Swollen Anterior Cervical Lymph Node: Infections, Autoimmune, Cancer, and Other Causes

Anterior cervical nodes (along sternocleidomastoid) drain the pharynx, tonsils, thyroid, larynx, and scalp.

Common Causes

• Infections (viral > bacterial): URI, EBV (mono), CMV, HIV, strep throat, TB, cat-scratch disease.
• Dental/oral: Caries, periodontitis, pericoronitis.
• Skin/scalp: Impetigo, cellulitis, lice.
• Autoimmune: SLE, RA, sarcoidosis, Kikuchi-Fujimoto.
• Malignancy: Lymphoma (HL, NHL), metastatic SCC (H&N primary), thyroid cancer.
• Drug reactions: Phenytoin, allopurinol (DRESS).

Workup

• History: duration, progression, systemic symptoms, exposures.
• Exam: size, consistency, mobility, fixation, other node groups.
• Labs: CBC, ESR/CRP, EBV/HIV serology, TSH, ANA.
• Imaging: US (cortical thickness, hilum), CT neck/chest.
• Biopsy (FNA or excisional) if >1 cm, hard, fixed, supraclavicular, or persistent >4–6 weeks.