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Enlarged supraclavicular lymphnodes, painful. Cause and treatment?

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44 Year old female with enlarged supraclavicular lymphnodes on my left side, I've had bloodwork, x-rays, ct and ultra sound, my doctor says it's nothing. I've had them for almost 5 months and they are getting painful and I can feel them when I turn my head and also with my hand. I can tell there is a lump there just by turning my head. They hurt at night when I lay that side. What else can I do to determine the cause and treatment? Do I need to see someone other than my family doctor?
Posted Sun, 29 Apr 2012 in General Health
Answered by Dr. Sumit Bhatti 32 minutes later

Thank you for your query.

1. If your supraclavicular lymph nodes are sub centimeter sized, soft to firm in feel and tender, it may be due to infection in the neck, arm, lungs or breast area.

2. If any one of your supraclavicular lymph nodes is more than a centimeter and hard, then keeping your age in mind (above 40), the possibility of Virchow's or 'Signal' / 'Sentinel' node must be ruled out. This involves checking the Abdomen and especially the Stomach area, Lungs, Breast for any malignancy.

3. Get an FNAC (Fine Needle Aspiration Cytology) of the nodes. Have a USG (ultrasound) Neck and Abdomen with a new generation 4D Scanner with doppler.

4. Was your CT a contrast or plain CT? Has your thyroid been evaluated? Was there any abnormality in your test results? Do you have access to a 3T MRI Scanner?

5. Non specific lymphadenitis will show up on the FNAC (which may be USG guided) and is usually harmless. However be sure to rule out lymphoma, thyroid disease, other neck structures and do not hesitate to do a PET Scan if there is the slightest suspicion of malignancy or if the lymph nodes continue to grow and trouble you.

6. An open biopsy with IHC (Immuno Histo Chemistry) with tumor markers may be done if other options are inconclusive. PCR (Polymerase Chain Reaction) for ruling out Tuberculosis, other infections and early malignancies may be performed on this biopsy sample. These are extremely sensitive tests.

Hope I have answered your query. You may need to fill in the latest information. If you have any follow up queries I will be available to answer them.

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