Skip to main content

Abstract

Sonographic examination of neck nodes is an essential part of a routine complete ultrasound examination of head and neck lesions. It is therefore necessary for all sonologists to be familiar with the location and sonographic appearance of normal and abnormal lymph nodes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Castenholz A. Architecture of the lymph node with regard to its function. In: Grundmann E, Vollmer E, editors. Reaction patterns of the lymph node. Part 1. Cell types and functions. New York: Springer; 1990. p. 3–9.

    Google Scholar 

  2. Hall FG. The functional anatomy of lymph nodes. In: Stansfeld AG, d’Ardenne AJ, editors. Lymph node biopsy interpretation. 2nd ed. London: Churchill Livingstone; 1992. p. 10–3.

    Google Scholar 

  3. Papadimitriou CS, Kittas CN. Normal structure and function of lymph nodes. In: Pangalis GA, Polliack A, editors. Benign and malignant lymphadenopathies. Chur: Harwood Academic; 1993. p. 113–26.

    Google Scholar 

  4. Ying M, Ahuja A, Brook F, Brown B, Metreweli C. Sonographic appearance and distribution of normal cervical lymph nodes in a Chinese population. J Ultrasound Med. 1996;15:431–6.

    PubMed  CAS  Google Scholar 

  5. Ying M, Ahuja A, Brook F, Metreweli C. Power Doppler sonography of normal cervical lymph nodes. J Ultrasound Med. 2000;19:511–7.

    PubMed  CAS  Google Scholar 

  6. Ying M, Ahuja A, Brook F. Gray scale and power Doppler sonography of normal cervical lymph nodes: comparison between Chinese and white subjects. J Ultrasound Med. 2002;21:59–65.

    PubMed  Google Scholar 

  7. Ahuja A, Ying M, King W, Metreweli C. A practical approach to ultrasound of cervical lymph nodes. J Laryngol Otol. 1997;111:245–56.

    Article  PubMed  CAS  Google Scholar 

  8. Som PM. Lymph nodes of the neck. Radiology. 1987;165:593–600.

    PubMed  CAS  Google Scholar 

  9. Ahuja A, Ying M. Sonography of neck lymph nodes. Part II: abnormal lymph nodes. Clin Radiol. 2003;58:359–66.

    Article  PubMed  CAS  Google Scholar 

  10. van den Brekel MW, Stel HV, Castelijns JA, Nauta JJ, van der Waal I, Valk J, et al. Cervical lymph node metastasis: assessment of radiologic criteria. Radiology. 1990;177:379–84.

    PubMed  Google Scholar 

  11. Som PM. Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. Am J Roentgenol. 1992;158:961–9.

    CAS  Google Scholar 

  12. Bruneton JN, Balu-Maestro C, Marcy PY, Melia P, Mourou MY. Very high frequency (13 MHz) ultrasonographic examination of the normal neck: detection of normal lymph nodes and thyroid nodules. J Ultrasound Med. 1994;13:87–90.

    PubMed  CAS  Google Scholar 

  13. Swartz JD, Yussen PS, Popky GL. Imaging of the neck: nodal disease. Crit Rev Diagn Imaging. 1991;31:413–69.

    PubMed  CAS  Google Scholar 

  14. van den Brekel MW, Castelijns JA, Stel HV, Golding RP, Meyer CJ, Snow GB. Modern imaging techniques and ultrasound-guided aspiration cytology for the assessment of neck node metastases: a prospective comparative study. Eur Arch Otorhinolaryngol. 1993;250:11–7.

    Article  PubMed  Google Scholar 

  15. van den Brekel MW, Stel HV, Castelijns JA, Croll GJ, Snow GB. Lymph node staging in patients with clinically negative neck examinations by ultrasound and ultrasound-guided aspiration cytology. Am J Surg. 1991;162:362–6.

    Article  PubMed  Google Scholar 

  16. Ahuja A, Ying M, Leung SF, Metreweli C. The sonographic appearance and significance of cervical metastatic nodes following radiotherapy for nasopharyngeal carcinoma. Clin Radiol. 1996;51:698–701.

    Article  PubMed  CAS  Google Scholar 

  17. Ahuja A, Leung SF, Ying M, Metreweli C. Echography of metastatic nodes treated by radiotherapy. J Laryngol Otol. 1999;113:993–8.

    Article  PubMed  CAS  Google Scholar 

  18. Chan JM, Shin LK, Jeffrey RB. Ultrasonography of abnormal neck lymph nodes. Ultrasound Q. 2007;23:47–54.

    Article  PubMed  Google Scholar 

  19. Vassallo P, Edel G, Roos N, Naguib A, Peters PE. In-vitro high-resolution ultrasonography of benign and malignant lymph nodes. A sonographic-pathologic correlation. Invest Radiol. 1993;28:698–705.

    Article  PubMed  CAS  Google Scholar 

  20. Ying M, Ahuja AT, Evans R, King W, Metreweli C. Cervical lymphadenopathy: sonographic differentiation between tuberculous nodes and nodal metastases from non-head and neck carcinomas. J Clin Ultrasound. 1998;26:383–9.

    Article  PubMed  CAS  Google Scholar 

  21. Solbiati L, Rizzatto G, Bellotti E, Montali G, Cioffi V, Croce F. High-resolution sonography of cervical lymph nodes in head and neck cancer: criteria for differentiation of reactive versus malignant nodes. Radiology. 1988;169:113.

    Google Scholar 

  22. Tohnosu N, Onoda S, Isono K. Ultrasonographic evaluation of cervical lymph node metastases in esophageal cancer with special reference to the relationship between the short to long axis ratio (S/L) and the cancer content. J Clin Ultrasound. 1989;17:101–6.

    Article  PubMed  CAS  Google Scholar 

  23. Vassallo P, Wernecke K, Roos N, Peters PE. Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US. Radiology. 1992;183:215–20.

    PubMed  CAS  Google Scholar 

  24. Rubaltelli L, Proto E, Salmaso R, Bortoletto P, Candiani F, Cagol P. Sonography of abnormal lymph nodes in vitro: correlation of sonographic and histologic findings. Am J Roentgenol. 1990;155:1241–4.

    CAS  Google Scholar 

  25. Evans RM, Ahuja A, Metreweli C. The linear echogenic hilus in cervical lymphadenopathy–a sign of benignity or malignancy? Clin Radiol. 1993;47:262–4.

    Article  PubMed  CAS  Google Scholar 

  26. Sakai F, Kiyono K, Sone S, Kondo Y, Oguchi M, Watanabe T, et al. Ultrasonic evaluation of cervical metastatic lymphadenopathy. J Ultrasound Med. 1988;7:305–10.

    PubMed  CAS  Google Scholar 

  27. Ying M, Ahuja A, Brook F, Metreweli C. Vascularity and grey-scale sonographic features of normal cervical lymph nodes: variations with nodal size. Clin Radiol. 2001;56:416–9.

    Article  PubMed  CAS  Google Scholar 

  28. Solbiati L, Cioffi V, Ballarati E. Ultrasonography of the neck. Radiol Clin North Am. 1992;30:941–54.

    PubMed  CAS  Google Scholar 

  29. Ahuja AT, Chow L, Chick W, King W, Metreweli C. Metastatic cervical nodes in papillary carcinoma of the thyroid: ultrasound and histological correlation. Clin Radiol. 1995;50:229–31.

    Article  PubMed  CAS  Google Scholar 

  30. Rosario PW, de Faria S, Bicalho L, Alves MF, Borges MA, Purisch S, et al. Ultrasonographic differentiation between metastatic and benign lymph nodes in patients with papillary thyroid carcinoma. J Ultrasound Med. 2005;24:1385–9.

    PubMed  Google Scholar 

  31. Ahuja A, Ying M, Yang WT, Evans R, King W, Metreweli C. The use of sonography in differentiating cervical lymphomatous lymph nodes from cervical metastatic lymph nodes. Clin Radiol. 1996;51:186–90.

    Article  PubMed  CAS  Google Scholar 

  32. Ishii J, Fujii E, Suzuki H, Shinozuka K, Kawase N, Amagasa T. Ultrasonic diagnosis of oral and neck malignant lymphoma. Bull Tokyo Med Dent Univ. 1992;39:63–9.

    PubMed  CAS  Google Scholar 

  33. Ahuja AT, Ying M, Yuen HY, Metreweli C. ‘Pseudocystic’ appearance of non-Hodgkin’s lymphomatous nodes: an infrequent finding with high-resolution transducers. Clin Radiol. 2001;56:111–5.

    Article  PubMed  CAS  Google Scholar 

  34. Landry CS, Grubbs EG, Busaidy NL, Staerkel GA, Perrier ND, Edeiken-Monroe BS. Cystic lymph nodes in the lateral neck are an indicator of metastatic papillary thyroid cancer. Endocr Pract. 2010;16:1–16.

    Article  Google Scholar 

  35. King AD, Tse GM, Ahuja AT, Yuen EH, Vlantis AC, To EW, et al. Necrosis in metastatic neck nodes: diagnostic accuracy of CT, MR imaging, and US. Radiology. 2004;230:720–6.

    Article  PubMed  Google Scholar 

  36. Gor DM, Langer JE, Loevner LA. Imaging of cervical lymph nodes in head and neck cancer: the basics. Radiol Clin North Am. 2006;44:101–10.

    Article  PubMed  Google Scholar 

  37. Ahuja A, Ying M, Evans R, King W, Metreweli C. The application of ultrasound criteria for malignancy in differentiating tuberculous cervical adenitis from metastatic nasopharyngeal carcinoma. Clin Radiol. 1995;50:391–5.

    Article  PubMed  CAS  Google Scholar 

  38. Som PM, Brandwein M, Lidov M, Lawson W, Biller HF. The varied presentations of papillary thyroid carcinoma cervical nodal disease: CT and MR findings. Am J Neuroradiol. 1994;15:1123–8.

    PubMed  CAS  Google Scholar 

  39. Leboulleux S, Girard E, Rose M, Travagli JP, Sabbah N, Caillou B, et al. Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid cancer. J Clin Endocrinol Metab. 2007;92:3590–4.

    Article  PubMed  CAS  Google Scholar 

  40. Johnson JT. A surgeon looks at cervical lymph nodes. Radiology. 1990;175:607–10.

    PubMed  CAS  Google Scholar 

  41. Greenberg JS, Fowler R, Gomez J, Mo V, Roberts D, El Naggar AK, et al. Extent of extracapsular spread: a critical prognosticator in oral tongue cancer. Cancer. 2003;97:1464–70.

    Article  PubMed  Google Scholar 

  42. Ahuja AT, Ying M, Ho SS, Metreweli C. Distribution of intranodal vessels in differentiating benign from metastatic neck nodes. Clin Radiol. 2001;56:197–201.

    Article  PubMed  CAS  Google Scholar 

  43. Ahuja A, Ying M. Sonographic evaluation of cervical lymphadenopathy: is power Doppler sonography routinely indicated? Ultrasound Med Biol. 2003;29:353–9.

    Article  PubMed  Google Scholar 

  44. Na DG, Lim HK, Byun HS, Kim HD, Ko YH, Baek JH. Differential diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography. Am J Roentgenol. 1997;168:1311–6.

    CAS  Google Scholar 

  45. Wu CH, Chang YL, Hsu WC, Ko JY, Sheen TS, Hsieh FJ. Usefulness of Doppler spectral analysis and power Doppler sonography in the differentiation of cervical lymphadenopathies. Am J Roentgenol. 1998;171:503–9.

    CAS  Google Scholar 

  46. Dangore-Khasbage S, Degwekar SS, Bhowate RR, Banode PJ, Bhake A, Choudhary MS, et al. Utility of color Doppler ultrasound in evaluating the status of cervical lymph nodes in oral cancer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108:255–63.

    Article  PubMed  Google Scholar 

  47. Steinkamp HJ, Maurer J, Cornehl M, Knobber D, Hettwer H, Felix R. Recurrent cervical lymphadenopathy: differential diagnosis with color- duplex sonography. Eur Arch Otorhinolaryngol. 1994;251:404–9.

    Article  PubMed  CAS  Google Scholar 

  48. Furukawa MK, Furukawa M. Diagnosis of lymph node metastases of head and neck cancer and evaluation of effects of chemoradiotherapy using ultrasonography. Int J Clin Oncol. 2010;15:23–32.

    Article  PubMed  Google Scholar 

  49. Ho SS, Ahuja AT, Yeo W, Chan TC, Kew J, Metreweli C. Longitudinal colour doppler study of superficial lymph nodes in non- Hodgkin’s lymphoma patients on chemotherapy. Clin Radiol. 2000;55:110–3.

    Article  PubMed  CAS  Google Scholar 

  50. Moritz JD, Ludwig A, Oestmann JW. Contrast-enhanced color Doppler sonography for evaluation of enlarged cervical lymph nodes in head and neck tumors. Am J Roentgenol. 2000;174:1279–84.

    CAS  Google Scholar 

  51. Rubaltelli L, Khadivi Y, Tregnaghi A, Stramare R, Ferro F, Borsato S, et al. Evaluation of lymph node perfusion using continuous mode harmonic ultrasonography with a second-generation contrast agent. J Ultrasound Med. 2004;23:829–36.

    PubMed  Google Scholar 

  52. Rickert D, Jecker P, Metzler V, Lehmann T, Ernst E, Westhofen M. Color-coded duplex sonography of the cervical lymph nodes: improved differential diagnostic assessment after administration of the signal enhancer SH U 508A (Levovist). Eur Arch Otorhinolaryngol. 2000;257:453–8.

    Article  PubMed  CAS  Google Scholar 

  53. Zenk J, Bozzato A, Steinhart H, Greess H, Iro H. Metastatic and inflammatory cervical lymph nodes as analyzed by contrast-enhanced color-coded Doppler ultrasonography: quantitative dynamic perfusion patterns and histopathologic correlation. Ann Otol Rhinol Laryngol. 2005;114:43–7.

    PubMed  Google Scholar 

  54. Zenk J, Bozzato A, Hornung J, Gottwald F, Rabe C, Gill S, et al. Neck lymph nodes: prediction by computer-assisted contrast medium analysis? Ultrasound Med Biol. 2007;33:246–53.

    Article  PubMed  Google Scholar 

  55. Evans RM, Ahuja A, Rhys Williams S, Waldron C, Van Hasselt CA, King W, et al. Ultrasound and ultrasound guided fine needle aspiration in cervical lymphadenopathy. Br J Radiol. 1991;64:58.

    Google Scholar 

  56. Baatenburg de Jong RJ, Rongen RJ, Verwoerd CD, van Overhagen H, Lameris JS, Knegt P. Ultrasound-guided fine-needle aspiration biopsy of neck nodes. Arch Otolaryngol Head Neck Surg. 1991;117:402–4.

    Article  PubMed  CAS  Google Scholar 

  57. Knappe M, Louw M, Gregor RT. Ultrasonography-guided fine-needle aspiration for the assessment of cervical metastases. Arch Otolaryngol Head Neck Surg. 2000;126:1091–6.

    PubMed  CAS  Google Scholar 

  58. Zanella AB, Meyer EL, Balzan L, Silva AC, Camargo J, Migliavacca A, et al. Thyroglobulin measurements in washout of fine needle aspirates in cervical lymph nodes for detection of papillary thyroid cancer metastases. Arq Bras Endocrinol Metabol. 2010;54:550–4.

    Article  PubMed  Google Scholar 

  59. Hodder SC, Evans RM, Patton DW, Silvester KC. Ultrasound and fine needle aspiration cytology in the staging of neck lymph nodes in oral squamous cell carcinoma. Br J Oral Maxillofac Surg. 2000;38:430–6.

    Article  PubMed  CAS  Google Scholar 

  60. Lo CP, Chen CY, Chin SC, Lee KW, Hsueh CJ, Juan CJ, et al. Detection of suspicious malignant cervical lymph nodes of unknown origin: diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy with nodal size and central necrosis correlate. Can Assoc Radiol J. 2007;58:286–91.

    PubMed  Google Scholar 

  61. Robinson IA, Cozens NJ. Does a joint ultrasound guided cytology clinic optimize the cytological evaluation of head and neck masses? Clin Radiol. 1999;54:312–6.

    Article  PubMed  CAS  Google Scholar 

  62. van den Brekel MW, Reitsma LC, Quak JJ, Smeele LE, van der Linden JC, Snow GB, et al. Sonographically guided aspiration cytology of neck nodes for selection of treatment and follow-up in patients with N0 head and neck cancer. Am J Neuroradiol. 1999;20:1727–31.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael T. C. Ying .

Editor information

Editors and Affiliations

Electronic Supplementary material

66-Hyperplastic lymph node with well-developed hilum (4,389 KB)

67-Hyperplastic lymph nodes demostrating hilar line (45,593 KB)

68-Axial vascular pattern with Power Doppler, reactive lymph (7,648 KB)

69-Reactive lymphadenopathy demonstrating elliptical shape a (6,035 KB)

70-Reactive lymph node with echogenic hilum (15,726 KB)

71-Axial vasculature in multiple hyperplastic lymph nodes de (19,188 KB)

72-Hyperplastic lymph node with arborized vascular pattern w (1,108 KB)

73-Post-treatment tuberculous lymphadenopathy demonstrating (6,026 KB)

74-Tuberculosis, cervical adenopathy with Power Doppler (7,829 KB)

75-Metastatic hypoechoic lymph nodes (15,698 KB)

76-Metastatic lymphadenopathy demonstrating irregular border (5,651 KB)

77-Metastatic malignant lymphadenopathy demonstrating periph (15,598 KB)

78-Metastatic squamous cell carcinoma to zone IIa cervical l (81,884 KB)

79-Metastatic squamous cell carcinoma demonstrating round co (5,301 KB)

80-Metastatic lymphadenopathy, squamous cell carcinoma demon (4,301 KB)

81-Metastatic lymphadenopathy papillary carcinoma (15,926 KB)

82-Metastatic lymphadenopathy papillary carcinoma demonstrat (7,693 KB)

83-Metastatic medullary thyroid carcinoma to lower cervical (57,443 KB)

84-Metastatic medullary thyroid carcinoma to lower cervical (56,974 KB)

85-Internal jugular vein thrombosis scondary to enlarged, co (6,017 KB)

86-Reticulated lymph nodes, non-Hodgkin's lymphoma (6,089 KB)

87-Mixed vascularity with Power Doppler, non-Hodgkin's lymph (4,901 KB)

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Ying, M.T.C., Cho, C.C.M., Ahuja, A.T. (2012). Lymph Nodes. In: Sofferman, R., Ahuja, A. (eds) Ultrasound of the Thyroid and Parathyroid Glands. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-0974-8_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-0974-8_10

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-0973-1

  • Online ISBN: 978-1-4614-0974-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics