Level 2 lymph nodes

[Niek Vink]

Dear all,

I have a question regarding myself. Since about 6 weeks I have noticed a bilateral swelling in my neck in zone 2.

I have had no other clinical symptoms, also not in the weeks before first noticing the swelling.

I went to the doctor this week to check it out and they did some bloodwork that came back negative. She did not feel any lumps though and since I have it bilateral she is not worried and told me to wait another six weeks. She did not think an ultrasound was necessary.

Did not really feel comfortable since I do feel the lumps and the swelling. Decided to scan my neck (I am a physio and not trained in thyroid ultrasdound) and found some swollen lymph nodes I think. The largest one I measured in short and long axis (see attached pic).

The good:
It is wider than tall
It is completely a-vascular (guess that is a good thing?)
Homogeneous
No signs of high peripheral

The bad:
I have no explanation for the swelling
I cant see a hilum in any of the nodes
I feel them getting bigger instead of smaller

I hope these are just reactive lymph nodes, but the loss of the hilum and normal bloodwork makes me doubt.

What do you think?

For all my scans see this link:
https://www.dropbox.com/scl/fo/2f9g45q95ftry8p78rmlf/AM3RusqPPaKB2PpydF6VgfY?rlkey=07wckl1qlrk9j09gyh25iq4qd&st=w3dqrvr4&dl=0

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[Stephen Bird]

Hi Niek,

First let me tell you off for scanning yourself.

Never advisable in my experience!

But since you can’t unseen yourself let’s look at the images.

These look like pretty standard lever 2 reactive nodes.

I don’t see any features that concern me.

Make sure you follow up with your GP.

If you notice any change in the nodes follow up sooner.

If they grow significantly or change in morphology a FNA is easy to perform.

I feel like this is a less likely pathway that simple resolution.

Have you had a sore throat, cold, virus, cigarettes etc?

All of these things are simple causes of reactive level 2 nodes.

Steve.

[Niek Vink]

Hi Steve,

Thank you so much for your reply. Luckily they look like normalreactive lymph nodes to you. The loss of an echogenic hilum and complete absence of Doppler made me doubt.

Since my GP did not allow me to go to a professional to get a scan I decided to do it myself. Tricky stuff indeed but the temptation was just too big. Now I cannot unsee it 😉

I have had no clinical symptoms at all, don’t smoke, don’t drink, no stress and live healthy. The lumps are not tender either, they are ‘just there’ and don’t get smaller.

I wish I had some explanation for having these swollen lumps, perhaps my body is battling some low grade virus or something.

Will give it two more weeks and then I will consult my GP again and press for a professional ultrasound in the hospital.

Thanks again Stephen!

[Stephen Bird]

Sounds like a good plan !

Steve

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