Cervical lymphadenopathy

CAUSES OF CERVICAL LYMPHADENOPATHY

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Acute:

  1. Acute bacterial lymph node inflammation.
  2. Acute lymphatic leukemia.
  3. Acute infectious mononucleosis – Epstein Barr Virus.

Chronic:

I. Inflammatory:

  1. Nonspecific chronic pyogenic lymphadenitis.
  2. Specific
    1. Tuberculosis.
    2. Syphilis.
    3. Sarcoidosis.
    4. Brucellosis.
    5. Fungal disease.

II. Neoplastic:

  1. Primary Lymphoma.
  2. Lymphosarcoma.
  3. Reticulum cell sarcoma.
  4. Chronic lymphatic leukemia.
  5. Burkitt’s lymphoma.
  6. Metastasis from neoplastic lesions from oral cavity and larynx.

III. Autoimmune:

  1. Systemic lupus erythromatosis.
  2. Juvenile rheumatoid arthritis.
Generalised: 1.Inflammatory:

    a) Acute
    -Septicemia
    -Infectious Mononucleosis

    b) Chronic
    -Tuberculosis
    -Syphilis

2) Reticulosis:

    a) Hodgkin’s disease.

    b) Lymphosarcoma.

    c) Lymphatic leukemia.

3) Sarcoidosis.

Diagnosis:

  1. Routine blood and X ray tests.
  2. Fine Needle Aspiration Cytology.
  3. Excision Biopsy of the swelling if required.
  4. CT scan to show the extent and consistency of the lymphadenopathy.
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Levels of Cervical lymph node

Level

Lymph nodes

Boundaries

I

A

Submental nodes

Bilaterally: Anterior belly of digastric
Inferiorly: Hyoid bone

B

Submandibular nodes

Superiorly: Mandible
Posteroinferiorly: Posterior belly of digastric
Anteroinferiorly: Anterior belly of digastric

II

A (Anterior to the vertical line in relation to spinal accessory nerve)

Upper internal jugular (deep cervical) nodes

Superiorly: Skull base
Inferiorly: Inferior border of hyoid bone and carotid bifurcation
Posteriorly: Posterior border of sternocleidomastoid (SCM)
Anteriorly: Lateral border of sternohyoid and stylohyoid

B (Posterior to the vertical line in relation to spinal accessory nerve)

III

Mid internal jugular (deep cervical) nodes

Superiorly: Inferior border of hyoid bone and carotid bifurcation
Inferiorly: Inferior border of cricoid cartilage and junction of omohyoid muscle and IJV
Posteriorly: Posterior border of SCM
Anteriorly: Lateral border of sternohyoid

IV

Lower internal jugular (deep cervical nodes)

Superiorly: Inferior border of cricoid cartilage and Junction of omohyoid and IJV
Inferiorly: Clavicle
Posteriorly: Posterior border of SCM
Anteriorly: Lateral border of sternohyoid

V

A (Above the horizontal plane marking the inferior border of arch of cricoid cartilage)

Posterior triangle (spinal accessory) nodes

Superiorly: Convergence of SCM and trapezius
Inferiorly: Clavicle
Posteriorly: Anterior border of trapezius
Anteriorly: Posterior border of SCM

B (Below the horizontal plane marking the inferior border of arch of cricoid cartilage)

VI (Prelaryngeal or Delphian, Pretracheal, Paratracheal, Prethyroidal)

Anterior compartment (midline) nodes

Superiorly: Hyoid bone 

Inferiorly: Suprasternal notch 

Bilaterally: Carotid arteries

VII

Upper mediastinal nodes

Below suprasternal notch

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