Neck Swelling

Reviewed By Anil Ghimire, MD

Any abnormal enlargement of structures between chin and clavicle bones can cause a neck swelling. Neck swelling usually occurs as a result of disease of lymph nodes in the neck or thyroid gland.  Sometimes salivary glands and diseases of muscle and skin around neck may produce a swelling.  A neck swelling from enlarged lymph nodes suggest diseases of head, ears, mouth or throat. However, small lymph nodes may be palpable in the neck of a child up to 12 years of age. Some neck swelling are present at birth.  Most lumps in the neck are not cancers but the likelihood of the lump being a cancer increases with age.  Apart from the symptoms of underlying disease causing neck swelling, you may develop symptoms of obstruction like difficult swallowing, difficult breathing or prominent and engorgement of veins in the neck or upper torso and extremities.

Some neck swelling are benign and self limiting, some need removal either to relieve symptoms caused by obstruction or simply for cosmetic reason and some indicate a serious medical conditions that need to be thoroughly investigated and managed accordingly.


Causes of Neck Swelling

  • Enlarged Thyroid Glands: The diseases affecting the thyroid gland may produce swelling in front of the neck, which moves with swallowing. The cause may be due to the following:
    • Goiter from deficiency of Iodine or
    • Autoimmune inflammation of the gland or
    • Graves’s disease
    • Cancers of the thyroid gland.
  • Enlarged Salivary Glands: Parotid glands in the angles of jaw or submandibular glands under the jaw may be swollen due to infection or cancer.
  • Benign Mass in the Neck: There may be a lump of fatty tissue called lipoma, cystic masses like sebaceous cyst, branchial cyst, cystic hygroma etc which usually do not cause much problems but can get infected causing swelling and pain. Injury or torticollis may lead to lumps in the muscles of the neck.
  • Enlarged Lymph Nodes:
    • Common Infections: When the lymph node swelling is a result of response to acute infection by bacteria or virus, it is generally painful, red and hot and it is called reactive lymphadenitis. If pus is formed in them, drainage of the pus would be needed; otherwise such lymph node swelling will resolve after some time, with or without treatment.
      • Viral rashes like Measles, Rubella, Mononucleosis
      • Sore-throat which may be streptococcal or viral
      • Skin or wound infections, such as cellulites or erysipelas
      • Ear infections
      • Tuberculosis
      • Infected gums or abscess in root of tooth
      • Human immunodeficiency virus (HIV) —causing AIDS
    • Uncommon Infections:
      • Cat scratch fever — an infection acquitted from a scratch or bite of cat
      • Syphilis – an infection which is sexually transmitted
      • Certain sexually transmitted infections, such as syphilis
    • Cancer: When the neck swelling results from swollen lymph nodes is the result of drainage of cancer cells, it is more ominous sign, as it suggests spread of cancer from the tissue of its origin. The size of the swollen lymph nodes may vary from the size of a pea or kidney bean to larger ones. These lymph nodes are usually firm to hard.
      • Leukemia — blood cancer
      • Lymphoma — cancer beginning from lymphatic tissues
      • Cancers of head, neck and upper GI tract or any other cancers in the body when it is widespread.
    • Disorders of the Immune System:
      • Systemic Lupus Erythematosus (SLE) — a chronic inflammatory disease affecting your skin, joints, kidneys, heart, lungs and blood cells
      • Rheumatoid arthritis — a chronic inflammatory disease affecting the synovium (the tissue lining the joints)

Certain medications like Phenytoin (used in seizure disorder) can also produce enlarged lymph nodes.


When to Seek Help?

When you are concerned about your neck swelling or your swollen lymph nodes have following features, you need to see the doctor.

  • The lymph nodes have appeared without any apparent reason
  • The neck lumps have been present for two to four weeks
  • The lymph nodes feel hard or rubbery, or they do not move when pushed
  • The neck swelling continues to enlarge
  • The neck swelling is accompanied by unexplained weight loss, night sweats or persistent fever
  • The neck swelling is associated with a sore throat or difficulty breathing or swallowing
  • Complications of infected swollen lymph nodes: Abscess formation, Sepsis(bloodstream infection), Cellulitis (a skin infection), Fistulas (seen in lymph nodes resulting from tuberculosis) etc.


Treatment Options

Swollen lymph nodes caused by viral infection resolve after the resolution of infection. Antibiotics are not used to treat viral infections. Treatment for neck swelling from other causes is based on the cause, as identified after investigations:

Infection: Your doctor should prescribe appropriate antibiotics for the swollen lymph nodes caused by bacterial infections. If HIV infection is the cause of swollen lymph nodes, you will be given antiretroviral therapy. Surgery to drain pus may be needed if abscess has formed.

Cancer: You will need treatment for the cancer if it is causing the neck swelling. Depending on the type of cancer, you may receive one or more of chemotherapy, surgery, and radiation therapy.

If your swollen lymph nodes are painful, you may need some relief by applying a warm, wet compress to the affected area, taking over-the-counter painkillers like aspirin, ibuprofen or paracetamol and adequate rest.

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