Causes of Swollen Neck Lymph Nodes

The neck contains a large number of lymph nodes, known as the cervical lymph nodes and many are superficial and easily palpable (can be felt by touch). A swollen neck lymph node is not uncommon and frequently occurs in children, even when there is no disease or obvious cause present. With age, the incidence of enlarged neck lymph nodes declines except when it is due to some pathology.

The most common cause for swollen neck (cervical) lymph nodes is an infection. While most incidents of cervical lymph node enlargement is self-limiting and resolves quickly, some may persist for a longer time and may need more active management. Amongst this group, the supraclavicular lymph nodes are of special significance. Their enlargement may be an ominous sign since it is most often associated with malignancy and careful assessment and investigation is indicated.

Anatomy of Cervical or Neck Lymph Nodes

Swollen lymph nodes of the neck may be localized, where only groups of lymph nodes in the neck are enlarged. In some cases, it may be generalized where lymph nodes in other parts of the body are also involved.

There are mainly six different groups of lymph nodes situated in the neck and according to their location they are classified as :

  • Anterior cervical lymph nodes which lie in the front of the neck and are of two types, superficial and deep. They drain the internal structures of the throat as well as the tonsils and thyroid gland.
  • Posterior cervical lymph nodes which are located in a line at the back of the neck, extending from the mastoid part of the temporal bone (from about the middle of the head) to the clavicle (collar bone). They normally become enlarged in the event of an upper respiratory tract infection.
  • Tonsillar lymph nodes which are situated just beneath the mandible (jaw bone). They drain the tonsils and posterior part (back) of pharynx.
  • Sub-mandibular lymph nodes which lie along the bottom of the mandible (jaw bone) and drain the floor of the mouth tongue, lips, and conjunctiva. They are normally enlarged due to infections of the head, neck, sinuses, ears, eyes and pharynx.
  • Sub-mental lymph nodes which are located just below the chin and help to drain the teeth, lower lip, floor of the mouth, tongue and cheek. They commonly enlarge due to mononucleosis, toxoplasmosis, and dental infections such as periodontitis.
  • Supraclavicular lymph nodes which are situated in the hollow just above the clavicle (collar bone).
  1. The right supraclavicular lymph nodes drain the lungs, mediastinum and esophagus. It is commonly enlarged due to lung cancer, gastrointestinal cancer or Hodgkin’s lymphoma.
  2. The left supraclavicular lymph node drains the thorax (chest) and abdomen. It may be enlarged due to thoracic or retroperitoneal cancer, breast cancer, lymphoma, or an infection. The left supraclavicular lymph node or Virchow’s node enlargement may be the first sign of stomach cancer, even before the presentation of any other symptoms.

Causes of Neck Lymph Node Swelling

The common causes of lymph node swelling of the neck include :

Infections

Infections are the most common cause of swollen neck lymph nodes whether it is a viral, bacterial or parasitic infection is an infection. Some of these infections include :

  • Strep throat.
  • Tonsillitis.
  • Peritonsillar abscess.
  • Mumps.
  • Measles.
  • Rubella (German measles).
  • Dental infections.
  • Ear infections.
  • Skin infections and infected wounds of the head and neck particularly.
  • Sinusitis.
  • Epiglottitis.
  • Infectious mononucleosis.
  • Tuberculosis.
  • Sarcoidosis.
  • Cat scratch disease.
  • Toxoplasmosis.
  • Sexually transmitted disease (STD) such as syphilis can also produce lymph node swelling of the neck.

Cancer

Malignant tumors, particularly in the head or neck, may cause lymphadenopathy of the cervical lymph nodes. This may also indicate metastasis (cancer spread) from other parts of the body or the areas drained by the affected lymph nodes. It is important to take note of the Virchow’s node which may be an early warning sign of stomach cancer.

  • Lymphoma is cancer of the lymph node and there are two forms of lymphomas – Hodgkin’s disease and non-Hodgkin’s disease.
  • Leukemia is cancer of the blood forming tissues, including bone marrow and lymphatic system and may cause lymph node enlargement.
  • Melanoma – a type of skin cancer.
  • Cancer of the mouth, larynx, or oropharynx can cause enlargement of the draining lymph nodes in the neck.

Systemic

Systemic causes of swollen neck lymph nodes usually involve different types of autoimmune diseases and other diseases that cause an immune deficiency. This includes :

  • HIV/AIDS.
  • Rheumatoid arthritis.
  • Systemic lupus erythematosus (SLE).

Usually the lymph node swelling is not isolated to the cervical lymph nodes and may be generalized.

Drugs and Vaccines

  • Certain drugs like  phenytoin and carbamazepine may cause swelling of the neck lymph nodes as a side effect. Other drugs may also be responsible.
  • Vaccinations like the MMR vaccine for protection against  measles, mumps, and rubella as well as the typhoid vaccine may occasionally cause lymph node swelling although this is usually temporary.

Diagnosis

The characteristics of the swollen lymph node often helps to determine the cause of the swelling. Usually, lymph node swelling due to an infection are soft, painful, and mobile, with signs of inflammation on the overlying skin. Cancerous lymph nodes are hard, fixed (not mobile) and usually not painful. Lymph nodes that seem connected to each other are called “matted” lymph nodes and may be associated with tuberculosis, sarcoidosis or malignancy.

Lymph nodes are sometimes described as “shotty” when they may be small, non-tender and have a rubbery consistency. This type of lymph node may be seen following an infection which has already resolved and does not have the typical characteristics of either an infected or a malignant lymph node.

Constitutional symptoms such as fever, night sweats, weight loss and fatigue may also give an indication as to the cause of lymph node swelling. If necessary, your doctor may consider a biopsy for further investigation in order to make a conclusive diagnosis.

Please note that any information or feedback on this website is not intended to replace a consultation with a health care professional and will not constitute a medical diagnosis. By using this website and the comment service you agree to abide by the comment terms and conditions as outlined on this page

Ask a Doctor Online Now!

  • Pingback: Lymph Node Cancer | Current Health Articles()

  • jonsyt

    I have had swollen gland in neck for about 2 years none stop they are not painful but they ich alot usually early on the morning for about an hour after i wake up the itching is centred mainly around the adams aplle on the rightand left side although the swelling is a bit further up between jaw bone and ear . I have been todoctors and have had 2 tests done one was a camera in my nose to look at throat (cant remember name) the other a ultrasound both showing nothing. I am not losing wait and dont feel unwell .any have any ideas what this could be ?

  • Dr. Chris

    Hi Jonsy1

    Firstly, it has to be assessed whether this is the thyroid gland or not. If it really is the lymph nodes, then further asssessment (possibly a biopsy) of the node is necessary. Persistent enlargement of the node, which from what you say is affecting multiple nodes and spreading, would only happen in a chronic infection like HIV or with conditions like cancer. Both are serious conditions that need to be diagnosed early. Of course there are other causes but these are the most common. I would advise that you start with the HIV test.

  • m_p_kumar

    Hi,

    For past 1 month I am having swollen lymph nodes in my arm pit. It started with high fever [103+ deg] and could not be controlled with normal antibiotics.

    The temperature is now in control after taking IV antibiotics but the lymph glands are continue to swell. During another Ultra Sound, doctors found swollen lymph nodes in my neck and left collar bone area also.

    Have got couple of FNAC done for the axillary nodes and both time it has come negative for malignancy and as reactive.

    Doctors have suggested wait and watch approach but I am very concerned because of family history and the swelling spreading into other areas.

    Please suggest.

    Thanks

  • Dr. Chris

    HI M_P Kumar

    Lymph node swelling after an infection may occur for a short period. The wait and watch approach is advisable since and FNAC has been done. The procedure may need to be repeated at a later stage. Ensure that all the necessary blood tests have been done, including a CBC (complete blood count) and HIV test.

  • Nataliia Kubyshkina

    hi…on my left side , right behind my ear i fill swollen little ball…it heats like crazy…i just had cold for about 3 days with headache and sinuses …. how to treat it ?

  • Hi Nataliia. This is very likely a swollen lymph node. The lymph nodes in this area does swell with a viral infection like the common cold. It can take days or weeks for it to shrink back to a normal size. You do not have to do anything. It will resolve on its own. However, if the swelling persists or gets larger then you should see a doctor. It is also possible that this is not a swollen lymph node but instead a boil or abscess. It is difficult to say with any certainty on an online platform. Rather see a doctor.

  • Bill S

    I am being treated for cervical dystonia and taking Artane (Trihexyphenidyl) for the spasms, and Gralise (Gabapentin) for the associated nerve pain. I’ve received 2 treatments with botox, 1st was October 2014, 2nd was January 2015 (3 months apart). My symptoms (intense spasms in several neck muscles and traps on the right side only) are permanent, but the Rx and botox are supposed to decrease the symptoms (they do, but as stated there are times where it seems they are doing nothing, other times I am able to deal with it). That’s the background. My concern now is swollen cervical anterior (mostly left side) and just recently Supraclavicular lymph nodes on left side. All are palpable, semi-soft / rubbery and movable. I am going to see my PCP regarding this (recommended by the neurology Dr dealing with the dystonia). Here’s my question however: When I press/massage the lymph nodes in question (softly) I get a tingling pain down my right arm. Note that the dystonia is on the right side. I can’t find a single reference doing research on how this could be, and my neurologist is also uncertain. Has any heard of this before?

  • Hi Bill S. Please provide us with any feedback that you may have received from your PCP. The logical assumption would be that the pressure on the lymph node is pressure on a nerve going down the arm. But as you say the enlarged lymph node is on the left side and the tingling is on the right side. Would be very interesting to hear what is eventually diagnosed.

  • Bill S

    I had a CT scan that showed all lymph glands are fine, and not large. I just notice them more because I rubbing/massaging the neck due to the dystonia. My PCP feels I am inflaming the nerves coming out the neck and that is causing the issue, but he has no solid answer why rubbing the left causes tingling on the right, other than the way I am using my arm/hand to massage somehow is engaging muscles/nerves on the other side. But it doesnt matter which hand I use to rub, it always results in the right arm going numb/tingling. I am seeing my neurologist this week to see if he has any additional tests or ideas. I’ll post the results!

  • Hi Bill. Thank you for coming back to us. It would be interesting to hear if this is probably emanating from your cervical spine and possibly related to the dystonia which may have put pressure on this area of the spine. Waiting to hear the results. Thanks again. Your reports will surely help many of our readers.

  • Stef

    Hey, I’m 22 and I recently slept in the incorrect posture and got neck spasm for 4 days till I got a massage which it all went away but then I noticed this small soft ball on my right side under my ear in the back. For 4 days I thought it was my neck spasm but now that it’s gone I’m left with this uncomfortable little pain. Please help I’m really scared

  • Hi Stef. Hopefully it has resolved by now. This could be an enlarged lymph node which is not uncommon with an ear infection. In fact any infection in the neighboring areas could also cause this lymph node to swell. It usually isn’t a problem if it arose suddenly. It may go away gradually. However, if it persists and is growing in size then you must have it checked up.

  • shanell

    Hello! Im a 28 yr healthy female.I have had a swollen lymphnode on the left side of the back of my neck mear my hair line. It has been this way for a few weels possibly longer (just notifed it) it doesnt hurt, I haven’t been sick, I dont have any dental infections (although i did have one on the right side of my lower mouth for about a month month ago, now has been treated with root canal) , I don’thave a fever, weight loss etc.. It is small maybe the size a a pea maybe a little bigger. It hasn’t grown in size. My question is should i be concerned about cancer or any other serious illness? I had the same thing a few years ago on the right (i think could of been this side) and doctor said i was fine. I have no family hx of lymphoma etc..only breast cancer. I am pn wellbutrin and birth control and thats it. What are your thoughts / questions? Should i get an ultrasound (although, I am terrified)

  • Satriana

    Hi. My son is 14 and was playing american football for a while. Now he’s telling me he was hit a month ago under the mandible. He has now 2 lumps where the sub-mental lymphs are.. He thinks they were growing but, of course, he didn’t tell me! They are not painful and they are very hard.
    He also has a bad case of acne on his face. Not sure if there is a connection. I have been waiting for 3 weeks for a family doctor appointment for his acne but now, with the new issue, I hope the doctor will accept to talk about both… Please help, I am desperate.

  • Bryan Reed

    I have the exact same thing. Went to the doctor today and got blood tested. Depending on the results they’re gonna refer me to an ear nose and throat specialist.

  • Natosha

    Hi, my story started back in July of 20015 I noticed a small lump on the left side of my neck I didn’t pay no mind to it till another one popped up on my right side a few weeks later. I still didn’t think anything of it till I noticed that my left side of neck felt matted. In Sept I went to dr. and they did blood work all came back normal. A few month went by and I still had them but now more have popped up above my collar bone and both sides of my neck felt all matted up. I went back to dr and they did X-rays of my chest those came back normal my Dr sent me to a surgeon and he just felt around and said he don’t fell anything but he sent me to do an ultrasound. By this time we are already in April 2016 my results came back which he won’t tell me much except that my left and right side neck is all matted up and one of my lymph nodes that stands alone is almost 2cm. (Cervical) He wants to do a biopsy on it on the 18th for my cervical one and for the one by my collar bone. Throughout all this I have lost weight, very tired, night sweats, I’m always hot and cold and bad headaches. My lymph nodes have been swollen for 9 months. My question is should I be worried now, I’ve read that matted means “bad”. Is this true? Please help my Dr. won’t tell me anything, I just need honesty from someone. I have lost 2 cousins to lymphoma, my grandma is a survivor of lymphoma and my grandfather is trying to beat it as we speak. What are my odds of it being passed to me? My swollen nodes are fixed, some what hard and doesn’t hurt at all.

  • EggyHerman

    My baby girl is 17 months old today. Five days ago, my wife noticed a lump on her neck behind and down from her ear. She is not certain if it grew gradually or just appeared suddenly, since my daughter’s hair may have covered it when smaller.

    I have tentatively identified it as the right superficial cervical lymph node. Only the right side is swollen. My baby is otherwise asymptomatic, no fever, and she doesn’t wince or flinch when we touch it. It does not seem to have any marks on or near it. It is hardish, and not mobile, but I have not really squeezed it hard for fear of hurting her or spreading any infection. She is eating normal, behaving normal and seems healthy otherwise.

    We lived in Macau for her first year, which is pretty developed, but have been living in rural East Java, Indonesia for 8 months. It is underdeveloped, but It is not crowded here, so I don’t think Tuberculosis is common as it is in the more congested areas or cities like Jakarta or Surabaya. I had read TB can infect the lymph nodes of the neck this way. Would it be only one side? And this particular lymph node?

    We brought her to a local doctor who gave us some antibiotics in powder form to be mixed with a sweet syrup, but I will not give them to her since they are unlabeled, and I want to wait until tomorrow to identify them with the doctor. I was away when my wife visited the doctor.

    Normally I wouldn’t worry too much, since I have had two other children and things usually came and went. However, I read somewhere about painless immovable lymph nodes as being indicative of lymphoma cancer, and now my wife and i are very worried. We will try and get to a major city hospital this week if the lump remains this large. I do not know how to measure it, since it is sloping, not a little ball I can measure. My best guess is it is around 45-50mm long parallel to her neck, and about 20-25mm wide. She weighs 9.7kg, and is around 82cm tall. She has been relatively healthy except for a cold 4 months ago, and the typical fever after two of her vaccinations before that.

    Please, any advice would be appreciated. We will of course follow up with a proper doctor visit. This is just a call for some outside perspective on this. Thanks.

    Rob

  • Hi Rob. Yes, you are correct about this being related to a chest infection like TB or even a lymphoma but there are many more likely and less serious causes that has to first be considered. Sometimes in an acute infection where there are little to no symptoms the swelling of a lymph nose may be the only sign present. Five days is a short period of time and it could resolve withina few days. However, it is always better to be safe than sorry. Given her age you should be following up with a pediatrician who will be better positioned to advise you accordingly.

  • EggyHerman

    Thanks for the reply! We were not hoping for an online diagnosis; it is just comforting to have a third voice chime in. We plan on taking her to a smallish hospital/clinic. It will be 8 days tomorrow, and 10 days by the time we go to the clinic.
    When I wrote immovable, it is relative to what I think is movable. It moves laterally, anterior to posterior a bit, but not so much vertically, from clavicle to top of head.
    Again, she remains asymptomatic, and I just viewed my mother-in-laws chest X-ray from 2 weeks ago. It is clear and does not show typical signs of TB disease, although she coughs consistently. I think it is due to the no water/food fast for Ramadan, so they all have dry throats and airways here in the house.
    Should I ask the clinician/surgeon for an FNA if it is still the same size in a few days? I don’t want her poked with needles just yet, but it could tell us if it is a myobacterial infection no?
    Should I get her on a course of antibiotics, or let it go as long as it does not get bigger and she remains aymptomatic?
    Lots of questions, I know, Just nerves, and children! I let myself lose an arm without concern, but with speechless babies you feel so helpless! Thanks for your time and consideration!

    Rob

  • Hi EggyHerman. We are unfortunately unable to suggest an exact course of diagnosis or treatment for the situation. It is best to wait for the clinician to decide on the approach. An FNA may be warranted when some of the symptoms you mention are present in an adult but the same approach may not be relevant to a baby. Sometimes the pediatrician may instead pescribe antibiotics if there are other symptoms of an infection and adopt a wait and watch approach. It is fully understandable that you would be nervous as most parents are when it comes to their children, particularly babies, but remember the course of action is not always the same for a child as it is for an adult. If in doubt, always seek a second or even third opinion.

  • Irisheyes

    Hi i have found a pea-sized bump on the right side of my throat. It is moveable and doesn’t seem to be connected to anything upon swallowing, etc. It has been there for about 2-3 weeks now (well, that is when I first noticed it). there was some discomfort associated with it at first, but I was also touching and feeling it pretty frequently that day.

    I’m wondering if it could a lymph node or possibly something else such as a thyroid nodule, etc?

    Location is about 1/4 inch lower than the adams apple, about an inch to the right, anterior (inside) of the sternocleidomastoid muscle.

  • Hi Mariel. As you mention it is swelling of the soft tissue around the clavicle and not an enlarged node specifically. It is definitely worth having it checked up as you may be missing the enlarged lymph node which can occur for various reasons. Similarly swelling of the soft tissue around the clavicle may also occur due to different causes which may be unrelated to the lymph node enlargement, if it is present. This may or may not be related to your previous history of TB but that conclusion will also depend on the results of diagnostic tests. Your doctor will be able to assist you further.

  • Hi Irisheyes. Based on your report, it is possible that this is an enlarged lymph node. Temporary enlargement can occur for various reasons but given that it is persisting, you should definitely have this checked. A thyroid nodule should also not be excluded as a possibility until your doctor says so . You should definitely follow up with your doctor as further investigations may be necessary. A referral to an ENT specialist may also be advisable but your family doctor will advise you accordingly.

  • gine

    hi last thursday night i had fever but it resolved the next day and on the same day i discovered my superficial cervical lymph node was swollen and this sunday i felt that my submandibular lymph node is also swollen. What could be wrong with me? i dont have any other symptoms except my swollen lymph nodes..

  • Hi Gine. Enlarged nodes can be present even if there are no other symptoms. Furthermore these enlarged lymph nodes can persist even after an infection resolves and other symptoms clear. It is therefore difficult to say for sure as to what may be causing these swollen lymph nodes. Speak to your doctor as soon as possibel