Sonographic diagnostics of cervical lymph node pathology

Titas Petruša1, Inga Ruželytė1, Domantas Kunigiškis1

1Lithuanian University of Health Sciences, Faculty of Medicine


Pathologies of cervical lymph nodes are met during physicians’ work every day. Physical examination and laboratory tests are very informative, however, they do not give definitive data for the diagnosis. When considering instrumental tests, ultrasonography is one of the best availability. However, this procedure requires a deep knowledge of anatomy, physiology, and other various disciplines. Clinically relevant lymph nodes, topographically align in three sections of the neck, which are determined in relation to hyoid bone, cricoid cartilage and jugular vein. Also, a few relevant groups of lymph nodes are near the center, body, and branch of the mandible. Since cervical lymph nodes are mostly superficial, their parameters can be measured quite easily. In order to diagnose cervical lymphadenopathy correctly, other tests, like lymph node biopsy and histological evaluation, other radiological methods are needed. When discussing neck lymph nodes pathology, concretization, whether it is an alteration related to the malignant process, or not, is very important. Most sonographic examinations of neck lymph nodes are done, when there is suspicion about metastases from thyroid, head, mouth, connective tissue or other location cancer. Lymphadenopathy of an infectious origin is diagnosed when combining data from sonography and clinical manifestation of the disease. That is the reason why neck lymph node pathology is often related to oncological processes. When examining lymph nodes, these parameters should be measured: short-to-long axis ratio is mainly the first parameter measured. Metastatic lymph nodes tend to be more round, whereas lymph nodes, reactive due to infection, might be enlarged while keeping their oval form. This is the first discrepancy, with which an experienced physician can foresee what other aberrations might be. The border of the lymph node is evaluated as being sharp or non-sharp. This parameter is very important when differentiating between malignant and benign processes. The echogenicity of the hilum is the defining factor between metastatic and normal lymph nodes. A healthy lymph node has central vascularity. Metastatic lymph node more commonly than not has peripheral vascular architecture. This is evaluated while performing a doppler sonography. It is very important to determine whether or not the lymph node is pathological and if it is pathological, is it malignant or benign.

Keywords: Ultrasound, lymphadenopathy, neck lymph nodes, metastatic lymph node, reactive lymph node.