# How are enlarged lymph nodes diagnosed?

> An enlarged neck lymph node with no recent infection should be checked. Diagnosis uses history, examination, blood tests, ultrasound, scans and a needle sample.

Source: https://www.aysenurmerichafiz.com/en/blog/diagnosing-enlarged-lymph-nodes/  
Updated: 2026-10-29

Blog · Neck

By: [Prof. Dr. Ayşenur Meriç Hafız](https://www.aysenurmerichafiz.com/en/about/) · Updated: 29 October 2026 · 4 min read · Translated from the original Turkish article.

In brief

Step by step: history and examination, blood tests, a neck ultrasound and, if the cause is still unclear, a needle sample. A lump at increased risk of being malignant also has a CT or MRI scan with contrast, and a whole node may have to be removed if the needle sample gives no diagnosis.

Diagram The lymph nodes of the neck are assessed by anatomical regions (levels).

Lymph nodes that enlarge for no apparent reason are the ones that concern us. If you have an enlarged lymph node in your neck but do not feel ill and have not recently had an infection such as a cold, flu or a dental infection, make sure you see a doctor and have some tests done.1

## When does an enlarged lymph node need attention?

Lymph nodes that swell because of an infection usually get better by themselves within one to two weeks.2

A lump in the neck is at increased risk of being malignant when no infection explains it and it has been present for two weeks or longer without a marked change in size, or when it has one of these features:1

- It feels firm
- It is fixed to the tissues around it
- It is larger than 1.5 cm
- The skin over it has an open sore

Nodes that keep getting bigger, night sweats or a very high temperature, and swollen nodes just above or below the collarbone are also reasons to see a doctor.2

## What does the doctor ask and examine?

To diagnose what may be causing the swollen lymph nodes, we first want to know, from your medical history, when and how your lymph nodes enlarged and whether you have any other signs or symptoms. Fever, night sweats, weight loss, travel, contact with animals, medicines, smoking and alcohol are asked about as well.3,4

During the examination, we check the lymph nodes for size, tenderness, warmth and texture; the location of the swollen nodes and your other signs and symptoms also offer clues to the underlying cause.4

With a lump at increased risk, the throat, the base of the tongue and the larynx are also examined with a thin, flexible camera passed through the nostril.1,5

## Blood tests and imaging

When the enlargement has lasted more than four weeks or comes with general symptoms, blood tests and imaging are needed. First, a complete blood count and the inflammation markers CRP and sedimentation rate are requested; these tests help us to assess your general health and to detect a range of disorders, including infections and leukaemia. Depending on the suspected cause, specific blood tests may also be requested, such as antigen-antibody tests for certain viruses. If tuberculosis is suspected, a tuberculin skin test is performed.3,6

Next, a neck ultrasound is needed to assess all the lymph nodes in the neck and their structure. When the lump is considered at increased risk of being malignant, a CT or MRI scan of the neck with contrast is requested. A chest X-ray is also requested if a lung-related condition is suspected.1,6 In children, ultrasound is the first-choice imaging test.3

## The needle sample, and when a node is removed

The next step is an ultrasound-guided needle biopsy: a sample is taken with a fine needle first, in preference to an open operation, and sometimes with a larger (core) needle. A core needle sample is taken after a local anaesthetic injection; the procedure takes roughly 20 to 30 minutes, and you go home afterwards. Complications are rare, the commonest being bruising and bleeding, and the result usually takes a week or two.1,5

A fine-needle sample cannot show the internal architecture of the node, and there are concerns about its reliability in diseases such as lymphoma.4 If the sample does not give enough information, it may need to be repeated. In some patients, a whole lymph node then has to be removed in the operating theatre, under local or general anaesthetic, in order to reach a diagnosis.1,5

## What are the common causes in children and in adults?

In children, most enlarged lymph nodes are benign or caused by an infection, most often a short-lived viral illness; about half of otherwise healthy children have nodes that can be felt at any one time.4

Overall, an enlarged lymph node is benign and passes by itself in most patients, and infection is a common cause in the head and neck. In primary care a malignant disease is found in 1.1% of cases, but in approximately 4% of people older than 40.3,4

A lump that persists in an adult’s neck is different: most are tumours, and it may be the first or only sign of a head and neck cancer, a lymphoma, or a thyroid or [salivary gland cancer](https://www.aysenurmerichafiz.com/en/treatments/salivary-glands/salivary-gland-cancer/).1

Once the cause has been found, treatment is directed at it. A bacterial infection is treated with antibiotics, while enlargement caused by a virus generally settles with observation.6

## References

1. Pynnonen MA, Gillespie MB, Roman B, Rosenfeld RM, Tunkel DE, Bontempo L, et al. Clinical practice guideline: evaluation of the neck mass in adults. Otolaryngol Head Neck Surg. 2017;157(2 Suppl):S1-S30. [doi:10.1177/0194599817722550](https://doi.org/10.1177/0194599817722550) ↩
2. NHS. Swollen glands \[Internet\]. London: NHS; \[reviewed 2023 Sep 29; cited 2026 Oct 13\]. Available from: [nhs.uk](https://www.nhs.uk/symptoms/swollen-glands/) ↩
3. Falk N, Joseph R, Dieujuste M. Lymphadenopathy: evaluation and differential diagnosis. Am Fam Physician. 2025;112(3):286-293. Available from: [aafp.org](https://www.aafp.org/afp/2025/0900/lymphadenopathy) ↩
4. Gaddey HL, Riegel AM. Unexplained lymphadenopathy: evaluation and differential diagnosis. Am Fam Physician. 2016;94(11):896-903. Available from: [aafp.org](https://www.aafp.org/afp/2016/1201/p896) ↩
5. ENT UK. Neck lump clinic \[Internet\]. London: ENT UK; 2022 Jul 14 \[cited 2026 Oct 5\]. Available from: [entuk.org](https://www.entuk.org/patients/conditions/60/neck_lump_clinic/) ↩
6. Farmer A, Matto P. Lymphadenopathy. In: StatPearls \[Internet\]. Treasure Island (FL): StatPearls Publishing; 2026 \[cited 2026 Oct 12\]. Available from: [ncbi.nlm.nih.gov](https://www.ncbi.nlm.nih.gov/books/NBK513250/) ↩

[Read more in Treatment areas Diagnosis of Neck Cysts](https://www.aysenurmerichafiz.com/en/treatments/neck-cysts/diagnosis-of-neck-cysts/)

The outcomes of surgical and medical procedures vary from person to person; consult your doctor for an assessment specific to you.

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