck lymph node?

You can self-detect a swollen lymph node in your neck.

Here are some simple and easy steps you can follow:

Feel the lymph node with your fingertips rubbing in a circular motion
Gently press around your neck
Check both sides to compare between them

If you have a swollen lymph node you will easily detect it because swollen lymph nodes in the neck feel larger than usual, tender to the touch, sometimes painful, and warm which are signs of inflammation. You may also feel pain while doing sudden movements. Some systemic symptoms can reveal these swollen nodes.

How often should we check our neck lymph nodes?

It is advised to check lymph nodes once a month in order to discover asymptomatic swollen neck lymph nodes early.

Swollen lymph nodes treatment

No specific set treatment for swollen lymph nodes in the neck is available. It all depends on the underlying cause. If it isn’t a serious disease that is causing your swollen neck lymph node, then it will disappear by itself in a few days even without any treatment. You can take some remedies to alleviate certain symptoms such as antipyretics and pain relievers if needed. Don’t forget to get a good rest, as it may help.

If the swollen neck lymph node is caused by a bacterial or viral infection, then your doctor will prescribe antibiotics or antivirals to treat it. By the elimination of the infection agent, the swollen lymph node will shrink back to its normal size.

When a tumor is responsible for the swollen neck lymph node, the doctor will choose the best treatment option for you by removing the entire node, by using radiation, chemotherapy, or by a combination of treatments.

Complications of a Swollen neck lymph node

As explained, a swollen neck lymph node can be a normal reaction of the body to an illness.

In many cases, it usually gets better and shrinks by itself within a few weeks. Nevertheless, the neck node may remain swollen even after the illness has been treated and this chronically swollen lymph node in the neck leads to several complications. These complications depend on the cause behind the swollen neck lymph node.

For example, if the cause is infectious and the cervical lymphadenopathy is not treated, it may develop an abscess which is a collection of pus under the skin and could be a serious problem that requires surgical treatment. Otherwise, a neglected swollen neck lymph node can cause the spread of the infection to the blood causing septicemia which is a life-threatening condition.

Differential Diagnosis

Because of the variety of causes of lymphadenopathy, doctors are frequently faced with diagnostic hurdles. To eliminate confusion and increase diagnostic accuracy, collect a full history and physical, develop a set of differentials, and categorize them based on their presentation.

Causes of lymphadenopathy include but are not limited to:

Malignant: Lymphadenopathy may be alarming for diagnoses such as metastatic breast cancer, Kaposi sarcoma, leukemias, lymphomas, metastatic illness (e.g., stomach cancer), and malignant diseases of the skin if the history and physical examination are consistent.
Autoimmune: Several immune-mediated diseases, such as dermatomyositis, Kawasaki disease, rheumatoid arthritis, sarcoidosis, Sjogren syndrome, Still disease, and systemic lupus erythematosus, can cause lymph node abnormalities.
Infectious: A variety of infections can cause benign alterations in the lymph nodes. Infections of many types, such as bacterial, viral, and others, maybe considered by health care providers:

Bacterial diseases include brucellosis, cat scratch illness, bacterial pharyngitis, syphilis, TB, tularemia, and typhoid fever.
Cytomegalovirus, hepatitis, herpes simplex, HIV, mononucleosis, rubella, viral pharyngitis are all viral infections.

Medications: Medical treatments can frequently cause benign lymph node growths. Allopurinol, atenolol, captopril, carbamazepine, cephalosporins, gold, hydralazine, penicillin, phenytoin, primidone, pyrimethamine, quinidine, sulfonamides, and sulindac are examples of these medicines.

When to see a doctor for a Swollen lymph node in the neck?

It's high time to seek medical care if:

Nodes have swollen up suddenly with no apparent reason
Nodes remain enlarged for more than two weeks
You are having difficulty breathing or swallowing
You are having a persistent high fever and night sweats
You are having an unexplained weight loss or loss of appetite
The swollen neck lymph node is getting bigger over time
The swollen lymph node is painful or hard to move

If you are experiencing one or more of these symptoms, don’t hesitate to consult a physician as soon as possible. You can start by seeing your primary care doctor who will be able to diagnose your issues by discussing your symptoms, doing a physical exam, and maybe some biological tests in order to evaluate your case and either prescribe treatment or refer you to a specialist (hematologist, infection diseases specialist, oncologist or surgeon as it would depend on the reason behind the swollen neck lymph node).

Prognosis

Lymph node enlargement in younger populations (for example, children) is often benign and associated with infection. There are several exceptions to the norm, especially if the patient's history and physical are suspicious of persistent infection, cancer, or autoimmune disorders.
Other risk factors that may be bad prognostic indicators include advanced age, lymphadenopathy duration (> 4 weeks is worrying), widespread lymphadenopathy, male sex, lack of resolution of node size, and systemic indications such as fever, night sweats, weight loss, and hepatosplenomegaly.

Prevention of swollen lymph nodes

The only method to avoid swollen lymph nodes is to avoid the situations that might lead to them. The following are some actions you can take:

Maintain good dental hygiene to keep your teeth and gums healthy.
Hands should be washed often.
Obtain immunizations against diseases such as shingles, TB, and the flu.
Avoid sharing food, beverages, or personal belongings like towels with somebody who has an infectious virus-like mono or the common cold.
During sexual activity, use condoms or other barrier techniques.
If you're having an unfavorable or allergic response to your drugs, talk to your doctor about altering them.
Avoid allowing your pet cats to play outside or allowing them to interact with wild cats.

To sum up:

Swollen neck lymph nodes are one of the most common lymphadenitis. They usually appear as a response from the body to another condition essentially as an infection. It is a symptom but not a disease. Swollen lymph nodes in the neck tend to normally disappear spontaneously within a short period and without any treatment.

Still, it is important to check a doctor in order to diagnose the cause behind it and decide whether you need treatment, especially when you are experiencing some specific symptoms such as persistent high fever, swallowing or breathing difficulties, and night sweats. Only identifying the exact cause of the swollen neck lymph node can help determine its correct treatment.