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Swollen Lymph Nodes Neck One Side: Causes

Swollen lymph nodes on one side of the neck are often a sign of a local infection but can also indicate other conditions. Medical evaluation is recommended.

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Swollen lymph nodes on one side of the neck are often a sign of a local infection but can also indicate other conditions. Medical evaluation is recommended.

What Are Unilateral Swollen Lymph Nodes in the Neck?

Lymph nodes are small, bean-shaped organs of the immune system distributed throughout the body. The neck contains a particularly high concentration of lymph nodes. They filter lymph fluid and help the body fight pathogens such as bacteria and viruses. When one or more lymph nodes swell on only one side of the neck, this is referred to as unilateral cervical lymphadenopathy.

Causes

There are many possible reasons why lymph nodes on one side of the neck may become enlarged. The most common causes include:

Infectious Causes (Most Common)

Bacterial infections: e.g., tonsillitis, dental abscess, ear infection, or scarlet fever
Viral infections: e.g., the common cold, influenza, infectious mononucleosis (glandular fever), or COVID-19
Local skin infections: Wounds or inflammations in the head and neck region can activate nearby lymph nodes

Non-Infectious Causes

Reactive lymphadenopathy: An immune system overreaction, e.g., in autoimmune diseases
Malignant conditions: In rarer cases, lymphomas (e.g., Hodgkin lymphoma) or metastases from other cancers (e.g., oral, throat, or thyroid cancer) can cause one-sided lymph node swelling
Sarcoidosis: A chronic inflammatory disease that can affect lymph nodes

Symptoms

In addition to visible or palpable swelling in the neck, the following accompanying symptoms may occur:

Pain or tenderness in the affected area
Redness or warmth over the swollen lymph node
Fever, chills, or a general feeling of illness
Difficulty swallowing or hoarseness
Unintentional weight loss (in rarer, more serious cases)
Night sweats (in rarer, more serious cases)

Diagnosis

A doctor will first perform a physical examination and take a medical history. Depending on the suspected cause, the following diagnostic steps may be initiated:

Blood tests: Inflammatory markers (e.g., CRP, leukocytes), differential blood count, antibody tests
Neck ultrasound: To assess the size, shape, and structure of the lymph nodes
Swab tests: e.g., throat swab if a bacterial infection is suspected
Imaging: CT or MRI scan if deeper causes are suspected
Lymph node biopsy: Tissue sampling if a malignant condition is suspected

Treatment

Treatment depends on the underlying cause:

Bacterial infections: Antibiotics, e.g., amoxicillin for streptococcal tonsillitis
Viral infections: Usually symptomatic treatment with pain relievers and rest; antiviral medications only for specific pathogens
Malignant conditions: Depending on the diagnosis, chemotherapy, radiation therapy, or surgery
Inflammatory conditions: Anti-inflammatory medications or corticosteroids

When to See a Doctor

Medical evaluation is strongly recommended if:

The lymph node remains swollen for more than 2 to 3 weeks
The lymph node is steadily growing in size
It feels hard, firm, or immovable
Significant general symptoms such as fever, night sweats, or weight loss are present
There is no obvious cause such as a cold or infection

References

Swartz MH. Textbook of Physical Diagnosis: History and Examination. 8th edition. Elsevier, 2021.
Mohseni S, Shojaiefard A, Khorgami Z et al. Peripheral Lymphadenopathy: Approach and Diagnostic Tools. Iranian Journal of Medical Sciences. 2014;39(2 Suppl):158-170.
Gaddey HL, Riegel AM. Unexplained Lymphadenopathy: Evaluation and Differential Diagnosis. American Family Physician. 2016;94(11):896-903.

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