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Noticed inflamed postauricular lymph nodes. Sonogram and blood work done. What does the report say?

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Oncologist, Radiation
Practicing since : 1989
Answered : 8 Questions

Around a 6 weeks ago I woke up to inflammed and enlarged post auricular lymph nodes. This has happened to me in the past, once requiring antibiotics to go down. This time after 2 days of it just getting worse I went and got a prescription. I saw my dr about a week after this started. (to calm my fear of lymphoma she did a chest x XXXXXXX which came back clean) She sent me for a sonogram and blood work. The sonogram showed a swollen lymph node of 0.5X1.0X1.1CM.

The bloodwork showed positive antibodies for EBV for Igm, Igg and Nuclear Antigens. My friend who is an infectious disease dr said that it was a false positive for mono since my WBC was normal and my lymphocytes were lower than my nuetrophils.

I went for a follow up sonogram two weeks later. My major concern is that the report from the first sono described it as retro-auricular, the second says that the images were of the left submandibular region...aren't those two different areas?

the second report says that there is a hypoechoic nodule or lymph node measuring 0.4cm on or adjacent to the submandibular gland.

I'm a bit freaked out as I'm scared to death of cancer. I see an ENT next week. Any thoughts? If it helps, nothing is palpable as far as I can tell in my submandibular area. The postauricular node feels much less swollen though it is still palpable through my skin. And there is a definite lump on my mastoid process that also has gotten smaller but remains palpable.

Posted Thu, 19 Jul 2012 in Cancer
Answered by Dr. J. Krueger 6 hours later
Thanks for writing in.
It is very unlikely that you have cancer. While retroauricular and submandibular are technically different regions, different doctors use different terminology for the same location.

A routine cold/infection can cause multiple small neck nodes.

Continue to see your doctor. He/she is ordering appropriate tests. Be sure to see the ENT.

Hope this helps. Let me know if I can address any more concerns.

Above answer was peer-reviewed by
Follow-up: Noticed inflamed postauricular lymph nodes. Sonogram and blood work done. What does the report say? 2 days later
Thank you.

I should have mentioned that I already saw an ENT, he recommended that I go to see his colleague who can remove the nodes.

He looked just in my ears and nose, not my throat and proclaimed it allergies. he did a CT of the sinuses that showed no infection, but an inflamed lining.

Today is my sonogram to see how they're doing. This morning I woke up and my right side was sore, there is a painful swollen lump/node just adjacent to where my ear lobe meets my skull on the right side and a swollen non painful lump around the side of my jaw.

Why on earth after six weeks would it spread to my right side? I do have a very small lump/sore on my mouth on the inside by the corner of my mouth.

I'm so frustrated as I was feeling so much better on Saturday. Then on Sunday I had an aural migraine. I get those about 1-2 times a year.

Any further insight? Could all this really be allergies? What about nasopharyngeal cancer? I've had EBV in the past and I have had a post nasal drip for months.
Answered by Dr. J. Krueger 41 hours later
Hi and thanks again,

I understand your concern.

First of all relax. Lymph nodes are connected by a network of lymphatic vessels. It is common to find multiple lymph nodes getting enlarged simultaneously following an inflammation and yes; allergies could result in inflammation; besides sinus scan also revealed inflammation. Sore mouth and recent post nasal drip are commonly associated.

If you have already visited ENT, a mass of Nasopharyngeal cancer would not go undetected by a direct examination. Second it is not detected by the Computed Tomography (CT) scan of sinuses too. CT scan of sinuses specially the lower slices can visualize part of pharynx and enough to rule out nasopharyngeal growths. Remember smoking is the biggest risk associated with Nasopharyngeal cancer. EBV was false positive.

As the lymph nodes are significantly enlarged, getting it removed and biopsied will reveal the true cause which is most likely to be reactive lymph node due to infections. So as your treating ENT suggested it may be the best option and I expect all your doubts will be cleared following the procedure.

Hope this answers your query.

Wish you good health

Above answer was peer-reviewed by
Follow-up: Noticed inflamed postauricular lymph nodes. Sonogram and blood work done. What does the report say? 2 days later
Hi Dr Krueger,

Thanks for your reply. I saw the ENT and he had me sent for a CT of the neck. That came back normal. The ENT spoke of possibly doing a fine needle biopsy, but mentioned that those are generally inconclusive.

Unfortunately now the node in my right clavicle is enlarged. This of course started the day after the scan.

Should I insist on it being biopsied via an open biopsy? I'm so frustrated that this is spreading and continuing.

Answered by Dr. J. Krueger 16 hours later

It is unlikely you have cancer; so try to stay calm and follow your local doctor’s advice.

It is safe to wait 4 weeks to see if the lymph nodes disappear before doing a biopsy.
A fine needle biopsy should be done first as it is easy on a patient and does not leave a scar. An open biopsy can be done later if the fine needle biopsy does not provide an answer.

Hope this answers your queries.

Above answer was peer-reviewed by
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