I have had a swollen area above my left collarbone for over 2 months. My primary doctor wanted to watch and see. In the meantime, I had also been on antibiotics and a bacterial medicine, none of which caused the swelling to go down. When I went back for a checkup, she ordered a CT scan of my neck area. The results came back:
Mildly enlarged left-sided supraclavicular lymph node measuring 1cm AP x 1.4cm transverse x 1.1cm CC. Enlarged bilateral level 2 lymph nodes noted as well. The left-sided level 2 lymph node measures 2.1 cm AP x 9mm transverse. The right sided level 2 lymph node measures 1.9 cm AP x 1 cm transverse.
The recommendations: Clinically correlate. Followup is recommended.
My primary doctor is sending me to an Ear, Nose and Throat specialist. I want to know what should happen next. I am concerned since the swelling has not gone down and I have not been sick. The bacterial meds were for an infection in my vagina. The antibiotic was to try and see if the swelling would go down. Which it did not.
Any advice to proceed would be great and thank you!
I would be in a better position to answer your query if I could know your age as it is very helpful in the differential diagnosis. From the CT scan report that you describe the lymph node in the (L) supraclavicular region does not appear to be anything to worry about. I agree with your doctor’s approach to 'wait and watch' this swelling. (L) supraclavicular lymph node is usually seen in the infections of the lung and thyroid, as well as a part of secondaries from the malignancy of the stomach. But if it was because of any of these reasons, it would have progressed by now and would be associated with pain.
Regarding the lymph nodes in the Level 2 region on either side, it could be due to an infection in the upper throat or in the nasopharynx (the region behind your nose). Let me answer your queries one by one:
- My primary doctor is sending me to an Ear, Nose and Throat specialist. I want to know what should happen next.?
I presume, your doctor is suspecting some infection in the throat or in the nasopharynx region and that is the reason for the referral to an ENT specialist. An ENT specialist can do a thorough check up of the nose and throat as well as do a nasendoscopy and telescopic laryngoscopy to look for any infection in these regions followed by blood tests to rule out any lympho-reticular diseases.
- I am concerned since the swelling has not gone down and I have not been sick.
Most of the time, the lymph nodes that appear because of an infection remain there for quite some time even after treatment with antibiotics and they are relatively harmless.
- The bacterial meds were for an infection in my vagina. The antibiotic was to try and see if the swelling would go down. Which it did not.
The antibiotic prescribed for your vaginal infection might not be suitable for an infection in the throat and the neck which could be the reason for the lymph node to remain unchanged.
To sum it up, I would say that you should not worry. It could be a harmless lymph node. I too would suggest you to consult a good ENT specialist and get a thorough check-up done.
Hope that this information helps and hope that you will get better soon.
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You said you would like to know my age and that is 54. After reading your answer, very helpful, thank you, I thought I would mention that in May I had a subtotal colectomy (since there was mention of abdominal issue) The only pain I have is in my collarbone areas. Thank you for such a thorough answer. I will print out and take with me to my appt. Thank you!
I wanted to know your age as it helps one be more specific about the relative likelihood of malignancies such as nasopharyngeal carcinoma, carcinoma of stomach, breast tumor and lymphoreticular diseases. However, your age and the additional history that you have provided does not change my initial response. But I would certainly advise you to go ahead with the ENT consultation. Your ENT specialist would most likely do a nasal endoscopy with or without biopsy of the lymph node. Further line of management can be decided depending on the results.
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