ENT (Otorhinolaryngology) · MU Sofia

50. Differential diagnosis of cervical lymphadenopathy.

Covers the causes of enlarged neck lymph nodes, grouped as inflammatory, neoplastic, congenital and systemic, with a classification by infectious, neoplastic and other aetiologies. Contrasts benign and malignant features in a comparison table covering duration, pain, consistency and mobility, then outlines laboratory and imaging work-up including ultrasound and fine needle aspiration. Also lists treatment options, possible complications such as abscess and airway compression, and mimicking lesions like salivary tumours and carotid body tumours.

Inside: 2 sections · 2 labelled pictures · 1 table · 14 flashcards · 4 min

Topic 50 of 52 in the MU Sofia syllabus for ENT (Otorhinolaryngology) (Medicine, Year 4). The free AceMed note covers it in 2 sections, about 600 words (4 min of reading), with 14 flashcards.

In this note

  1. Differential diagnosis of cervical lymphadenopathy.
  2. I. CLASSIFICATION (MOST IMPORTANT)

Differential diagnosis of cervical lymphadenopathy.

1. Definition: Cervical lymphadenopathy refers to any abnormality in the size, consistency, or number of lymph nodes in the neck. A lymph node is considered enlarged if it is >1 cm in diameter (except for jugulodigastric nodes, which can be up to 1.5 cm in healthy individuals).Due to - Inflammatory causes

2. Neoplastic causes

3. Systemic diseases

4. Etiopathogenesis

  1. 1. Antigenic Stimulation (Hyperplasia): Proliferation of lymphocytes in response to bacteria, viruses, or fungi.
  2. 2. Infiltration by Inflammatory Cells: Neutrophils or macrophages entering the node during acute infection (Lymphadenitis).
  3. 3. Primary Neoplastic Proliferation: Malignant transformation of the lymphoid tissue itself (Lymphoma).
  4. 4. Secondary Neoplastic Infiltration: Deposition of metastatic cancer cells from a primary site in the aerodigestive tract.

5. Classification:

  • K - Congenital: Branchial cleft cysts, thyroglossal duct cysts, dermoid cysts (aren’t nodes but they mimic primary).
  • I - Infectious:
  • Viral: EBV (Mononucleosis), HIV, CMV, Adenovirus.
  • Bacterial: Staph. aureus, Strep. pyogenes, Cat-scratch disease (Bartonella).
  • Specific: Tuberculosis (Scrofula), Syphilis, Toxoplasmosis.
  • T - Toxic/Metabolic: (Rare in the neck).
  • T - Trauma: Post-surgical or accidental trauma.
  • E - Endocrine/Autoimmune: Sarcoidosis, Systemic Lupus Erythematosus (SLE), Kawasaki disease.
  • N - Neoplastic:
  • Primary: Hodgkin and Non-Hodgkin Lymphoma - Nodes: Rubber-like, painless
  • Secondary: Metastatic SCC (larynx, pharynx, oral cavity) or Virchow's node. Hard, non-tender, fixed

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