An enlarged cervical lymph node is the commonest cause of lump in the neck. Cervical lymph des may become enlarged as a result of inflammation or neoplastic process. Tuberculosis is one of common causes of cervical lymphadenopathy.

Causes of lymphadenopathy and clinical features

Condition : Acute inflammation

Cause : Infection of the upper Aero- digestive tract, Head and neck or swelling in the neck or Other infections

Features : Fever, sore throat, firm, tender nodes 1-2 cm in diameter swelling in the neck and fever cough may or may not be present

Condition : Chronic Inflammation                                               

Cause : Tuberculosis, sarcoidosis, Histiocytosis X

Features : Variable on presentation depending on the stage of the disease: multiple matted lymph Nodes/ cold abscess

Condition : Lymphomas/                                                

Cause : Hodgkin, Non- Hodgin, Lymphoma

Features : painless rubbery lymph nodes symptoms related to primary disease

Condition : Malignancy                                                                                                                      

Features : Metastatic Carcinomas of The upper aero- digestive tract Squamous Cell Carcinoma Melanoma- firm to hard lymph nodes

Management

•           Detailed history and examination are essential to pinpoint specific aetiology. Majority of the lymph nodes are reactive to viral infections of upper respiratory tract, therefore, do not require any treatment.

•           In case of acute suppurative lymphadenopathy secondary to any focus of bacterial infection in the drainage area:

Cap. Cephalexin 250-500 mg every 6 hours for 7 days, or Cap. Amoxicillin 250-500 mg every 8 hours for 7 days.

•           If lymph nodes persist, perform fine needle aspiration cytology (FNAC) and treat accordingly. If FNAC is inconclusive take a biopsy from the enlarged lymph node and treat accordingly.

•           In case of chronic lymphadenopathy perform FNAC and treat accordingly, If FNAC is inconclusive, perform biopsy and treat accordingly.

•           Tubercular lymphadenopathy

Start anti-tubercular therapy. Reassess the patient after 6 months. If lymph nodes are either not present or less 1 cm size keep the patient under follow – up and continue treatment. However, if lymph nodes are palpable and more than 1 cm take a biopsy of the node and accordingly and consider second line anti-tubercular drugs.