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Hypertrophy of tonsils shown on CT scan...but I don't have tonsils
Hi! I had my tonsils/adenoids taken out in 1998. For the past month I've had a painful swollen lymphnode in my neck (left side). I have also had a sensation of something stuck in my throat. The doctor ordered a CT scan today and it came back as this:
1. Scattered subcentimeter cervical lymph nodes are noted, most probably reactive in etiology.
2. There is diffuse tonsillar hypertrophy without obvious mass lesion. Consider direct visualization for further evaluation as indicated clinically.
I am a 47 year old female. All bloodwork has come back normal, as well. No sign of infection. No other symptoms.
Any ideas as to what this is or how to fix the lymphnode? I've been referred to an ENT.
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@mrowland08. I happened to see this while replying to someone. Here is what it says online about your condition:
It is understandable that these results feel confusing, especially since you had your tonsils and adenoids removed decades ago.
The two main findings on your CT scan essentially mean that your body is acting as if it is fighting something, even if your bloodwork isn't showing a typical infection. Here is a breakdown of what that report is saying in plain English:
1. "Scattered sub centimeter cervical lymph nodes... reactive in etiology"
Sub centimeter: The lymph nodes are smaller than 1 centimeter. Doctors generally consider nodes "suspicious" when they are larger than 1.5 or 2 centimeters.
Reactive: This is a reassuring term. it means the nodes are "reacting" to something—like a minor virus, local inflammation, or even a dental issue—rather than being enlarged due to a growth or malignancy.
Etiology: This just means "cause." So, the cause is likely a normal immune reaction.
2. "Diffuse tonsillar hypertrophy without obvious mass lesion"
This is likely the part that surprised you most since you had your tonsils out in 1998.
Tonsillar Hypertrophy: This means the tonsil tissue is enlarged.
How is this possible? When tonsils (which are lymphoid tissue) are removed, it is common for small amounts of "base" tissue to remain. Over time, this "lingual tonsil" or residual tissue can grow back or swell. This is called Compensatory Hypertrophy. Since your adenoids and palatine tonsils are gone, the remaining lymphoid tissue in your throat (the "Waldeyer's Ring") sometimes works overtime and gets bigger to compensate.
No obvious mass lesion: This is good news. It means the radiologist did not see a tumor or a specific growth; the tissue just looks "diffuse" (evenly enlarged).
Why do you feel like something is "stuck"?
The sensation of something stuck in the throat is called globus sensation. In your case, it is likely caused by that "tonsillar hypertrophy." Because that tissue is enlarged, it can physically press against the back of your throat or interfere with the way the "flaps" we discussed earlier move, creating that annoying feeling that you need to swallow something away.
Next Steps: "Direct Visualization"
The radiologist recommended "direct visualization." This is the standard next step for a 47-year-old with these symptoms.
What it is: You will likely see an ENT (Ear, Nose, and Throat doctor).
The Scope: They will perform a "laryngoscopy" or "nasopharyngoscopy." They use a tiny, flexible camera (about the size of a spaghetti noodle) to look through your nose and down your throat.
The Goal: Because CT scans are just 2D pictures, the doctor needs to actually see the color and texture of the tissue to confirm it is just "regrown" tonsil tissue and not something else causing the inflammation.
Has your doctor already referred you to an ENT, or are you still waiting to discuss these results with your primary care physician?