Midline Neck Swellings: Cervical Lymphadenopathy

This chapter explores the different causes of enlarged cervical lymph nodes (LNs), the most common cervical swelling, in both children and adults. Cervical LNs are enlarged in children mainly due to inflammation, and in adults mainly due to neoplasms. In adults, LNs tend to be more firm and less tender than those usually found in the neck of children due to recurrent upper respiratory tract infections. Cervical lymphadenopathy (CLA) may represent a local neck disease, be a part of generalized disease such as lymphoma, or reflect a metastatic disease from below the clavicles as in the case of Virchow’s (left supraclavicular) LNs. Based on duration, CLA is further classified into acute (2 weeks), subacute (2–6 weeks), and chronic (does not resolve by 6 weeks). Suspicious features of LNs on ultrasonography are considered when LNs are rounded, with irregular contour, internal necrosis, and lost echogenic hilum. Detection of extracapsular invasion and accurate assessment of their relation to carotid sheath vessels can be achieved by computed tomography scan. Assessment of the patients with CLA is not complete without fine needle aspiration cytology.