Cervical Lymphadenopathy

What Is It, Causes, Workup, Treatment, and More

Author: Benisha Julian, MD

Editors: Antonella Melani, MD, Ahaana Singh, Lisa Miklush, PhD, RN, CNS

Illustrator: Aileen Lin


What is cervical lymphadenopathy?

Cervical lymphadenopathy refers to the swelling of lymph nodes located in the neck. Lymph nodes, situated all over the body, are part of the lymphatic system, which works to protect the body against microbes, maintain adequate fluid levels, absorb nutrients, and remove certain waste products. Lymphocytes, or white blood cells, are activated in the lymph nodes, after which they travel into the bloodstream to defend the body against microbes. When the lymph nodes accumulate excessive amounts of lymphocytes, they can increase in size and become swollen. 

Cervical lymph nodes are usually very small and cannot be felt upon touch unless an underlying infection or inflammatory process has triggered an increase in size. Depending on the underlying cause, enlarged cervical lymph nodes may be painless or painful to touch, tender, firm or rubbery in consistency, and mobile or fixed to the underlying tissue. 

Cervical lymphadenopathy can often be confused with cervical lymphadenitis. Although cervical lymphadenitis does usually present with cervical lymphadenopathy, cervical lymphadenitis refers to a direct infection of the cervical lymph nodes, often resulting from bacterial or viral infection. Cervical lymphadenitis can occur from Mycobacterium tuberculosis, resulting in tuberculous cervical lymphadenitis, or by other atypical mycobacteria, resulting in non-tuberculous cervical lymphadenitis. Additionally, cat scratch disease, which is caused by the bacterium Bartonella henselae, can result in cervical lymphadenitis.

What causes cervical lymphadenopathy?

Cervical lymphadenopathy is most commonly localized to inflammatory processes in the neck or nearby areas. For instance, throat infection, the common cold, dental decay, ear infection, bronchitis, conjunctivitis, and infections of the salivary glands are all causative factors. These infections can be of viral or bacterial origin. Certain cancers of the head and neck regions can also cause localized cervical lymphadenopathy. Such cancers usually involve the skin and underlying soft tissue, nose, paranasal sinuses, mouth, throat, vocal cords, salivary glands, and thyroid glands. 

In some cases, lymphadenopathy can be generalized due to a systemic disease affecting organs far away from the neck. Generalized cervical lymphadenopathy is often seen in chronic infections, cancerous conditions, autoimmune disorders, and some other miscellaneous conditions. Chronic infections such as AIDS or acquired immunodeficiency syndrome, infectious mononucleosis, and pulmonary tuberculosis often present with cervical lymphadenopathy.

Certain cancers—such as Hodgkin’s and Non-Hodgkin’s lymphoma, acute lymphoblastic leukemia, and acute myeloblastic leukemia—can also result in generalized cervical lymphadenopathy. 

Autoimmune diseases may also result in cervical lymphadenopathy. Systemic lupus erythematosus, also known as lupus, is an inflammatory autoimmune disorder that often results in the swelling of lymph nodes throughout the body. Similarly, rheumatoid arthritis is a chronic inflammatory condition that typically affects the joints but can also lead to the inflammation of tissues throughout the body, and the consequent swelling of lymph nodes. Sarcoidosis is characterized by the growth of abnormal inflammatory cell masses, and commonly targets the lymph nodes. Kawasaki disease, a rare inflammatory disease in children, usually presents with cervical lymphadenopathy. 

Rare causes of cervical lymphadenopathy include Kikuchi–Fujimoto disease, a self-limiting condition typically seen in young females, as well as storage disorders in which excessive metabolic products are accumulated in the cell, such as Gaucher’s disease, Niemann–Pick disease, and amyloidosis.

Is cervical lymphadenopathy serious?

Cervical lymphadenopathy on its own is not a serious condition; however, it may indicate a more serious underlying condition. In many cases, it can be a sign of a mild, benign, self-limiting condition of acute onset. However, it can also be a sign of more serious chronic conditions, such as cancer or autoimmune diseases, and should be thoroughly evaluated in order to make a sound diagnosis.

How is cervical lymphadenopathy diagnosed?

Cervical lymphadenopathy can be identified during physical examination of the neck region, following a history suggestive of infection affecting the throat, ear, salivary glands, skin, or surrounding structures. It can also be identified and confirmed through ultrasound imaging, CT scan, or an MRI of the neck.

How is cervical lymphadenopathy evaluated further?

Cervical lymphadenopathy may be a non-specific clinical sign of an underlying disease, requiring further investigations depending on additional clinical features presented by the individual. Additional information that may be useful for a physician include the duration of the lymphadenopathy, the characteristics of the lymph nodes, and involvement of lymph nodes in other body areas. 

Localized cervical lymphadenopathy often won’t require further evaluation. However, if an individual presents with symptoms such as weight loss, fever, fatigue, or night sweats, it could suggest a much more serious condition such as cancer, an autoimmune disease, or other serious infections such as tuberculosis, infectious mononucleosis, AIDS, and cat scratch disease, among others. These conditions may require further testing, including laboratory tests and imaging, to make a definitive diagnosis. In some cases, a biopsy of the node may be required; this is typically performed through fine needle aspiration, core needle biopsy, or excisional biopsy.

How is cervical lymphadenopathy treated?

Treatment for cervical lymphadenopathy will vary based on the underlying cause, and will typically resolve with appropriate treatment of the underlying condition. Infectious conditions may require a course of antimicrobial medications, while autoimmune conditions may need anti-inflammatory medications. In cancer-related lymphadenopathy, chemotherapy, radiotherapy, or surgical removal can help resolve the swollen lymph nodes.

What are the most important facts to know about cervical lymphadenopathy?

Cervical lymphadenopathy refers to the enlargement of cervical lymph nodes, or the lymph nodes in the neck region. It often serves as an important clinical indicator of an underlying condition, most commonly of infectious origin. Localized lymphadenopathy may occur as a result of infection or inflammation of nearby structures such as the throat, common cold, bronchitis, dental decay, conjunctivitis, ear infection, and infection of the salivary glands. In other cases, cervical lymphadenopathy can be indicative of a more generalized infection as a result of systemic conditions, such as certain cancers, autoimmune disorders, and chronic infections. Therefore, a thorough review of medical history and a physical exam, in addition to any necessary testing, imaging, and biopsy, can help in the differential diagnosis to better identify the underlying cause. Treatment for cervical lymphadenopathy will vary based on the underlying cause, and will typically resolve with appropriate treatment of the underlying condition.

Related links

High Yield: Nasal, oral, and pharyngeal diseases
Francisella tularensis (Tularemia)
Clinical Reasoning: Pediatric upper airway conditions
Hodgkin lymphoma

Resources for research and reference

Balm, A. J. M., van Velthuysen, M. L. F., Hoebers, F. J. P., Vogel, W. V., & van den Brekel, M. W. M. (2010). Diagnosis and Treatment of a Neck Node Swelling Suspicious for a Malignancy: An Algorithmic Approach. International Journal of Surgical Oncology, 2010. DOI: 10.1155/2010/581540.

Bosch, X. & Guilabert, A. (2006). Kikuchi-Fujimoto disease. Orphanet Journal of Rare Diseases, 2016. DOI: 10.1186/1750-1172-1-18

Ferrer, R. (1998). Lymphadenopathy: Differential Diagnosis and Evaluation. American Family Physician, 58(6): 1313–1320. Retrieved October 21, 2020, from https://www.aafp.org/afp/1998/1015/p1313.html

Freeman, A. M. & Matto, P. (2020). Adenopathy. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Retrieved October 21, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK513250

Modesti, A. M. & Plewa, M. C. (2020). Kawasaki Disease. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Retrieved September 16, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK537163/

Mohseni, S., Shojaiefard, A., Khorgami, Z., Alinejad, S., Ghorbani, A., & Ghafouri, A. (2014). Peripheral Lymphadenopathy: Approach and Diagnostic Tools. Iranian Journal of Medical Sciences, 39(2 suppl): 158–170. Retrieved October 21, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3993046/

Ralston, S. H., Penman, I. D., Strachan, M. W., Hobson, R., & Britton, R. (2018). Blood Disease. In Davidson's Principles and Practice of Medicine (23 edition). Edinburgh: Elsevier.