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Having enlarged lymph nodes in neck. Done with blood test and chest X-ray. What is the next course of action?

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Gastroenterologist
Practicing since : 1985
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Hello

I have a pair of not particularly enlarged lymph nodes in the right side of the posterior triangle of the neck. The largest measure 9mm and the slightly more inferiorly placed node measures only 7mm.
Blood tests are normal. Chest x XXXXXXX normal. No other diseases. No tonsilar enlargement. No adenopathy is demonstrated.

Could you explain what all this means? What is the next course of action?
Posted Wed, 21 Aug 2013 in General Health
 
 
Answered by Dr. Dinesh Kumar Singal 1 hour later
Dear XXXXXXX

Thanks for contacting Healthcare Magic.

You have not mentioned for how long are you having these nodes.

These are small nodes. Since you do not have any other symptoms and your routine investigations are normal, there should not be any cause to be worried.

Lymph nodes in this location are usually due to bacterial infections of throat, tuberculosis, malignancies of lymph nodes. The best way to decide the cause of lymph node is to do a FNAC test from the lymph node. FNAC involves placing a needle in the node and taking a sample and making slides. These slides are viewed under the microscope to know the cause of its enlargement.

Sometimes FNAC does not give a concrete answer, in that case an excision biopsy needs to be done. Biopsy involves removal of lymph node under local anesthesia and directly studying it for the cause.

In your case I think FNAC is the next step to be done.

Best wishes,

Dr Dinesh Singal

Above answer was peer-reviewed by
 
Follow-up: Having enlarged lymph nodes in neck. Done with blood test and chest X-ray. What is the next course of action? 26 minutes later
Hello. thanks for the reply.

The bottom node I have had for many years. I used to think it was just a part of my neck. It never hurt or ached. The one near the upper region of the neck by the back base of the head I noticed in the first week of January this year. It only began to ache in February. I used to have neck aches but that has stopped. Sometimes I do have headaches though. Those aches come and go occasionally at the back of the head and at the top.
 
 
Answered by Dr. Dinesh Kumar Singal 9 minutes later
Dear XXXXXXX

I still think next step is FNAC as it will clarify the cause. After FNAC the treatment can be planned. Headache in your case may or may not be related to these lymph nodes.

Dr XXXXXXX Singal

Above answer was peer-reviewed by
 
Follow-up: Having enlarged lymph nodes in neck. Done with blood test and chest X-ray. What is the next course of action? 18 minutes later
Will I have to be put to sleep for the fnac? or will a general anaesthetic be appropriate?

Why would the nodes have to be investigated? Can they not be removed without examining them? I don't show any symptoms of bacterial infections of throat, tuberculosis. My blood test and ct scan were already normal?

Do you feel there is anything to be concerned for at this stage? Given by your knowledge in this field, what do you feel the outcome will be?
 
 
Answered by Dr. Dinesh Kumar Singal 8 hours later
Dear XXXXXXX

FNAC is done by just putting a needle once, just like an injection. So there not much pain. It is important to know what it is since it may be treatable easily at this stage. Though I am not suspecting anything in particular. Sometimes TB can present like this.

Best wishes,

Dr Dinesh Singal
Above answer was peer-reviewed by
 
Follow-up: Having enlarged lymph nodes in neck. Done with blood test and chest X-ray. What is the next course of action? 40 hours later
okay. thank you.

I hope that isn't the case. But if so, is it curable? and in what way?

Would having a FNAC not be harmful to the lymph node? Would it not cause serious damage to the lymphatic system?

If the node reveals nothing and there is no diagnosis, what would be the next course of action?

Under what circumstance would a node have to be surgically removed?
 
 
Answered by Dr. Dinesh Kumar Singal 21 hours later
Dear XXXXXXX

If it turns out to be TB on FNAC then it is treated with medicines for 6 months. It gets completely cured.

There will be no harm to any tissue due to FNAC.

If FNAC does not reveal anything then one can go for an surgical excision biopsy right away or can wait and get it done if the size of lymph node is increasing or there are new lymph nodes coming up.

If you have anyother queries you can always get back to me.

Best wishes,

Dr Dinesh Singal

Above answer was peer-reviewed by
 
Follow-up: Having enlarged lymph nodes in neck. Done with blood test and chest X-ray. What is the next course of action? 20 hours later
I am in England. Health laws are not the same in all countries.

I visited the consultant yesterday and he felt there was nothing to be concerned about. He said the size of the nodes are within normality. He also refused to refer me for a biopsy saying the nodes are not of the size that a biopsy can be performed for 7mm and 9mm. There is a risk of damaging it. He also said that he has been in medical field for 25 years now. He knows his job and that he knew I had read things off the internet too much.

What should I do now? Is there anything I can do to stop anything from getting worse? Do most common people not have nodes like this?



 
 
Answered by Dr. Dinesh Kumar Singal 4 hours later
Dear XXXXXXX

As I have also already said there is nothing to be worried about. These are certainly small nodes. But to be on safer side I guess FNAC should be done which is a simple procedure. More so since you said that the upper node appeared in January.

Keep monitoring the size of nodes if these are increasing in size or numbers then FNAC / excision biopsy becomes a must. FNAC is a simple procedure and excision of cervical lymphnode is also not a big deal. It is also a minor procedure.

But in any case you can take it easy and just monitor the nodes.

Best wishes,

Dr Dinesh Singal
Above answer was peer-reviewed by
 
Follow-up: Having enlarged lymph nodes in neck. Done with blood test and chest X-ray. What is the next course of action? 4 days later
Hello again. Thanks for your reply.

The consultant at the hospital refused to refer me for the biopsy because the ct scan report did not request it. I insisted but he did not put me forward for it. Do you know why he did not do it? Would they do it at India?

If I had any arthritis in the neck even at small level would it have showed in the m.r.i and ct scan? I still have some neck aches but the scan showed nothing wrong in the neck.

Is there any alternative treatment other than FNAC? I;ve heard there is medication for lymph nodes. I had an ear blocked by wax in my canal and had it syringed but it never entirely cleared. maybe infection is being fighted so the node has inflamed. Could mouthwash do anything clear the throat. Maybe the node can become smaller.

Is it advisable that I can do weightlifting? Or would that aggravate my condition?


 
 
Answered by Dr. Dinesh Kumar Singal 18 hours later
Dear XXXXXXX

I think your physician does not consider it to be of significance, probably that is the reason he did not get it done. You can certainly get it done in India.

Mild arthritis may not show on CT or MRI.

Blocked ear due to wax and infection there or in throat can certainly cause enlargement of lymph node. Treating these conditions can cause it to regress.

You can lift weights.

Best wishes,

Dr Dinesh Singal
Above answer was peer-reviewed by
 
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