Differential Diagnosis for Unilateral Swollen Tonsilar and Submandibular Lymph Nodes
- The following differential diagnosis is organized into categories to guide the thought process:
Single Most Likely Diagnosis
- Tonsil stones (tonsilloliths) with reactive lymphadenitis:
- This diagnosis is the most likely because tonsil stones can cause a localized inflammatory response, leading to unilateral swollen lymph nodes in the submandibular region, even in the absence of visible tonsil swelling.
Other Likely Diagnoses
- Unilateral tonsil infection (tonsillitis) or abscess:
- Although the question states no tonsil swelling, a small or early infection could potentially cause lymph node swelling without significant tonsil enlargement.
- Dental infection or abscess:
- Dental issues can lead to referred pain and swelling in the lymph nodes of the submandibular region, similar to tonsil stones.
- Viral pharyngitis:
- Viral infections, such as mononucleosis, can cause lymphadenitis and might not always present with significant tonsil swelling.
Do Not Miss Diagnoses
- Lymphoma:
- Although less common, lymphoma can present with unilateral lymph node enlargement and should be considered to avoid a potentially devastating delay in diagnosis.
- Metastatic cancer (e.g., squamous cell carcinoma of the head and neck):
- Cancer can cause lymphadenopathy, and the absence of tonsil swelling does not rule out a malignancy, especially if there's a history of smoking or other risk factors.
- Tuberculosis:
- TB can cause lymphadenitis, and while less common in some regions, it's crucial to consider due to its significant implications for treatment and public health.
Rare Diagnoses
- Catatonia or other psychiatric conditions:
- In rare cases, psychiatric conditions can lead to neglect or unusual behaviors that might result in the formation of tonsil stones or other conditions leading to lymphadenopathy.
- Immunodeficiency:
- Conditions that impair the immune system can lead to unusual or recurrent infections, which might present with lymph node swelling.
- Autoimmune disorders (e.g., systemic lupus erythematosus, rheumatoid arthritis):
- These conditions can cause lymphadenopathy among other symptoms, though they would typically be accompanied by other systemic signs.