Didactic Module 3

SPECIAL ULTRASOUND
Course 3.5.CERVICAL ADENOPATHIES
Author
Viorela Enachescu
E-EDUMED e-Learning Educational Center in Medicine
Agreement N. LLP/LdV/TOI/RO/2010/006
This project has been funded with support from the European Commission.
This communication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the
information contained therein.

CONTENT
Introduction
Systematization of cervical lymph node groups
Examination technique
Cervical lymph nodes ultrasound appearence
Normal appeareance
Pathological appereance

Reactive lymph nodes

Inflammatory lymph nodes
Malignant lymph nodes
Tuberculisis
Lymphoma
Suppurative lymphadenitis
Sentinel lymph node

Conclusions

Introduction
Ultrasonography has a central position
according to all imaging techniques,
facilitating visualization and evaluation of
superficial lymph node system.
Ultrasonography meets the non invasive
and non irradiation conditions, carries a
low effective cost and promotes both
diagnosis and/or differential diagnosis,
and interventional maneuvers.

Systematization of cervical lymph node

groups
Anatomical and functional clasification
perivisceral lymph node group
(prelarigeal, pretraheal)
submandibular and submental lymph
nodes group
parotid lymph node group
facial lymph node group
retropharyngeal lymph node group

Systematization of cervical lymph node

groups
Topographically
lymph node
groups:
submental
submandibular
parathyroid
upper deep
cervical
lower middle
cervical
supraclavicular
occipital
mastoid

Examination technique

linear transducers

variable frequency (7.5 - 11 MHz)

equipment with color Doppler

investigation possibilities for
highlighting lymph nodes vascular
architecture (possibility of 3D
reconstruction software and digital
subtraction)

Cervical lymph nodes ultrasound

appearence

NORMAL

Normal lymph nodes:

under 5mm in diameter (in their longest

axis)
oval shape, similar to beans
net separation
hilum is hiperecogen
parenchyma echogenity is medium to
hypoechogenic

Cervical lymph nodes ultrasound

appearence
PATHOLOGIC

Pathological lymph nodes

Diameter> 8 mm
Changes in shape, contour, echogenicity,
structure
reactive lymph nodes
inflammatory lymph nodes
neoplasic lymph nodes

Cervical lymph nodes ultrasound

appearence

PATHOLOGIC

Reactive lymph nodes

In inflammatory processes, benign, local or
systemic
Features:
Moderate increase of volume
Oval shaped
Ratio of perpendicular diameters <0.65
Discrete parenchymal hypoechogenity
Discrete exacerbation of internal
circulation

Cervical lymph nodes ultrasound

PATHOLOGIC
appearence
Inflammatory lymph nodes
Occur in acute infections, located near the
affected organ (submaxilitis, mumps,
otitis) Features:
Moderate increase in volume
Oval shaped
Clear delimitation
Hypoechogenic parenchyma
Highly echogenic hilum
Exacerbation of vascularity at hilum level

Cervical lymph nodes ultrasound

appearence

PATHOLOGIC

Malignant lymph nodes

In the ganglionic invasion from lympho or
myeloproliferative syndromes and in lymph
nodal metastases
Features:
Volume increase and tendency in rounding
Change of echogenicity (lymph nodes become
overall hypoechogenic, with thin hilum, or
unapparent)
Echostructure:
homogeneous
non-homogeneous by:
dislocation of peripheral cortex, corresponding
to tumoral infiltration
Presence of necrosis-characteristic for
malignancy

Cervical lymph nodes ultrasound

appearence

PATHOLOGIC

Malignant lymph nodes

Capsular discontinuity- occurs in
dissemination of neoplastic cells outside of
the lymph node
Alteration of internal blood flow
Thin hilum,efilated, with lower
echogenicity compared to normal lymph
nodes by compression of vessels by tumor
cells
Exacerbation of Doppler signal in
peripheric areas

Cervical lymph nodes ultrasound

appearence
PATHOLOGIC
Tuberculosis
Lymph nodes:
Painless , fluctuence, when
necrosis occurs
Bulky
Hypoechogenic parenchyma
Narrow hilum
Reactive appearance

Cervical lymph nodes ultrasound

appearence
PATHOLOGIC

Lymphoma
Lymph nodes:
Conglomerates,
symmetrical, located
bilaterally
Round or oval shaped
Reduced echogenicity
Unapparent hilum

Cervical lymph nodes ultrasound

appearence
PATHOLOGIC
Suppurative
lymphadenitis
Pseudotumoral mass
Polycyclic contour
Hypoechogenic areas due
to necrosis

Cervical lymph nodes ultrasound

appearence

Sentinel lymph
node
Identification is important in
breast cancer and malignant
melanoma.
Administration of contrast
agents increase the rate of
sentinel lymph nodes
detection

PATHOLOGIC

Conclusions
Ultrasound evaluation of cervical lymph nodes
offers additional data to clinical examination.
Ultrasound is a rapid noninvasive technique, of
great performance for the diagnosis of cervical
adenopathies, providing important information for
differentiating reactive from malignant
adenopathies as well as for tumor staging
Ultrasound imaging may become the method of
screening in post treatment evaluation of
neoplasic patients.