Lymphadenopathy of the Head and Neck

Aka: Lymphadenopathy of the Head and Neck, Head and Neck Lymphadenopathy, Lymphadenitis of the Head and Neck, Submandibular Lymphadenopathy, Submental Lymphadenopathy, Supraclavicular Lymphadenopathy, Jugular Lymphadenopathy, Posterior Cervical Lymphadenopathy, Anterior Cervical Lymphadenopathy, Occipital Lymphadenopathy, Suboccipital Lymphadenopathy, Preauricular Lymphadenopathy, Postauricular Lymphadenopathy, Generalized Cervical Lymphadenopathy, Cervical Lymphadenopathy

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II. Anatomy: Images

  1. Head and neck Lymph Node chains
    1. entLympGrayBB602.gifLewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy)

III. Evaluation

  1. See Lymphadenopathy for general approach

IV. Signs: Submandibular Nodes (below angle of jaw)

  1. Drainage Pattern
    1. Tongue
    2. Submaxillary gland
    3. Submental node drainage
    4. Lip and Mouth mucosa
    5. Medial Conjunctiva
  2. Lymphadenopathy Causes (Infections of head and neck)
    1. Acute Sinusitis
    2. Chronic Sinusitis
    3. Otitis Media
    4. Conjunctivitis
    5. Tinea Capitis
    6. Pharyngitis (Mononucleosis, Upper Respiratory Infection)
    7. Atypical Mycobacterial Infection
    8. Cat-Scratch Disease
    9. Rubella
    10. Dental Infections
    11. Mononucleosis
    12. Cytomegalovirus
    13. Bacterial Lymphadenitis (may effect any Lymph Node, but submandibular is most common)
      1. Staphylococcal Lymphadenitis (esp. in preschool children, and unilateral in 90% of cases)
      2. Streptococcal Lymphadenitis
  3. Other Neck Masses
    1. Cystic Hygroma
    2. Sialadenitis (Submandibular Gland)
    3. Vascular Malformations
    4. Squamous Cell Carcinoma of the head and neck
    5. Lymphoma
    6. Leukemia

V. Signs: Submental Nodes (below chin)

  1. Drainage Pattern
    1. Lower lip
    2. Floor of Mouth
    3. Tip of Tongue
    4. Skin of Cheek
  2. Lymphadenopathy Causes
    1. Mononucleosis (Epstein-Barr Virus)
    2. Cytomegalovirus
    3. Toxoplasmosis
  3. Other midline Neck Masses (into hyoid region)
    1. Thyroglossal Duct Cyst
    2. Dermoid Cyst
    3. Cystic Hygroma
    4. Thyroid tumor

VI. Signs: Anterior Cervical Nodes or Jugular Nodes (anterior border of sternocleidomastoid)

  1. Drainage Pattern
    1. Tongue (except apex)
    2. Tonsil
    3. Ear Pinna
    4. Parotid Gland
  2. Lymphadenopathy Causes
    1. See Submandibular Nodes (same causes)
  3. Other Neck Masses (jugular or carotid region)
    1. Branchial Cleft Cyst
    2. Cystic Hygroma
    3. Vascular Malformations
    4. Lymphoma

VII. Signs: Posterior Cervical Nodes (behind sternocleidomastoid)

  1. Drainage Pattern
    1. Scalp
    2. Neck
    3. Arm and pectoral skin
    4. Thorax
    5. Cervical and axillary node drainage
  2. Lymphadenopathy Causes
    1. Tuberculosis
    2. Lymphoma (especially Hodgkin's Lymphoma)
    3. Head and neck cancer
    4. African Trypanosomiasis (Winterbottom's Sign)
    5. Lymphangioma
      1. Congenital lymph malformation presenting by age 2 years (50% found at birth)
    6. Kikuchi-Fujimoto Disease
      1. Benign, self-limited tender adenopathy in young adults, with necrotic nodes on biopsy

VIII. Signs: Occipital or Suboccipital nodes (base of skull, below occiput)

  1. Suboccipital Lymphadenopathy may causes Headache
  2. Drainage Pattern
    1. Back of Scalp and Head
  3. Lymphadenopathy Causes
    1. Local infection
    2. Tinea Capitis
    3. Pediculosis capitis (Lice)
    4. Seborrheic Dermatitis
    5. Secondary Syphilis
    6. Neoplasm including metastases
    7. Lymphoma
  4. Other Neck Masses
    1. Cystic Hygroma
    2. Vascular Malformations

IX. Signs: Postauricular nodes (behind pinna of ear)

  1. Drainage Pattern
    1. External auditory meatus
    2. Posterior Ear Pinna
    3. Temporal Scalp
  2. Lymphadenopathy Causes (Local infection)
    1. Otitis Externa
    2. Tinea Capitis
    3. Secondary Syphilis
    4. Rubella

X. Signs: Preauricular nodes (anterior to ear tragus)

  1. Drainage Pattern
    1. Lateral Eyelids
    2. Palpebral Conjunctiva
    3. Temporal skin
    4. Anterior Ear Pinna
    5. External auditory canal
  2. Lymphadenopathy Causes: Non-ocular
    1. Squamous Cell Carcinoma or Basal Cell Carcinoma (Rodent Ulcer)
    2. Epithelioma
    3. Chancre on face
    4. Erysipelas
    5. Ophthalmic Herpes Zoster
    6. Rubella
    7. Trachoma
    8. Atypical Mycobacterial Infection
    9. Cat Scratch Disease
  3. Lymphadenopathy Causes: Conjunctivitis
    1. Viral Conjunctivitis
      1. Epidemic Keratoconjunctivitis
      2. Adenoidal-pharyngeal-ConjunctivitisVirus
    2. Not usually seen in Bacterial Conjunctivitis
    3. Chronic Granulomatous Conjunctivitis
      1. Parinaud's oculoglandular syndrome
        1. Complication of Cat Scratch Disease (Tularemia)
      2. Chancre (Syphilis)
      3. Tuberculosis
      4. Leptotrichosis (Leptothrix Infection)
      5. Gonorrhea ophthalmia
      6. Sporotrichosis
      7. Glanders
      8. Chancroid
      9. Lymphogranuloma venereum
      10. Chagas Disease
  4. Other Neck Mass causes
    1. Cystic Hygroma
    2. Hemangioma
    3. Type I Branchial Cleft Cyst
    4. Pilomatrixoma
    5. Parotid Gland tumor
    6. Parotid Gland inflammation (Parotitis)

XI. Sign: Supraclavicular Nodes

  1. Drainage pattern
    1. Right supraclavicular node
      1. Mid-chest
      2. Esophagus
      3. Lungs
    2. Left supraclavicular node
      1. See Virchow's Node
      2. Thoracic Duct drainage (Chest, Abdomen)
  2. Lymphadenopathy Causes
    1. Malignancy (represents 90% of cases age>40 years old)
      1. Fijten (1988) J Fam Pract 27:273-6 [PubMed]
    2. Lymphoma
    3. Mediastinal disease
      1. Tuberculosis
      2. Histoplasmosis and other Fungal Lung Infections
      3. Sarcoidosis
  3. Other Neck Mass causes
    1. Cystic Hygroma
    2. Thyroid Goiter
    3. Laryngeal Lesions

XII. Signs: Generalized Acute Cervical Lymphadenopathy Causes

  1. Common Causes
    1. Tinea Capitis
    2. Infectious Mononucleosis (Epstein Barr Virus)
    3. Cytomegalovirus
    4. Adenovirus
  2. Less common causes
    1. Secondary Syphilis
    2. Lice infestation
    3. Serum Sickness
    4. Severe drug allergy (e.g. Penicillin)
    5. Cat Scratch Disease
    6. Rubella
    7. Generalized Furunculosis
  3. Exotic causes (outside U.S.)
    1. Toxoplasmosis
    2. African Trypanosomiasis (African Sleeping Sickness)
    3. Kala Azar
    4. Scrub Typhus

XIII. References

  1. Degowin (1987) Diagnostic Exam, Macmillan, p. 222
  2. Dornbland (1992) Adult Ambulatory Care, p. 662-7
  3. Lee (1999) Wintrobe's Hematology, p. 1826-30
  4. Wilson (1991) Harrison's Internal Medicine, p. 354-6
  5. Ferrer (1998) Am Fam Physician 58(6): 1313-2 [PubMed]
  6. Gaddey (2016) Am Fam Physician 94(11): 896-903 [PubMed]
  7. Ichinose (2022) Am Fam Physician 105(4): 423-4 [PubMed]
  8. Meier (2014) Am Fam Physician 89(5): 353-8 [PubMed]

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