Enlarged Lymph Nodes in the Left Occipital Region: What You Need to Know

Regarding the issue of left occipital lymphadenopathy?

Hello Doctor,
At the beginning of August, I discovered a lymph node in the left posterior neck and initially consulted a general practitioner who diagnosed it as skin inflammation.
I was prescribed antibiotics for six days, which reduced the size of the lymph node but did not eliminate it completely.
The redness and swelling have decreased by about 1/9.
I then saw an otolaryngologist who, after examination, also suggested skin inflammation/cellulitis and prescribed Bactroban ointment, but it seems to have had little effect; my head still itches, but there is no further redness or swelling (about 7/9).
I consulted another otolaryngologist who referred me for an ultrasound in radiology.
The results indicated inflammation-related lymphadenopathy, and no medication was prescribed.
The report is as follows:
"A well-circumscribed, smoothly marginated flat 2.5x8x10mm (AP.W.L.) node with a uniform hypoechoic cortex and thin echogenic hilum is present over the left suboccipital region, corresponding to the clinically concerned lump.
No intranodal calcification or cystic components are noted.
No adjacent tissue plane involvements or dermal thickenings are noted.
No significantly enlarged nodes are noted over the rest of the left neck.
No enlarged nodes are demonstrated over the left supraclavicular fossa.
No enlarged nodes seen in the left submandibular and submental region.
A small left suboccipital node consistent with reactive origin and corresponding to the clinically concerned lump is presented."
I would like to ask the doctor:
1.
Should I still be concerned about this lymph node? Do I need further tests or a biopsy? (In July, I had a nasal endoscopy due to bleeding from the right nostril, and the doctor said the nasopharynx was normal, diagnosing it as nasal vestibulitis, and after applying ointment, there have been no further bleeding issues.)
2.
Does the ultrasound report indicate that this is a normal lymph node? Is there a chance it could be cancer?
3.
Is it likely that this lymph node will persist and not resolve completely?
I really appreciate your help; I am very worried about this situation, and it has been over a month.
Thank you.

Xu, 30~39 year old female. Ask Date: 2020/09/11

Dr. Zheng Jueyi reply Otolaryngology

Hello, according to the current report, there is reactive lymphadenopathy.
Enlargement of the lymph nodes in the posterior cervical region is often associated with infections in the scalp area.
Currently, the size is less than one centimeter, and you may observe it for now.
If it continues to enlarge or remains painful, a follow-up visit for further examination is necessary.
Additionally, benign lymphadenopathy does not always resolve to the point of being undetectable; if there is no ongoing enlargement, it is generally indicative of a benign condition.
Wishing you peace and good health.
Sincerely, Dr.
Jue-Yi Cheng, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2020/09/11

More Info

Understanding enlarged lymph nodes, particularly in the left occipital region, can be a source of concern for many patients. Based on your description and the ultrasound findings, it appears that the lymph node in question is likely reactive in nature, which is a common response to infection or inflammation. Here’s a detailed breakdown of your situation and what you should consider moving forward.

1. Should You Be Concerned About the Enlarged Lymph Node?
The ultrasound report indicates that the lymph node is well-circumscribed, with a smooth margin and a uniform hypoechoic cortex. These characteristics are typically associated with benign (non-cancerous) lymph nodes. The fact that there are no signs of intranodal calcification or cystic components further supports the idea that this lymph node is reactive rather than malignant.
Given that you have already been evaluated by multiple specialists, including an ENT doctor, and have undergone imaging studies, it seems that the consensus is that this lymph node is a result of inflammation, possibly related to a skin infection or other benign processes.

2. Is Further Testing or a Biopsy Necessary?
In most cases, if a lymph node is reactive and there are no alarming features noted on imaging, further invasive testing such as a biopsy may not be necessary. However, if the lymph node continues to grow, becomes painful, or if you develop new symptoms, it would be prudent to follow up with your healthcare provider for further evaluation.
The recommendation to monitor the lymph node is standard practice. If it remains stable in size and you do not experience any new symptoms, it is likely safe to continue observation.

3. Can This Lymph Node Persist or Will It Disappear?
Reactive lymph nodes can sometimes remain palpable for an extended period, even after the initial cause of inflammation has resolved. This does not necessarily indicate a serious problem. Many individuals have lymph nodes that remain enlarged for months or even years after an infection has cleared.
If your lymph node does not change in size or characteristics, it is generally not a cause for concern. However, if you notice any changes, such as increased size, firmness, or if you develop systemic symptoms like fever or weight loss, you should seek medical advice promptly.

Conclusion
In summary, the findings from your ultrasound suggest that the enlarged lymph node in your left occipital region is likely reactive and not indicative of malignancy. It is understandable to feel anxious about changes in your body, but based on the information provided, there is no immediate cause for concern. Regular follow-ups with your healthcare provider and monitoring the lymph node's status will be essential. If you have any further questions or if your symptoms change, do not hesitate to reach out to your doctor for guidance.
Maintaining open communication with your healthcare team and addressing any new symptoms as they arise will help ensure your peace of mind and overall health.

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