Family, Internal Medicine, General Medical Questions/recurring lymph nodes

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QUESTION: I'm a generally healthy non smoking 27 year old. Starting last year I had an instance where both of my submandibular lymph nodes for swollen and were very painful. I got an MRI and they were enlarged but not of any clinical significance. They are still slightly enlarged but no longer painful. Then about 6 months ago I started getting episodes of painful swelling. The location would vary, some months it would be auxiliary and others it would be just above my collar bone. It would last a week or maybe a little more and by the time I'd start to consider getting it checked out they'd be gone. In none of these instances was I such our recovering from anything. Recently I haven't had too many episodes. But I did notice that I now have a small hard, painless lump just above the mastoid process. It's only on one side and again I am not ill not have I been recently. Is this enough to where I should consider looking into it. I have 5 kids so often I put things on the back burner unless I have to. I'm sure it's nothing but it gets hard to keep ignoring them. Thank you for your input.

ANSWER: Dear Violet,

Swollen lymph nodes are a symptom that the body is fighting infection. However, there are certain lymph nodes that are of particular concern. The lymph nodes around the collar bone and the mediastinum, which is your sternum, are concerning. I strongly recommend you make an appointment with your primary care provider as soon as possible for a full workup. A biopsy should also be done.

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QUESTION: Thank you very much I have scheduled one for next week. The only one I can feel right now is the one on my head and under my jaw. The one on my head is small, hard, but not painful. The ones that hurt come and go in my underarms, collarbone, and jaw. At the moment I can't feel them. But they'll just pop up for a couple of weeks then disappear. Will this make much of a difference in terms of how I should present to the doctor.

ANSWER: Dear Violet,

Diagnoses are made by the medical history given by the patient, the physical examination, and the imaging and lab results. Your history is going to be the most important part of this visit. Be sure to express your concern for all of the nodes, but predominantly the collar bone. In medical nomenclature, this the supraclavicular node. Please let me know how the visit goes.

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QUESTION: Thank you for your response. My doctor was a little upset at me as though he was aware of the submandibular lymph nodes and he knew I hadn't followed up with the ENT, which was as he clearly reminded me 16 months ago. If it helps any this was due to several factors. Mostly being that my 9 yr old (at the time) was hospitalized and diagnosed with a stroke, vertigo, blood clotting disorders, etc. And my 6 yr old was diagnosed with autism. So with that and 5 kids I often forget to take care of myself. But I digress. When I went to him back in January of last year he ordered an MRI. At that point the nodes in my throat were swollen, sometimes painful, and for no apparent reason. This was before the random swelling of the other lymph nodes. While he took note of the other nodes and the random swelling he said most likely if they were bad they wouldn't have come and gone. But was told to go back if they did. I will be following up with my ENT and will be taking him the CT w/ contrast that I just had done.  

I do have one question. It seems as the CT did see the nodes in my neck and said they were similar to the ones seen in the MRI I had in January '13. But looking at the two reports Which I will put as following I noticed one difference and I wonder if this should be of significance or if I should really push it any further.

The January '13 MRI impression was as follows: Mildly prominent bilateral level Ib lymph nodes, more conspicuous on the right, as described above, possibly resulting in perception of soft tissue swelling/mass. If there is continued clinical concern, further evaluation with CT of the neck with IV contrast is recommended, which would allow a higher resolution and signal-to-noise ratio. Otherwise unremarkable MRI of the neck without and with IV contrast.  

May '14 CT /w contrast impression is as follows: Stable subcentimeter level IIa, IIb, posterior triangle, and submandibular lymph nodes bilaterally, none enlarged by CT size criteria, No cystic necrotic lymph node is seen. No mass, abnormal enhancement or fluid collection is identified elsewhere.

While I'm generally pleased that they are not large by CT size criteria, whatever that may be, I am slightly concerned that before they were only level Ib and now it states IIa, IIb, posterior triangle and submandibular. Should that concern me and should I push this with the ENT? The ones in my neck actually don't hurt me per se. At the most I feel a tightness or occasional discomfort but nothing more than that. And that still leaves the question as to why the others have been randomly swelling. And at the moment I still have one, I believe its the occipital lypmh node that is swollen. Its very small at the very most pea sized and not painful, red, or uncomfortable. Its just there.

Answer
Dear Violet,

The interpretation of the images is referring to the location of the lymph nodes. Ib is the submandibular group and IIb is the upper jugular group. It is difficult to compare a CT scan to an MRI. It is like apples to oranges. However, there appears to be different lymph node groups affected. This needs to be followed up in a timely manner. I would not delay.  

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Dr. Pamela M. Cipriano, DNP, APRN

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My name is Dr. Cipriano. I have a private practice specializing in adult health and wellness. I can answer questions associated with thyroid disease, cardiac disease, pulmonary disease, high blood pressure, muscular aches and pains, cholesterol levels, male/female sexual questions or questions on the sexual organs, gastrointestinal problems, healthy ways to lose weight and maintain a healthy lifestyle, and nearly anything else that pertains to medicine.

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