Sonographic Evaluation of Cervical Lymph Nodes
Anil T. Ahuja1 and
Michael Ying2
1 Department of Diagnostic Radiology and Organ Imaging, The Chinese University
of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
2 Department of Optometry and Radiography, The Hong Kong Polytechnic University,
Hung Hom, Kowloon, Hong Kong SAR, China.
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Fig. 1. —Schematic diagram of neck shows classification of cervical
lymph nodes in sonography examinations.
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Fig. 2A. —Gray-scale sonograms of lymph nodes in healthy subjects.
Image of 45-year-old man shows normal intraparotid lymph node is hypoechoic
and oval. Lymph node shows echogenic hilus (arrows), which is
continuous with adjacent soft tissues (arrowheads).
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Fig. 2B. —Gray-scale sonograms of lymph nodes in healthy subjects.
Image of 20-year-old man shows normal posterior triangle lymph node is
hypoechoic, elliptic, and elongated (arrows). Arrowheads indicate
echogenic hilus that is continuous with adjacent soft tissues.
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Fig. 3A. —42-year-old man with palpable submandibular lymph nodes.
Color Doppler sonogram shows extensive vascularity originating in hilus and
branching radially toward periphery of lymph node (arrows).
Subsequent fine-needle aspiration cytology confirmed reactive node.
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Fig. 3B. —42-year-old man with palpable submandibular lymph nodes.
Power Doppler sonogram of same lymph node as in A shows hilar
vascularity of reactive lymph node (arrows).
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Fig. 3C. —42-year-old man with palpable submandibular lymph nodes.
Three-dimensional power Doppler sonogram of same lymph node as in A and
B shows hilar vascularity of reactive lymph node (arrows).
More extensive vascularity is shown on 3D power Doppler sonography than power
Doppler sonography.
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Fig. 4A. —53-year-old man with confirmed reactive lymph nodes in neck.
Spectral Doppler sonogram shows low vascular resistance of lymph node with
resistive index (RI) of 0.59 and pulsatility index (PI) of 0.94, which are
lower than cutoff values commonly used to differentiate benign and malignant
nodes (RI, 0.7; PI, 1.5).
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Fig. 4B. —53-year-old man with confirmed reactive lymph nodes in neck.
Longitudinal gray-scale sonogram of same lymph node as in A shows lymph
node is hypoechoic and oval (arrows). Arrowheads indicate echogenic
hilus where blood vessels enter and leave lymph node.
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Fig. 5A. —Gray-scale sonograms of patients with metastatic nodes. Image
of 63-year-old man with lung carcinoma and proven metastatic lymph nodes in
lower cervical and supraclavicular regions shows lower cervical node is
hypoechoic, round, and without echogenic hilus (arrows). Note
intranodal coagulation necrosis that appears as demarcated echogenic focus and
is not continuous with adjacent soft tissues (arrowheads).
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Fig. 5B. —Gray-scale sonograms of patients with metastatic nodes. Image
of 60-year-old woman with carcinoma of breast and proven metastatic nodes in
supraclavicular region and internal jugular chain shows eccentric cortical
hypertrophy of upper cervical lymph node due to focal tumor infiltration
(arrowheads).
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Fig. 5C. —Gray-scale sonograms of patients with metastatic nodes. Image
of 70-year-old man with carcinoma of tongue and with bilateral metastatic
upper cervical lymph nodes shows one of metastatic upper cervical nodes is
hypoechoic, round, and without echogenic hilus (arrows). Lymph node
also shows multiple areas of intranodal cystic necrosis
(arrowheads).
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Fig. 5D. —Gray-scale sonograms of patients with metastatic nodes. Image
of 25-year-old man with nasopharyngeal carcinoma and proven metastatic nodes
in posterior triangle shows metastatic node in posterior triangle with
ill-defined nodal borders (arrows), which indicates extracapsular
spread.
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Fig. 5E. —Gray-scale sonograms of patients with metastatic nodes. Image
of 44-year-old woman with papillary carcinoma of thyroid and associated
metastatic node in right upper cervical region shows metastatic node appears
hyperechoic (arrowheads) when compared with adjacent muscle and has
intranodal punctate calcification (arrow). These sonographic features
are common in metastatic nodes from papillary carcinoma of thyroid.
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Fig. 6. —68-year-old man with proven bilateral non-Hodgkin's
lymphomatous nodes in submandibular region. High-resolution gray-scale
sonogram shows lymphomatous node appears hypoechoic, round, and without
echogenic hilus and shows intranodal reticulation—that is, micronodular
appearance (arrows). (Reprinted with permission from
[8])
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Fig. 7A. —43-year-old woman with nasopharyngeal carcinoma and proven
metastatic nodes in posterior triangle. Color Doppler sonogram shows
metastatic node with peripheral vascularity (arrows) that runs along
periphery of nodes, with perforating branches into lymph nodes.
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Fig. 7B. —43-year-old woman with nasopharyngeal carcinoma and proven
metastatic nodes in posterior triangle. Power Doppler sonogram of same lymph
node as in A shows peripheral vascularity (arrows) similar to
that seen in A.
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Fig. 7C. —43-year-old woman with nasopharyngeal carcinoma and proven
metastatic nodes in posterior triangle. Three-dimensional power Doppler
sonogram of same lymph node as in A and B shows peripheral
vascularity of lymph node (arrows) is better depicted on 3D power
Doppler sonography.
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Fig. 8A. —43-year-old man with proven non-Hodgkin's lymphomatous nodes in
posterior triangle. Color Doppler sonogram shows lymphomatous node with both
hilar (arrows) and peripheral (arrowhead) vascularity.
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Fig. 8B. —43-year-old man with proven non-Hodgkin's lymphomatous nodes in
posterior triangle. Power Doppler sonogram of same lymph node as in A
shows hilar (arrows) and peripheral (arrowheads) vascularity
similar to that seen in A.
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Fig. 9. —41-year-old man with nasopharyngeal carcinoma and metastatic
lymph nodes in posterior triangle. Spectral Doppler sonogram shows high
vascular resistance of lymph node with resistive index (RI) of 0.85 and
pulsatility index (PI) of 2.18, which are higher than cutoff values commonly
used to differentiate benign and malignant nodes (RI, 0.7; PI, 1.5).
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Fig. 10A. —Gray-scale sonograms of two patients with proven tuberculous
lymphadenitis. Image of 59-year-old woman shows two tuberculous nodes
(arrows) matted together without normal intervening soft tissues.
Note cystic necrosis within lymph nodes (arrowheads), which is common
in tuberculous lymphadenitis.
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Fig. 10B. —Gray-scale sonograms of two patients with proven tuberculous
lymphadenitis. Image of 31-year-old woman shows hypoechoic and round
tuberculous node in posterior triangle (arrows) with adjacent
soft-tissue edema (arrowheads), which is common in tuberculous
lymphadenitis.
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Fig. 11A. —20-year-old man with proven tuberculous lymphadenitis. Color
Doppler sonogram shows tuberculous node in posterior triangle with hilar
vascularity (arrows) is being displaced by intranodal cystic necrosis
(arrowheads).
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Fig. 11B. —20-year-old man with proven tuberculous lymphadenitis. Power
Doppler sonogram of same lymph node as in A shows displaced hilar
vascularity (arrows) and intranodal cystic necrosis
(arrowheads).
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Fig. 11C. —20-year-old man with proven tuberculous lymphadenitis.
Three-dimensional power Doppler sonogram of same lymph node as in A and
B shows displaced vascularity (arrows); however, intranodal
cystic necrosis (arrowheads) is not shown because 3D power Doppler
sonography did not provide superimposed gray-scale image.
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Fig. 12A. —30-year-old woman with palpable nodes in upper cervical
region proven to be Kikuchi's disease. (Reprinted with permission from
[12]) Gray-scale sonogram of
upper cervical node (small arrows) shows node is hypoechoic and
elliptic and has echogenic hilus (arrowheads). Large arrows indicate
common carotid artery, and asterisk indicates internal jugular vein. Note
gray-scale sonographic appearance of lymph nodes in Kikuchi's disease is
similar to that of reactive nodes.
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Fig. 13A. —42-year-old man with palpable nodes in submandibular area
that were subsequently proven to be Kimura's disease. Gray-scale sonogram
shows submandibular lymph node (arrows) is hypoechoic, is round, and
has echogenic hilus (arrowheads). Gray-scale sonographic appearance
is similar to that of reactive nodes except that lymph nodes in Kimura's
disease tend to be round and are located in the vicinity of the salivary
glands.
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Fig. 12B. —30-year-old woman with palpable nodes in upper cervical
region proven to be Kikuchi's disease. (Reprinted with permission from
[12]) Power Doppler sonogram
of same lymph node as in A (arrows) reveals that lymph node
involved with Kikuchi's disease shows hilar vascularity (arrowheads)
that is similar to vascular pattern of reactive lymph nodes.
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Fig. 13B. —42-year-old man with palpable nodes in submandibular area
that were subsequently proven to be Kimura's disease. Power Doppler sonogram
of same lymph node as in A (arrows) shows extensive hilar
vascularity (arrowheads), which is similar to vascular pattern of
reactive lymph nodes.
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Fig. 14A. —13-year-old boy with palpable nodes in submental and
submandibular areas that were subsequently proven to be Rosai-Dorfman disease.
Gray-scale sonogram shows two submental nodes that are hypoechoic, round, and
without echogenic hilus (arrows). Sonographic appearance is similar
to that of malignant nodes.
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Fig. 14B. —13-year-old boy with palpable nodes in submental and
submandibular areas that were subsequently proven to be Rosai-Dorfman disease.
Power Doppler sonogram of same submental node as in A shows peripheral
vascularity (arrows), which is similar to malignant lymph nodes.
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Copyright © 2005 by the American Roentgen Ray Society.
