Overview of cervical lymphadenitis
Cervical lymphadenitis is the inflammation of lymph nodes of the head and neck; it is characterised by redness, warmth, tenderness on palpation and swellingHaynes, 2015. It is associated with infection, autoimmune disorders, drugs (eg anticonvulsants) and cancer. An inflamed lymph node can progress into an abscess (suppurative lymphadenitis), which may require surgical review for drainageSrivanitchapoom, 2020.
Patient age is an important predictor of the frequency and aetiology of cervical lymphadenitis. More than one-third of healthy children will have cervical lymphadenitis, typically associated with viral upper respiratory tract infectionsDeosthali, 2019. Cervical lymphadenitis is uncommon in adults; if present, consider noninfective causes.
A painless, hard, irregular mass or a firm, rubbery lesion is suggestive of serious noninfective causes. Similarly, generalised symptoms such as weight loss, night sweats or unexplained bruising warrant further investigation including a more detailed patient history, blood tests and radiological investigations.
Management of cervical lymphadenitis depends on its durationHaynes, 2015Srivanitchapoom, 2020:
- acute cervical lymphadenitis has a duration shorter than 2 weeks – see Acute unilateral cervical lymphadenitis and Acute bilateral cervical lymphadenitis
- subacute cervical lymphadenitis has a duration between 2 to 6 weeks
- chronic cervical lymphadenitis has a duration of longer than 6 weeks.
The location (localised vs generalised), associated symptoms, exposure to specific pathogens (eg Mycobacterium tuberculosis, Bartonella species) and examination findings can help with differential diagnosis.
Lymphatic drainage follows well-defined patterns, so the location of the enlarged lymph node can be an indicator of the likely site of pathogen entry or primary source of infection (eg dental abscess causing enlarged submandibular or submental node)Haynes, 2015.