Cervical adenopathy: A clinical approach to diagnosis

Cervical adenopathy has many causes, including a variety of infections, malignancies, and immunologic disorders. It is usually benign in young persons, but the likelihood of malignancy increases with advanced age. Generalized adenopathy suggests systemic infection or lymphoma. Localized cervical adenopathy requires a careful examination of the scalp, eyes and conjunctivae, ears, nose, and throat. Associated signs and symptoms help focus the workup - for example, fever, night sweats, and weight loss may signal malignancy, while the presence of an exanthem suggests viral infection. The likelihood of malignancy is increased if the node is nontender, "rock hard," and larger than 2.25 cm². Immediate biopsy is indicated if the node is larger than 4 cm². Serologic studies are not routinely indicated but are more likely to be useful if the patient has generalized adenopathy or systemic symptoms.