• Clinical science

Unilateral cervical lymphadenopathy

Abstract

Unilateral cervical lymphadenopathy (UCL) refers to the localized swollen lymph node(s) on one side of the neck and is usually associated with bacterial infections. Acute UCL is most commonly caused by S. aureus and Streptococcus species, while chronic UCL is the result of tuberculous or nontuberculous mycobacterial infections. UCL is most often seen in children under 5 years of age and typically affects the submandibular or deep cervical lymph nodes. In acute UCL, these are often tender, warm, and mobile, and may be accompanied by fever and malaise. Chronically inflamed lymph nodes are typically nontender and become indurated and matted over time. Laboratory tests for inflammatory markers, serology, and bacterial cultures from pus samples are used to monitor the course of the disease and detect pathogens. Biopsies may be needed to rule out malignant etiologies. Most cases of UCL are treated empirically with antibiotics such as clindamycin to cover the most common pathogens. Surgical incision and drainage may be indicated in cases with suppurative lymphadenitis.

Epidemiology

  • Age: most common in children < 5 years

References:[1]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

References:[1][2][3]

Clinical features

  • Usually child appears healthy; possibly history of preceding upper respiratory tract infection or dental conditions
  • May have symptoms of an underlying infection (e.g., fever, malaise, tachycardia)
  • Lymph node involvement
    • Most common: submandibular or deep cervical nodes (> 80% of cases)
    • 3–6 cm large, tender, warm, possibly erythematous skin over the node
    • Lymph nodes may become fluctuant and form an abscess over time or become indurated.
  • Chronic cases: insidious enlargement; nontender, immobile; , matted nodes; may form to sinus tracts

References:[1][2]

Diagnostics

  • Laboratory tests
    • CBC, ESR, CRP
    • Serology if tularemia or cat-scratch disease is suspected
    • Tuberculin test in chronic cases
  • Bacterial culture
    • Blood culture
    • Throat swab and oral swab
    • Gram stain and culture of material obtained from fine needle aspiration
    • Histopathological evaluation of sample obtained by excisional biopsy
  • Imaging: ultrasound exam or CT scanning

References:[2]

Differential diagnoses

References:[2]

The differential diagnoses listed here are not exhaustive.

Treatment

  • Antibiotics
  • Supportive therapy: antipyretics, analgesics, warm compresses
  • Surgical measures: incision and drainage of large abscesses

References:[2]