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Clinical Challenge
November 2015

Cervical Lymphadenopathy

Author Affiliations
  • 1Division of Otolaryngology–Head and Neck Surgery, Department of Surgical Services, Naval Medical Center San Diego, San Diego, California
JAMA Otolaryngol Head Neck Surg. 2015;141(11):1023-1024. doi:10.1001/jamaoto.2015.2358

A woman in her 60s presented to the emergency department with a 3-week history of enlarging and painful cervical masses. She reported a distant history of breast cancer and a recent history of an oral cavity lesion, which was not biopsied or followed up. She did not have any known tuberculosis exposure, recent foreign travel, exposure to unpasteurized food, history of immunodeficiency, or alcohol or tobacco use. She did not have fever, chills, cough, dysphagia, or odynophagia. Physical examination revealed a healthy-appearing woman with normal vital signs. She was found to have bilateral cervical lymphadenopathy, which included fixed and bulky nodes in level IB and IIA and nontender level IV and V nodes. An oral cavity examination revealed no evidence of masses or lesions, floor of mouth and base of tongue were soft, and the palatine tonsils had no lesions or ulcers. Flexible laryngoscopy revealed no evidence of pharyngeal or laryngeal lesions. Contrast-enhanced computed tomographic (CT) scans of the neck (Figure) revealed bilateral lymphadenopathy with central necrosis.