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Column originally published May 27, 2008

Enlarged Lymph Gland Caused By Infection

Question: Several weeks ago, our four-year-old son had a bad cold. He was very congested in his nose. A few days later, he complained that his neck was sore. When I checked him, I found a large lump just behind his jaw. I was really terrified, and the worst possible illness crossed my mind. Fortunately, our family doctor was able to see him that same day. After examining him thoroughly, she told us that he had a sinus infection and the lump that I found was an infected lymph gland. She gave him a course of antibiotic, and since then our son is back to his normal self. This lump in his neck is much smaller than before, but it is still there. I wonder whether we should be concerned about this enlarged lymph gland.


From what you have described, I donʼt think you have to be concerned about it. Let me explain to you in greater detail here.

Lymph glands, also called lymph nodes by many doctors, are present in most parts of the body. They are very small and almost undetectable if they are not enlarged. Most of them are found in groups in the neck, under the armpits, and in the groins. Other lymph glands are present inside our chest and in our abdomen.

Lymph glands are our first line of defense. If you hurt your finger while you are gardening this spring, and some dirt gets inside the wound, germs can get into the wound and start an infection. When your finger becomes red and swollen from the infection, some of the germs will travel from your finger through tiny channels called lymphatic ducts to the closest lymph glands, which are located in your armpit.

When germs arrive at the lymph glands, they are picked up by white blood cells present there. These white blood cells not only kill the germs, they also process the genetic information of the germs so that your body can produce antibodies against these them. In future, when you encounter these same germs from another infection, your body will be able to fight the infection much faster. This is the way our body builds up natural immunity to harmful germs around us.

As you have described, your son had a recent cold, which is almost certainly caused by a virus infection. Most of the time, virus infections can last a few days. Children usually have some congestion in the nose and a few coughs; everything will get better in a matter of days.

However, once in a while, these common colds can lead to sinus infections. The mucous membrane that covers the inside of the nose gets swollen from the virus infection, blocking the opening of the sinuses so that sinus infection sets in. If the sinus infection is not severe, it can still get better on its own after a few days, and the sinuses will open up again without any treatment.

Unfortunately, sometimes the sinus infection does not get better on its own, and this can make a child very sick. What started as a simple virus infection develops into a bacterial infection. The bacteria that grow inside the sinuses travel to local lymphatic tissues around the back of the throat as well as the lymph glands in the upper part of the neck. As a result, the lymph glands become enlarged and infected, and this can be quite painful.

Once a lymph gland is enlarged from an infection like what you have described, it does not go back to its original size for a very long time, and sometimes can still be palpable even years later. The main reason is because the lymph gland is now filled with many more white blood cells that went there to fight the infection.

These somewhat larger lymph glands are usually not painful because there is no infection any more, and they are usually no larger than the size of a pea. They will move around if you push them, and they are not attached to the skin or to the surrounding tissues.

I know you are concerned that these lymph glands may be a sign of cancer. It is very true that children can get cancers like leukemia and lymphoma. In both of these conditions, the lymph glands can be enlarged.

However, children with leukemia are usually very sick, and they become sick fairly quickly, over a few days or several weeks, and they do not get better with a course of antibiotic. If your son does have leukemia, his condition will get worse in a short time. However, if he stays healthy, then it is unlikely that he has leukemia.

Lymphoma, on the other hand, is a cancer that starts from the lymph glands. These cancerous lymph glands are not only large, they are quite firm but usually not painful, and they donʼt get smaller with antibiotic. Most doctors are able to differentiate an infected lymph gland from one that has cancer. If a lymph gland stays fairly large in size and firm, and does not improve with treatment, more tests will need to be done to make sure there is no cancer inside.

I hope that I have given you some reassurance about your sonʼs condition. You can keep watching this lymph gland to make sure that it doesnʼt grow bigger over time. If in doubt, bring him back to see your doctor, and if needed, I am sure that you doctor will get another specialist to check him out or do additional tests on him.