Grey-scale sonography in assessment of cervical lymphadenopathy: review ofsonographic appearances and features that may help a beginner

Ultrasound examinations of the neck in 218 patients with confirmed cervical lymphadenopathy were reviewed. Lymph nodes were assessed for their size, s hape, internal architecture, echogenicity, nodal border, posterior enhancem ent, and ancillary features (adjacent soft tissues oedema, and matting). Th e hilus is a linear, echogenic, non-shadowing structure containing nodal ve ssels, and is continuous with fat around the node. Coagulation necrosis is an ill-defined, rounded, non-shadowing echogenic area within a node. It is less echogenic than the hilus and is not continuous with the fat around the node. Calcification is a highly echogenic focus within the node, which may be dense or punctate echogenic foci. It is not continuous with the fat aro und the node. Dense int anodal calcification usually produces shadowing. Ho wever, fine punctate calcification may not have posterior shadowing though, if the transducer frequency is increased, it may show thin lines. Cystic n ecrosis is focal, often ill-defined echolucent area within the node. Echoge nicity of lymph nodes is usually compared with the adjacent muscles, and is classified as hypoechogenicity, isoechogenicity, and hyperechogenicity. Th e nodal border is assessed for its sharpness. Posterior enhancement is when the structures posterior to the node look more echogenic than neighbouring areas. Oedema of soft tissues is an ill-defined, hypoechoic area around th e node with loss of adjacent fascial planes. Nodes are considered matted wh en they are clumped or adherent to each other with no normal intervening so ft tissue between them. Ultrasound features that help only in identifying a bnormal nodes include size, shape, echogenic hilus, hypoechogenicity or iso echogenicity, echogeneity, coagulation necrosis, and a sharp nodal border. Ultrasound features that help to identify abnormal nodes as well as giving clues to the primary lesion include hyperechogenicity, intranodal calcifica tion, intranodal cystic necrosis, ragged nodal border, posterior enhancemen t, adjacent soft tissue oedema, and matting. (C) 2000 The British Associati on of Oral and Maxillofacial Surgeons.