Swollen Lymph Nodes Below the Neck: Which Medical Specialty Should You Consult?

Experiencing swollen lymph nodes below the neck can be concerning, but it's a relatively common clinical condition that often points to an underlying health issue. If you notice swelling in this area, it's advisable to consult a specialist in general surgery or head and neck surgery for proper evaluation and diagnosis. The neck contains a complex network of lymphatic vessels that drain fluid from the head, face, and upper respiratory tract, making it a common site for lymph node enlargement when infections or inflammation are present.

Common Causes of Lower Neck Lymph Node Swelling

Lymphadenitis, or inflammation of the lymph nodes, is one of the most frequent causes of swelling in the neck region. Since the head and facial areas are constantly exposed to environmental pathogens, conditions such as oral infections (e.g., tooth abscesses), sinusitis, pharyngitis, conjunctivitis, or ear infections can trigger reactive lymph node enlargement—typically observed in the upper neck or submandibular regions.

However, when swelling occurs specifically in the lower part of the neck, clinicians must consider more serious potential causes beyond routine infections. One such possibility is tuberculous lymphadenitis, commonly known as scrofula. This condition often stems from active pulmonary tuberculosis, where Mycobacterium tuberculosis spreads from the lungs to nearby lymph nodes, particularly in the lower cervical or supraclavicular zones. Diagnosis usually involves imaging studies, fine-needle aspiration (FNA), and tuberculin skin testing or interferon-gamma release assays (IGRAs) to confirm exposure.

When Cancer Metastasis Should Be Considered

A particularly important consideration arises when swelling appears on the left side of the lower neck—a finding sometimes referred to as Virchow's node. Enlargement in this location may indicate metastatic spread from abdominal malignancies, especially gastrointestinal cancers like gastric (stomach) cancer or pancreatic cancer. Tumor cells can travel through the lymphatic system and lodge in the left supraclavicular lymph node, serving as an early warning sign of advanced internal disease.

Diagnostic Approach and Next Steps

To determine the exact cause of lower cervical lymphadenopathy, a comprehensive diagnostic approach is essential. Physicians typically begin with a detailed medical history and physical examination, followed by imaging tests such as neck ultrasound, CT scan, or MRI. These tools help assess the size, shape, texture, and blood flow within the affected nodes.

If initial tests raise suspicion for malignancy or infection like tuberculosis, further interventions become necessary. Ultrasound-guided fine-needle aspiration (FNA) allows for cellular analysis, while a core needle biopsy or excisional lymph node biopsy may be performed to obtain sufficient tissue for histopathological and microbiological evaluation.

In summary, persistent or unexplained lymph node swelling below the neck should never be ignored. Whether due to infection, autoimmune conditions, or potentially life-threatening diseases like cancer or TB, timely consultation with the appropriate medical specialist—such as a head and neck surgeon or oncologist—is crucial for accurate diagnosis and effective treatment planning.