Differential Diagnosis for Symmetrical Lymph Nodes under the Jaw Line

Single Most Likely Diagnosis

• Benign Lymph Node Hyperplasia: This condition is characterized by the enlargement of lymph nodes due to an increase in the number of lymphocytes, which can feel rubbery and are often painless and movable. The symmetrical nature and location under the jaw line, especially when they become more noticeable with pressure over the jaw, align with benign lymph node hyperplasia.

Other Likely Diagnoses

• Reactive Lymphadenopathy: This is a common condition where lymph nodes become enlarged in response to infection or inflammation elsewhere in the body. The nodes are typically painless, movable, and can feel rubbery, fitting the description provided.
• Tuberculosis (TB) Lymphadenitis: Although less common in some regions, TB can cause lymphadenopathy that is painless and has a rubbery consistency. The symmetrical nature could suggest a systemic cause like TB, especially if the individual has been exposed or has risk factors.
• Sarcoidosis: This autoimmune disease can cause lymphadenopathy that is often bilateral and symmetrical, painless, and has a rubbery texture. It's a consideration, especially if other systemic symptoms are present.

Do Not Miss Diagnoses

• Lymphoma: Although lymphoma is less likely given the painless and highly movable nature of the nodes, it is crucial not to miss this diagnosis. Some types of lymphoma can present with rubbery, movable lymph nodes, and the consequences of missing this diagnosis can be severe.
• Metastatic Cancer: Certain cancers can metastasize to lymph nodes in the neck, potentially feeling rubbery and being movable. Given the serious implications of cancer, this diagnosis must be considered and ruled out.

Rare Diagnoses

• Kikuchi-Fujimoto Disease: A rare condition that causes lymphadenopathy, typically in the neck, which can be painful but sometimes is not. It's more common in young women and can have a self-limiting course.
• Kimura Disease: A rare, chronic inflammatory disorder that can cause lymphadenopathy and eosinophilia. It's more common in Asian males and can present with subcutaneous nodules in the head and neck region.
• Castleman Disease: A rare disorder that involves an overgrowth of cells in the lymphatic system, which can cause lymphadenopathy. It can be localized or multicentric, with the latter form being more systemic and potentially life-threatening.