In two studies, malignancy was found in 34 and 50 percent of patients with this presentation the risk was highest in those over the age of 40. Supraclavicular - Supraclavicular lymphadenopathy ( figure 1) is associated with a high risk of malignancy.

Suboccipital - The nodes receive drainage from the posterior scalp and are commonly involved in bacterial or fungal infections. Most commonly, however, enlargement of this node group is noted in bacterial or fungal infections of the parieto-temporal scalp. Postauricular - These nodes (along with sub-occipital nodes) commonly enlarge and become tender in rubella infection.

Cat scratch disease accounts for most cases, though other bacterial and fungal causes are less commonly identified. The “Parinaud oculoglandular syndrome” refers to an uncommon unilateral granulomatous conjunctivitis affecting the bulbar or palpebral conjunctivae. They are commonly enlarged in conjunctivitis caused by viral or bacterial pathogens. Preauricular - The preauricular nodes drain the conjunctiva, portions of the auricle and external ear canal, and the anterior and temporal scalp. Hard cervical lymph nodes, particularly in older patients and smokers, suggest metastatic head and neck cancer (eg, oropharynx, nasopharynx, larynx, thyroid, or esophagus). (See 'Clinical manifestations, diagnosis, and treatment of miliary tuberculosis' and 'Microbiology, epidemiology, clinical manifestations, and diagnosis of cat scratch disease'.) Infection with Bartonella henselae, the agent of cat scratch disease, can also present as multiple enlarged cervical lymph nodes. Tuberculous adenitis is usually regional (except in cases of miliary tuberculosis) and mainly affects nodes of the head and neck. Infection with Mycobacterium tuberculosis or atypical mycobacteria is suggested when multiple enlarged cervical nodes develop over weeks to months and become fluctuant or matted without significant inflammation or tenderness, and it is occasionally associated with fever. (See 'Clinical manifestations and treatment of Epstein-Barr virus infection' and 'Epidemiology, clinical manifestations, and treatment of cytomegalovirus infection in immunocompetent adults', section on 'CMV mononucleosis' and 'Clinical manifestations, diagnosis, and treatment of miliary tuberculosis', section on 'Clinical manifestations' and 'Clinical presentation and initial evaluation of non-Hodgkin lymphoma', section on 'Lymphadenopathy'.) Posterior cervical lymphadenopathy may occur with EBV infection, tuberculosis, lymphoma, or head and neck malignancy (either lymphomas or metastatic squamous cell carcinoma). The anterior cervical lymph nodes are often enlarged because of one of a variety of infections of the head and neck or due to some systemic infections such as Epstein-Barr virus (EBV), cytomegalovirus infection, or toxoplasmosis. The location of lymphadenopathy can often be used to help identify specific etiologies ( table 3).Ĭervical - The anterior cervical lymph nodes are either superficial or deep to the sternocleidomastoid muscle and the posterior cervical nodes are posterior to the sternocleidomastoid muscle and anterior to the trapezius muscle ( figure 2). ĮTIOLOGIES - Lymphadenopathy can be caused by a vast array of diseases ( table 1) and drugs ( table 2). Normal lymph nodes are usually less than 1 cm in diameter and tend to be larger in adolescence than later in life.Ī clinically useful approach is to classify lymphadenopathy as localized when it involves only one region, such as the neck or axilla, and generalized when it involves more than one region. (See 'Evaluation of a neck mass in adults' and 'Differential diagnosis of a neck mass' and 'Peripheral lymphadenopathy in children: Evaluation and diagnostic approach' and 'Cervical lymphadenitis in children: Diagnostic approach and initial management' and 'Peripheral lymphadenopathy in children: Etiology' and 'Evaluation of inguinal swelling in children'.)ĪNATOMY AND DEFINITIONS - The location of peripheral lymph node groups is shown schematically in the figures ( figure 1 and figure 2). Evaluation and treatment of lymphadenopathy in children is also discussed separately. The evaluation and differential diagnosis of neck masses is presented separately. The general approach to the adult patient with peripheral lymphadenopathy is reviewed here. Although biopsy is sometimes the best way to reach a definitive diagnosis, it should be used judiciously. INTRODUCTION - Peripheral lymphadenopathy without an obvious cause after the history and physical examination presents a diagnostic dilemma.

Shotty lymph nodes groin