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.

Symptoms of shotty lymph nodes in groin