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)

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]

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Cervical lymphadenopathy (C0235592)

Definition (NCI) Enlargement of the cervical lymph nodes usually due to infections or involvement by malignant neoplasms.
Concepts Pathologic Function (T046)
SnomedCT 127086001
English LYMPHADENOPATHY CERVICAL, cervical lymph nodes enlarged, enlarged cervical lymph nodes (physical finding), enlarged cervical lymph nodes, cervical lymphadenopathy, cervical lymph node enlargement, enlarged lymph nodes of neck, Lymphadenopathy cervical, cervical enlarged lymph node, lymphadenopathy cervical, Enlargement of cervical lymph node, Cervical lymphadenopathy, Cervical lymphadenopathy (disorder), Cervical Lymphadenopathy
Dutch baarmoederhalslymfadenopathie
French Lymphadénopathie cervicale, LYMPHADENOPATHIE CERVICALE
German Lymphadenopathie zervikal, LYMPHADENOPATHIE ZERVIKAL
Italian Linfadenopatia cervicale
Portuguese Linfadenopatia cervical, LINFADENOPATIA CERVICAL
Spanish Linfadenopatía cervical, LINFADENOPATIA CERVICAL, linfadenopatía cervical (trastorno), linfadenopatía cervical
Japanese 頚部リンパ節症, ケイブリンパセツショウ
Czech Krční lymfadenopatie
Hungarian Nyaki lymphadenopathia

Ontology: Acute lymphadenitis of face, head and neck (C0452156)

Concepts Disease or Syndrome (T047)
ICD10 L04.0
SnomedCT 200700005
English Ac lymphadenit face/head/neck, acute lymphadenitis face, head and neck (diagnosis), acute lymphadenitis face, head and neck, Acute lymphadenitis of face, head and neck, Acute lymphadenitis of face, head and neck (disorder)
German Akute Lymphadenitis an Gesicht, Kopf und Hals
Korean 얼굴, 머리 및 목의 급성 림프절염
Dutch Acute lymfadenitis van aangezicht, hoofd en hals
Spanish linfadenitis aguda de cara, cabeza y cuello (trastorno), linfadenitis aguda de cara, cabeza y cuello

Ontology: enlarged posterior cervical lymph nodes (C0742175)

Concepts Finding (T033)
English enlarged posterior cervical lymph nodes, posterior cervical lymphadenopathy, enlarged posterior cervical lymph nodes (physical finding)

Ontology: enlarged preauricular lymph nodes (C0747788)

Concepts Finding (T033)
English preauricular lymph nodes enlarged, preauricular lymphadenopathy, enlarged preauricular lymph nodes (physical finding), enlarged preauricular lymph nodes

Ontology: Submental lymphadenopathy (disorder) (C0749111)

Concepts Pathologic Function (T046)
SnomedCT 127083009
English enlarged submental lymph nodes (physical finding), submental lymphadenopathy, submental lymph nodes enlarged, enlarged submental lymph nodes, Submental lymphadenopathy (disorder), Submental lymphadenopathy
Spanish linfadenopatía submentoniana (trastorno), linfadenopatía submentoniana

Ontology: Supraclavicular lymphadenopathy (C0749155)

Concepts Pathologic Function (T046)
SnomedCT 127088000
English supraclavicular lymph nodes enlarged, supraclavicular lymphadenopathy, Supraclavicular lymphadenopathy, enlarged supraclavicular lymph node (physical finding), enlarged supraclavicular lymph node, Supraclavicular lymphadenopathy (disorder)
Spanish linfadenopatía supraclavicular (trastorno), linfadenopatía supraclavicular

Ontology: Occipital lymphadenopathy (C0920024)

Concepts Pathologic Function (T046)
SnomedCT 127076002
Dutch achterhoofdlymfadenopathie
French Lymphadénopathie occipitale
German okzipitale Lymphadenopathie
Italian Linfadenopatia occipitale
Portuguese Linfadenopatia occipital
Spanish Adenopatía occipital, linfadenopatía occipital (trastorno), linfadenopatía occipital
Japanese 後頭部リンパ節症, コウトウブリンパセツショウ
Czech Okcipitální lymfadenopatie
Hungarian Occipitalis lymphadenopathia
English Occipital lymphadenopathy, Occipital lymphadenopathy (disorder)

Ontology: Posterior auricular lymphadenopathy (C1264051)

Concepts Pathologic Function (T046)
SnomedCT 127077006
English Posterior auricular lymphadenopathy (disorder), Posterior auricular lymphadenopathy
Spanish linfadenopatía auricular posterior (trastorno), linfadenopatía auricular posterior

Ontology: Submandibular lymphadenopathy (C1264056)

Concepts Pathologic Function (T046)
SnomedCT 127082004
Dutch submandibulaire lymfadenopathie
French Lymphadénopathie sous-mandibulaire
German submandibulaere Lymphadenopathie
Italian Linfoadenopatia sottomandibolare
Portuguese Linfadenopatia submandibular
Spanish Linfadenopatía submandibular, linfadenopatía submaxilar (trastorno), linfadenopatía submaxilar
Japanese 顎下リンパ節症, ガッカリンパセツショウ, ガクカリンパセツショウ
English Enlarged submandibular lymph nodes, enlarged submandibular lymph nodes (physical finding), submandibular lymph nodes enlarged, submandibular lymphadenopathy, enlarged submandibular lymph nodes, Submandibular lymphadenopathy (disorder), Submandibular lymphadenopathy
Czech Submandibulární lymfadenopatie
Hungarian Submandibularis lymphadenopathia

Ontology: Jugular lymphadenopathy (C1264060)

Concepts Pathologic Function (T046)
SnomedCT 127089008
English Jugular lymphadenopathy (disorder), Jugular lymphadenopathy
Spanish linfadenopatía yugular (trastorno), linfadenopatía yugular

Ontology: Anterior cervical lymphadenopathy (C1264061)

Concepts Pathologic Function (T046)
SnomedCT 127090004
English enlarged anterior cervical lymph nodes (physical finding), anterior cervical lymphadenopathy, enlarged anterior cervical lymph nodes, Anterior cervical lymphadenopathy (disorder), Anterior cervical lymphadenopathy
Spanish linfadenopatía cervical anterior (trastorno), linfadenopatía cervical anterior

Ontology: Lymphadenopathy of head AND/OR neck (C1827289)

Concepts Finding (T033)
SnomedCT 425061006
English Lymphadenopathy of head AND/OR neck, Lymphadenopathy of head AND/OR neck (disorder)
Spanish linfadenopatía de cabeza Y/O cuello (trastorno), linfadenopatía de cabeza Y/O cuello