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Swollen lymph node above collarbone, done CT scan, antibiotics ineffective. What should happen next?

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Swollen Lymph Nodes above the Collarbone

Hello Doctor,
I have had a swollen area above my left collarbone for over 2 months. My primary doctor wanted to watch and see. In the meantime, I had also been on antibiotics and a bacterial medicine, none of which caused the swelling to go down. When I went back for a checkup, she ordered a CT scan of my neck area. The results came back:

Mildly enlarged left-sided supraclavicular lymph node measuring 1cm AP x 1.4cm transverse x 1.1cm CC. Enlarged bilateral level 2 lymph nodes noted as well. The left-sided level 2 lymph node measures 2.1 cm AP x 9mm transverse. The right sided level 2 lymph node measures 1.9 cm AP x 1 cm transverse.

The recommendations: Clinically correlate. Followup is recommended.

My primary doctor is sending me to an Ear, Nose and Throat specialist. I want to know what should happen next. I am concerned since the swelling has not gone down and I have not been sick. The bacterial meds were for an infection in my vagina. The antibiotic was to try and see if the swelling would go down. Which it did not.
Any advice to proceed would be great and thank you!
Posted Sun, 22 Apr 2012 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Naveen Kumar 1 hour later
Hi

Thanks for the query

Firstly, I would appreciate if you can mention your age, as it is very helpful for the differential diagnosis. Secondly, you are more worried about the (L) supraclavicular Lymph node which you have noticed couple of months back, than the ones present in the upper part of your neck.

According to the CT scan report, it seems to be that the lymph node in the (L) supraclavicular region is very insignificant. I too would agree with your doctor regarding 'wait and watch' policy about this swelling. If it were to be of infective in origin or secondaries to any malignancy then the swelling would have progressed by now and associated with pain. (L) supraclavicular lymph node is usually seen in the infections of the lung and thyroid, as well as a part of secondaries from the malignancy of the stomach.

Regarding the lymph nodes in the Level 2 region of the neck (that is below angle of the mandible) on either side, it could be due to infection in the upper throat or in the nasopharynx (the region behind your nose). Let me split your questions and answer each one

- My primary doctor is sending me to an Ear, Nose and Throat specialist. I want to know what should happen next.?

I presume, your doctor could be suspecting some infection in the throat or in the nasopharynx region and that is the reason for the referral to ENT specialist. ENT specialist can do a thorough check up of the nose and throat as well as do nasendoscopy and telescopic laryngoscopy to look for any infection in the above mentioned region followed by blood tests to rule out any lympho-reticular diseases.

- I am concerned since the swelling has not gone down and I have not been sick.

Most of the times, the lymph nodes which pop-out after an attack of infection remains even after the antibiotics are given and they are relatively harmless.

- The bacterial meds were for an infection in my vagina. The antibiotic was to try and see if the swelling would go down. Which it did not.

The antibiotic prescribed for your vaginal infection would not be suitable for the infection in the throat and the neck, which could be the reason for the lymph node to remain unchanged.

To sum it up, do not worry, it could be a harmless lymph node, I too would suggest you to consult a good ENT specialist and get a thorough check-up done.

Hope I have answered your query; if you have any more doubts you are welcome.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
Follow-up: Swollen lymph node above collarbone, done CT scan, antibiotics ineffective. What should happen next? 7 days later
Hello Doctor,

You said you would like to know my age and that is 54. After reading your answer, very helpful, thank you, I thought I would mention that in May I had a subtotal colectomy (since there was mention of abdominal issue) The only pain I have is in my collarbone areas. Thank you for such a thorough answer. I will print out and take with me to my appt. Thank you!
 
 
Answered by Dr. Naveen Kumar 15 hours later
Hi

Welcome back,

I wanted to know your age to make a differential diagnosis regarding malignancies such as nasopharyngeal carcinoma, carcinoma of stomach, breast tumor and lymphoreticular diseases.

Anyhow, once you visit the ENT specialist he would be performing nasal endoscopy with or without biopsy of the lymph node. Depending upon the result, further line of management can be decided.

Wish you good health

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
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