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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 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?

• Localized cervical lymphadenopathy is the result of inflammatory processes in the neck or nearby areas. This can result from a variety of conditions. 

  • Throat infections

  • Common cold

  • Dental decay

  • Ear infections

  • Bronchitis (inflammation of the lining of the bronchial tubes in the lungs)

  • Conjunctivitis (inflammation or infection of the outer membrane of the eyeball and the inner eyelid)

  • Infections of the salivary glands

  • Certain cancers affecting the head and neck regions 

    • Usually involving the skin and underlying soft tissue, nose, paranasal sinuses, mouth, throat, vocal cords, salivary glands, and thyroid glands.

• Generalized lymphadenopathy can result from a systemic disease affecting organs far away from the neck. 

  • Chronic infections such as acquired immunodeficiency syndrome (AIDS), 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. 

    • 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. 

  • There are some more rare causes of cervical lymphadenopathy.

    • Kikuchi–Fujimoto disease, a self-limiting condition typically seen in young females. 

    • Storage disorders in which excessive metabolic products are accumulated in the cell, such as Gaucher’s disease, Niemann–Pick disease, and amyloidosis. 

How is cervical lymphadenopathy diagnosed?

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. 

• Clinical evaluation 

  • Physical examination of the neck region following a history suggestive of infection affecting the throat, ear, salivary glands, skin, or surrounding structures. 

  • Symptom and sign review

    • 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. 

    • Symptoms, such as  weight loss, fever, fatigue, or night sweats, 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. 

• Imaging

  • Ultrasound imaging

  • CT scan 

  • MRI 

• Procedural diagnosis

  • Biopsy of affected lymph node

    • Fine needle aspiration

    • Core needle biopsy

    • 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. 

• Autoimmune conditions may need anti-inflammatory medications. 

• Cancer-related lymphadenopathy may require chemotherapy, radiotherapy, or surgical removal, which can help resolve the swollen lymph nodes. 

Frequently Asked Questions

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. 

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