Lymph Nodes: Concerns and Clarifications for Patients

Annoying lymph nodes

Hello Dr.
Chen, I am the person who consulted you regarding #138469.
In April, I underwent a neck CT scan, but I still felt uneasy, so on November 14, I had a neck ultrasound, blood tests, and a chest X-ray.
All reports came back normal.
The ultrasound report is as follows:
Lesion (V) Left thyroid gland: Normal presentation
(V) Right thyroid gland: Normal presentation
(V) Left jugular chain: No abnormal lymph node
(V) Right jugular chain: No abnormal lymph node
(V) Left accessory chain: No abnormal lymph node
(V) Right accessory chain: No abnormal lymph node
(V) Left submandibular gland: Normal presentation
(V) Right submandibular gland: Normal presentation
(V) Left parotid gland: Normal presentation
(V) Right parotid gland: Normal presentation (Superficial lobe)
(V) Submental area: Normal presentation
Lesion A
Location:
Size (mm): X
Shape:
Margin:
Echogenic Hilus:
Architecture:
Internal echo:
Echogenicity:
I would like to ask you the following questions:
1.
The doctor mentioned that the lymph node I discovered is located closer to the neck in the fourth zone (behind the sternocleidomastoid muscle, above the inferior belly of the omohyoid muscle), not in the supraclavicular area.
Can you confirm if that lymph node is indeed in the fourth zone and not in the supraclavicular area? What is the range of lymph nodes included in the fourth zone?
2.
The ultrasound indicated that the left lymph node is approximately 0.8 cm (which I felt in February), and the right side is about 0.5 cm (which I felt in May).
It seems that there has not been a significant increase in size.
Does this mean there is no issue? The examining doctor mentioned that if it were something concerning, it should become noticeably larger within a month or two, and any issues would also be visible on the chest X-ray.
Is this correct?
3.
I smoke, my throat is often red and tight, and I have small nodules on the throat wall that resemble lymphoid hyperplasia.
Could this also lead to hyperplasia of the lymph nodes in the fourth zone? Why did this not occur before, and why is it appearing now?

Rongyi danxin de ren, 30~39 year old female. Ask Date: 2018/11/28

Dr. Chen Sirong reply Oncology

1.
The doctor mentioned that the lymph node I discovered is located closer to the neck in the fourth zone (above the posterior border of the sternocleidomastoid muscle and the upper belly of the omohyoid muscle), not in the supraclavicular area.
Can you confirm if that lymph node is indeed in the fourth zone and not in the supraclavicular region? What area does the fourth zone lymph nodes encompass? A: This is not the main concern; you don't need to know.
You just need to know that your current lymph nodes are benign.
2.
An ultrasound examination showed that the lymph node on the left side is approximately 0.8 cm (which I felt in February), while the one on the right side is about 0.5 cm (which I felt in May).
It seems that neither has significantly increased in size; does this mean there is no issue? The examining doctor said that if there were something concerning, it should have become noticeably larger within a month or two, and any issues would also show up on a chest X-ray.
Is that correct? A: YES.
3.
I smoke, and my throat often feels red and tight, with small nodules on the throat wall that seem like lymphoid hyperplasia.
Could this also cause lymphoid hyperplasia in the fourth zone? Why did this not occur before and is now appearing gradually? A: Redirect your worrying energy towards quitting smoking and make some positive changes in your life.
As a side note: Continuing to worry is unproductive.
One might either get cancer or die from other diseases, or even face accidents.
Whatever happens, let it be.
If you can find peace in acceptance, that would be even better.
Best wishes, Chen Sih-Rong, Taoyuan Hospital.

Reply Date: 2018/11/28

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding your lymph nodes and recent imaging studies. It's understandable to feel anxious about any findings related to lymph nodes, especially given their role in the immune system and potential implications for health. Let's address your questions one by one.

1. Location of Lymph Nodes: The lymph nodes in the neck are categorized into different levels or regions, and the area you mentioned, which is located behind the sternocleidomastoid muscle and above the shoulder, corresponds to Level IV lymph nodes. These nodes are part of the cervical lymphatic system and are responsible for draining lymphatic fluid from various regions, including parts of the thyroid, larynx, and pharynx. The supraclavicular (above the collarbone) lymph nodes are classified as Level V. Therefore, if your doctor indicated that the nodes are in the fourth region, they are indeed referring to the nodes located in that specific area, not the supraclavicular nodes.

2. Size and Stability of Lymph Nodes: The size of lymph nodes can vary, and a measurement of 0.8 cm on the left side and 0.5 cm on the right side is generally considered within the range of normal, especially if there are no accompanying symptoms such as pain, fever, or significant changes in size over a short period. Your doctor’s reassurance that if there were something concerning, the nodes would likely have changed in size within one to two months is accurate. Lymph nodes can react to infections or inflammation, and it’s common for them to enlarge in response to such stimuli. If they remain stable and do not exhibit any concerning features on ultrasound, it is a good sign.

3. Smoking and Lymph Node Changes: Smoking can lead to chronic irritation and inflammation in the throat and respiratory tract, which may contribute to lymph node enlargement. The presence of red, inflamed areas in your throat and the appearance of small nodules could indicate reactive lymphoid hyperplasia, which is a benign response to chronic irritation or infection. It’s not uncommon for lymph nodes to become more prominent in response to new irritants or infections, even if they were previously normal. If you have noticed these changes recently, it could be related to your smoking or other environmental factors.

In summary, based on your ultrasound results and the stability of your lymph nodes, there is no immediate cause for concern. However, it is crucial to maintain regular follow-ups with your healthcare provider, especially given your smoking history and throat symptoms. They may recommend lifestyle changes, such as smoking cessation, which can significantly improve your overall health and reduce the risk of further complications.

If you have any further questions or if your symptoms change, please do not hesitate to reach out to your healthcare provider for additional guidance. Regular monitoring and open communication with your doctor are key to managing your health effectively.

Best wishes for your health and well-being.

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