الفهرس 
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Abstract
Of the approximately 800 lymph nodes in the body, about
300 are located in the neck. These lymph nodes acts as fortresses that aid
in the immune defence and have a considerable capacity to increase in
size. Generally, a normal-sized lymph node is < 1 cm in diameter.
Cervical lymphadenopathy is usually defined as cervical lymph
nodal tissue measuring > 1 cm in diameter. It is a common presentation in
the ORL out-patient departments, frequently seen in pediatric and adult
populations. Cervical lymphadenopathy is generally not a disease by itself;
rather, it is a clinical manifestation of one of many possible underlying
diseases. It is usually due to a benign, self-limited, local or systemic
diseases. However, it could be due to a more serious underlying disorder
such as malignancy. Cervical lymphadenopathy, therefore, has a broad
differential diagnosis. In management of patients with cervical lymphadenopathy, the
challenge to the attending ENT physicians is to differentiate between the
two major causes; benign and malignant disorders.
A thorough history taking and systematic physical examination
are mandatory for evaluation of patients with cervical lymphadenopathy
and usually sufficient to establish a diagnosis. Further diagnostic work-up
may be warranted, in the event of persistent or worrisome
lymphadenopathy. Special clues in the patient’s history and physical
findings can help to select the suitable work-up for the patient, including
laboratory tests, imaging modalities, and tissue diagnosis. Imaging plays an important role in evaluation of cervical
lymphadenopathy, particularly when the lymph nodes lack the
clinical features of benign causes or fail to resolve with treatment.
Imaging can identify node characteristics more accurately than can the
physical examination.
US plays an important role in differential diagnosis of cervical
lymph node swelling. It can assess the number, size, site, shape, margins,
pattern of vascularity and internal structure of cervical lymph nodes. US
is useful in answering one of the critical diagnostic questions: is there a
suspicion of malignancy? If so, lymph node biopsy may be necessary. CT and MRI are complementary and can further characterize
the nodal abnormalities and the related head and neck imaging
findings. FDG-PET is superior to anatomic imaging techniques for
detection of nodal metastases in HNSCC. FNAC can be considered in selected patients with the
possibility of avoiding excisional biopsy; however, excisional biopsy
remains the gold standard in evaluation of lymphadenopathy.
Clinical factors that propel the physician to tissue sampling,
due to possible increased risk of malignancy, include age > 40 years,
multiple sites of lymphadenopathy, supraclavicular location of
lymphadenopathy, nodal diameter > 2 cm, firm to hard consistency, fixed
nodes, lack of nodal tenderness, and abnormal chest X-ray.
Treatment of cervical lymphadenopathy depends on the
underlying cause. Most cases are self-limited and require no treatment
other than observation especially in children. Patients with unexplained
lymphadenopathy can be observed for 3-4 weeks, before lymph node
biopsy, if none of the predictive factors for malignancy is present.