Probably ES but worried about lymph node

Hello everyone,
I’m new here. Male , 37 years young :slight_smile:
first of all, i want to apologize for my English which is awful, but i will try my best.
Everything started at the end of Apr.23 - i felt a little pain under my right ear, and when i tried to touch there with a lot of pushing i was able to feel something like lymph node. next days i forgot about it and a month later i felt the same pain. when i was touching it, this time it was little bit more bigger, rock-hard and not movable. i had an a appointment with a doctor Hematologist , which was concerned that this is probably a lymph node ordered few blood tests, ultrasound of the neck and appointment with dentist and ENT. 2 ultrasounds didn’t saw anything in the lymph nodes . One ENT ordered more blood tests , because the first one was totally fine , and after them he said that i was fighting mononucleosis (with elevated only Igg and no other symptoms for this). I’ve drink antibiotic for 10 days with no effect .Probably this Igg is for mononucleosis in the past. i did a CT scan of neck (links at the end) and the guy who did it’wrote that all lymph nodes are normal, that there is slight problem in C5/C6 and that my ligament is thicker probably because of progressive enlargement of styloid process , and they say some lesion on my right salivary gland which is non cancerous . But the “lymph node” below my right ear is getting bigger - can’t be seen but it can be felt very easily , because it’s right under the skin and it’s rock-hard. Now when i’m touchng on my left side on the same spot i’m feeling the same thing but like at the beginning (not so big).
Went to a jaw surgeon which saw the CT but the readings of it was not ready and by the physical exam he was not able to say what is it and send me to perform a 3D of the neck/face (link at the end) because he thinks that maybe i have ES. on the 3D i’m able to say that it’s true and probably my styloid process on both sides are bigger than normal, but the right one is thicker and longer. But why he didn’t saw it on the CT when this is the gold standard to catch it???
My problem is that i will go to see him again after 1 month. Made a blood tests few times which are perfect. if i touch this thing i start to feel pain in that area and it’s going down on my neck, sometimes to the ear and jaw and it’s stays for 1-2 days. Sometimes it’s painful after sleep.
the muscle on my right side of the neck is already painful most of the time.
So can you check my 3D which is from 4 days ago and my CT which is form 27.JUN.23. Also as a bonus if it can help i’m leaving a link to HEAD CT which is made 17.10.22 due to few times my left side of the face was going numb , but they didn’t find anything and it was probably a damaged nerve .
Also is it possible to feel your styloid process almost under the skin by touching it ?

EDIT - i can’t include links for some reason. probably i need to made few posts before that. i hope i can send them on private msg if someone want to see them.


Mentioned CT’s are nit CT’s but MRI :smile:

3d X-ray 16.JUL.23

neck MRI 27.JUN.23

head MRI 17.NOV.2022

Hi Ross!

Welcome to our forum! Your English is really very good so no need to apologize!

I tried to view your images via the links you posted, but nothing comes up when I click on them. Did you post the “online viewer link” that dicomlibrary gives you for each scan you load or a different link?

Regarding what you’re feeling that you think might be a hardened lymph node under your right & now left ears, it could be your styloid on each side. I could feel mine under my right ear but I couldn’t on the leftt side. I could feel my left styloid under my jaw but not my right one. My right styloid was growing much more straight down whereas the left was angled more inward toward my cervical spine so it seems styloid angle impacts where you can feel it externally. Some people can only feel the styloid(s) in their throat & not at all externally.

Yes, I couldn’t see the scans either…& I agree, your English is great! Lots of members have had enlarged lymph nodes in the area of the styloids, at a guess I’d say maybe because of the inflammation enlarged styloids cause? And as @Isaiah_40_31 says, sometimes the styloids can be felt under the skin, or otherwise inside the mouth around the tonsil area, depending on the size & angle they grow. I’m not sure why (if I understand right) the CT report noted that there was enlargement of the styloid, but that he couldn’t see it?
The symptoms you describe could be ES, you mentioned having numbness in your face before, the styloids can compress the Trigeminal nerve and the Facial Nerve and can cause pain, pins and needles or numbness, so that might have been the start of it too?
I hope that you can get some answers when you see him next!


This is an issue I have noticed with DicomLibrary lately. The download links don’t seem to work, but the viewer ones do.

Here are the links to each study in the web viewer. You can still download them once the viewer has loaded.

3d X-ray 16.JUL.23

neck MRI 27.JUN.23

head MRI 17.NOV.2022

1 Like

Hi @Jules and @Isaiah_40_31 ,
Thank you for the fast answers. probably i’m posting the wrong links - for downloading. Let’s try with the ones for online view.

3D X-Ray 16.JUL.23 -

Neck MRI 27.JUN.23 - -

Head MRI 17.NOV.23 -

@Jules , regarding the numbness on the left side on my face i don’t think that’s the case , because it started 08.AUG.22 and probably the reason for it it’s that on 25.Jul.22 i had Hair transplant and probably they did some slight damage to the nerve. And my main problem is on the right side. But also what you’re saying is possible.
Also in my first post, on all places where i wrote CT i was meaning MRI.

@Isaiah_40_31 i saw few of your post and my “lump” is on the same spot, excepts that as i remember you said that you can feel it also under your jaw, but i can’t. It’s only at the end of my jaw and under the ear.
I saw posts of other users for the same “lump” and i think that we’re talking about the thing (hopefully).

I hope that this time the links will work!


Hi @Ross

I am no expert at looking at lymph nodes, so maybe someone else can confirm these findings. But in my opinion it look like you have some serious inflammation happening in your lymphatic system. It’s worse on right side, but it is also on your left. You really need to see a specialist about this as soon as possible. Especially since you have been having these symptoms since April and antibiotics are not working.

I really don’t how the heck the MRI radiologist didn’t see what I can see and read the scans as normal.

When looking at the pictures just keep in mind that left and right is reversed. So left is right and right is left.

T2 Stir MRI - Right Sagittal cut shows the large lymph node just under you ear, but it goes all the way down your neck. The Axial cut shows the relative size comparing the left and right side.

CT scan shows your right sinus is totally blocked and filled with fluid. The left side is also partially filled.

CT scan a little further into the sinuses shows you ethmoid and sphenoid sinus is also blocked on the left side.

CT scan of left styloid (right looks very similar). You definitely do have some amount of styloid calcification, but I don’t think this is your problem.

So to me it looks like you have a massive sinus infection. Possibly from the suggested mononucleosis. Hopefully that is what is causing your lymph nodes to swell up like that, but it may not be which is why you need to see a lymphologist. If left untreated and the lymph nodes stay enlarged, it could be a huge health risk.

The size of the one on the right looks very painful. I could theorize that from the size of these lymph nodes you could experience numbness, if they are compressing certain nerves and blood vessels.


Now my panic level is thru the roof, becase my lump is hard-rock and not movable, which Dr. Google said that it’s metastasis…
The MRI radiologist writed in the list that “There was no evidence of abnormally altered signal intensity of lymph nodes bilaterally” (Transleted with google translate)
When you’re staying that my right sinus is full and blocked, do you mean my actual right sinus from my POV, because in the same list ia written that my left one is blocked, but i had problems with my right one, because my tooths were in pain when i put my head down…

Full results from the MRI is (again transleted with google) : A multiparametric study with intravenous contrast.
Submandibular glands - size - 26/ 13 mm bilaterally, without data on areas with abnormal changes in
signal intensity.
Sublingual glands - normal MR image
Left parotid gland - normal dimensions and structure of superficial and deep lobe
Right parotid gland:
A STIR hyperintense area is visualized dorsally subcapsular in the superficial lobe measuring 5.4/
4.3 mm in the axial plane.
On the post-contrast images, the same area is depicted with a slight and homogeneous increase in
signal strength
There are no data on the volume of bilateral occupying formations.
The retromandibular veins have a normal MR image bilaterally
N. facialis - normal MR image
The stylomandibular ligament on the right is thickened against a prominent styloid process.
There was no evidence of abnormally altered signal intensity of lymph nodes bilaterally
High-wall hypertrophy of the mucosa of the maxillary sinuses with evidence of a liquid-air level in
the left maxillary sinus.
The muscles in the covered volume are of normal shape and signal intensity
Bones - no data on pathological changes.
Disc protrusion at the C6-C7 level of the cervical segment and the spine
The cervical myelon has a normal shape and signal intensity.
The finding in the superficial part corresponds to chronic inflammation in the background
thickened stylomandibular ligament.
DD - Benign lymphoepithelial lesion of the right parotid gland.
Acute maxillary sinusitis
Consultation with an ENT specialist and control ultrasound of salivary glands is recommended"

Also 3 ultrasound checks said that they can’t find lymph node bigger than 5mm…

Please remember this is not what I am use to looking at on MRI scans. I see a lot of scans, but never had to look at enlarged lymph nodes before. The big circled area on the mri may be the parotid gland , which is mentioned in your MRI report.

Let me look at it in better detail tomorrow. I’m at home now and don’t have the resources to look at the scans in depth.

In regards to your sinus. Yes, the right side is fully congested, the left side is only partially congested. That explains the pain in your tooth. As the roots go up and almost into the sinus area.

1 Like

Hey Ross,
If you didn’t have hard and tender lymph nodes prior to April, and you’ve been sick, it seems more likely this is related to an uncleared infection.

(I’m not a doctor), but my father, who is quite old, has lymphoma, and when we were going through diagnosis I remember being told, most often, it’s not painful.

If you do have a severe amount of inflammation, it is quite painful. These types of things are so scary, but I would try to not think catastrophically, but rather what is most likely to be the case, considering your age and the situation.

Hope you can rest easy and get answers and treatment quickly.


Thank you @GCD & @Ross for correcting the links.

Ross, @Leah has made a good point - lymphoma isn’t painful, but what you have IS painful thus it’s more likely an unresolved infection than a metastatic cancer problem. I think GCD’s findings may also confirm the infection theory since your sinuses are also potentially reflecting an infection. Seeing an ENT doctor (otolaryngologist) should be your next step. Once you have GCD’s updated information, you should take that along with your scans to your appointment & go over the scans with your doctor & share what you’ve learned from our members.

Though the lymph & sinus problems are most likely the root of your current pain & symptoms, the image GCD posted of your right styloid & partially calcified section stylohyoid ligament demonstrate that you do have something going on there as well, however, at this time it’s more important to take care of the possible infection. If your pain continues or changes after the sinuses & lymph glands heal up, then it will be time to consider looking into ES further.


I spent a lot of time thinking about your case last night and this morning. I also did more research to confirm the images I posted yesterday are correctly identifying your anatomy. I am confident that everything I circled in red on the MRI are swollen lymph nodes. I don’t know much about treatment for swollen lymph nodes except what Dr. Google tells me, so I think @Leah and @Isaiah_40_31 input is better to listen to.

Also, you do have calcified styloids and I probably shouldn’t have said this is not a problem. As @Jules pointed out it could be contributing to the pain you are having. I just think your main focus should be to get the sinus infection taken first. I see CTs like these everyday and your sinuses are about as bad as it gets.

This is another picture to show you the location of the lymph nodes relative to your ear. They do not appear as large here because I had to go anterior into the scan to get the ear lobe and lymph nodes in the same picture. Also for whatever reason, only the the coronal images on your MRI are reversed (I have seen this mistaken happen before), so this may be why the doctor told you the left sinus is blocked.

I don’t think the swollen lymph nodes are cancerous. I just think they are swollen due to whatever is causing the infection in the sinuses. The reason I say this is that I found a very good article on how to identify cancerous lymph nodes and yours look like the benign images. Look further down in the article to Figures 2 and 4.


@Leah, @Isaiah_40_31 and @GCD,
I don’t have the words to thank you for your time and what you’re doing for us.
@GCD, based on your findings i’ve decided to perform another ultrasound which was performed by 3 doctors and it took 45 minutes, and they did’t found them enlarged enough to have some concerns. They said that two of them are slightly bigger but are less than 1cm. Also i’ve visited ENT, and he didn’t find anything disturbing at the moment. Probably the blocked sinuses are fine now. His opinion is that the hard “lump” on my right side is not a lymph node but aome kind of inflamed “Connective tissue”.
In 5 days i have appointment in one of rhe biggest private hospitals here in Bulgaria, because a doctor there is a friend of my friend and He took my concerns very personally and arranged to take me from doctor to doctor (holding my hand :smile:) until everything is clear.
So i’m crossing fingers that evrything will be ok. I will keep you updated!
@GCD i want to thank you again for your effort and your time that you spend on my case. I really appreciate it!


This is all good news to hear. Definitely keep us up to date with their findings. We wish you the best for your upcoming appointment :slight_smile:


Hope your appt goes well, so pleased for you that you have a friend to help you!

1 Like

We’re a team here @Ross & are so happy to be able to help our members. I’m thankful that we each have different areas where we’re each knowledgeable so the pieces fit together to provide more complete information.

Hi guys, my appointment was today and i’m happy to say that tgere is nothinf to worry about. I saw ENT, Hematologist and infectionist. They all agree that those lymph nodes (which are less than 1cm) are probably activated by the sinus infection. The ENT and Hematologist made an exam of the hard thing below my ear and both of them said that this is not a lymph node, but it’s something like a bone or Connective tissue (they have managed to feel it on the left side too (where it is smaller).
Tomorrow i have appointment with one of the best neurosurgeons in my country, to see what we can do for the problem with my C6/C7 disc protrusion.
I’m just wondering if all doctors are saying that they are thinking that this hard “lump” is something like a bone, is it possible to be a styloid process when obviously by the 3D X-ray, mine are not so big :thinking:


Pleased that the lymph nodes aren’t anything to be concerned about! It’s possible to feel the styloid where your lump is, can’t say for sure whether it is the styloid or not…Hope that your appt goes well with the doctor tomorrow!

1 Like

Hope he appointment goes well too! I am very curious to see what they say.

I looked on your CT scan again, which shows hard cartilage and bone well. But I can’t see anything near or around the right ear.