Author Viorela Enachescu

Course 3.5.CERVICAL ADENOPATHIES

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.

Didactic Module 3 SPECIAL ULTRASOUND

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

Topographically lymph node groups:

submental submandibular

parathyroid upper deep

cervical lower middle

cervical supraclavicular occipital mastoid

Systematization of cervical lymph node

groups

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 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

NORMAL

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

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

Cervical lymph nodes ultrasound appearence

Tuberculosis Lymph nodes: Painless , fluctuence, when

necrosis occurs Bulky Hypoechogenic parenchyma Narrow hilum Reactive appearance

PATHOLOGIC

Cervical lymph nodes ultrasound appearence

Lymphoma Lymph nodes: Conglomerates,

symmetrical, located bilaterally

Round or oval shaped Reduced echogenicity

Unapparent hilum

PATHOLOGIC

Cervical lymph nodes ultrasound appearence

Suppurative lymphadenitis

Pseudotumoral mass Polycyclic contour

Hypoechogenic areas due to necrosis

PATHOLOGIC

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.

Course 3.5.CERVICAL ADENOPATHIESCONTENTIntroduction Systematization of cervical lymph node groups Systematization of cervical lymph node groups Examination techniqueCervical lymph nodes ultrasound appearenceSlide Number 8Slide Number 9Slide Number 10Slide Number 11Slide Number 12Slide Number 13Slide Number 14Slide Number 15Cervical lymph nodes ultrasound appearenceCervical lymph nodes ultrasound appearenceSlide Number 18Cervical lymph nodes ultrasound appearenceCervical lymph nodes ultrasound appearenceConclusions