Unilateral Cervical Lymphadenopathy in a Young Adult with Upper Respiratory Symptoms

Case at a Glance

A 25-year-old male presented with a 3-day history of unilateral left-sided neck swelling near the supraclavicular region, accompanied by mild pain and discomfort. The patient reported concurrent upper respiratory symptoms in the context of household members being ill with similar symptoms.

Patient's Story

The patient noticed a visible bulge on the lower left side of his neck, near the collarbone area, which appeared noticeably different from the right side. He described experiencing waves of slight pain and constant discomfort in the affected area. On the first day of symptoms, he reported unusual sensations in his neck, describing it as feeling like his veins were being compressed. The patient mentioned feeling generally unwell but attributed this to possible exposure to respiratory illness, as several household members were currently experiencing coughs and upper respiratory congestion.

Initial Assessment

Physical examination revealed a soft, compressible mass in the left supraclavicular region that appeared stable in size over the 3-day observation period. The patient described the swelling as having an 'airy' consistency upon palpation. He reported no known thyroid disorders and considered himself generally healthy prior to this episode. The patient appeared to have mild constitutional symptoms consistent with a viral upper respiratory infection.

The Diagnostic Journey

The differential diagnosis included reactive lymphadenopathy secondary to viral upper respiratory infection, bacterial lymphadenitis, salivary gland pathology, thyroid abnormalities including goiter, or less commonly, infectious mononucleosis (glandular fever). The soft, non-fixed nature of the mass and the concurrent respiratory symptoms in household contacts suggested an infectious etiology as most likely.

Final Diagnosis

Reactive cervical lymphadenopathy secondary to viral upper respiratory tract infection

Treatment Plan

Conservative management with symptomatic treatment including acetaminophen and ibuprofen for pain and discomfort. Patient advised to monitor the swelling for changes in size, consistency, or associated symptoms. Close observation recommended with instructions to seek immediate medical attention if the swelling increases significantly, becomes firm or fixed, or if systemic symptoms worsen.

Outcome and Follow-up

Patient was advised to continue monitoring symptoms and seek medical evaluation if no improvement occurred within 7-10 days or if concerning features developed. Follow-up appointment scheduled if symptoms persisted beyond the expected timeline for viral illness resolution.