![]() ![]() In asymptomatic patients and patients with nonspecific symptoms, imaging may be indicated to assist in evaluating a palpable neck mass. Note the adjacent inflammatory stranding and thickening of the platysma muscle ( arrowheads ). This article discusses the rationale for imaging cervical lymph nodes and reviews nodal anatomy and common drainage patters, imaging features of pathologic lymph nodes, and the advantages of various imaging modalities available.Ĭontrast-enhanced CT shows a conglomerate of enlarged, heterogeneously enhancing right level I and II lymph nodes ( arrow ) in an immunosuppressed patient with fungal lymphadenitis. Accurately staging nodal disease in HNSCC has both important prognostic and management implications. Head and neck squamous cell carcinomas (HNSCC) are the most common malignancy of the upper aerodigestive tract, and lymphatic spread is the most important mechanism of metastasis in these patients. This information can have significant management implications in cases of acute infection, but is perhaps most important when applied to staging of head and neck malignancies. Cross-sectional imaging has the ability to quickly assess the extent of cervical lymphadenopathy with greater accuracy than the physical examination and provide information regarding the relationship with adjacent vital structures. ![]() In asymptomatic patients and patients with nonspecific symptoms, imaging may be indicated to assist in evaluating a palpable neck mass.Ĭervical lymphadenopathy is a common clinical finding, which can be related to reactive nodal hypertrophy, granulomatous processes, lymphoma and head and neck cancers or mimicked by nonnodal neck masses. Imaging findings such as stranding of adjacent fat on CT may help distinguish suppurative nodes from metastatic disease however, common imaging findings such as nodal enlargement, enhancement, and hypodensity seen in the setting of lymphadenitis caused by typical or atypical pathogens can also be seen with nodal metastasis. Imaging, particularly computed tomography (CT), is valuable in cases concerning for suppurative lymphadenitis or deep neck infection by identifying abscesses requiring surgical drainage. Imaging these patients is generally unnecessary, unless atypical symptoms or findings concerning for aggressive infection are noted. In many cases of cervical lymphadenopathy, the clinical history, physical examination, and routine laboratory investigations can establish a presumptive diagnosis of reactively enlarged nodes related to viral or bacterial infection. ![]()
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