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Mistakes in ultrasound diagnosis of superficial lymph nodes

View Article: PubMed Central - PubMed

ABSTRACT

The article discusses basic mistakes that can occur during ultrasound imaging of superficial lymph nodes. Ultrasound is the first imaging method used in the diseases of superficial organs and tissues, including lymph nodes. The causes of mistakes can be either dependent or independent of the performing physician. The first group of mistakes includes inappropriate interpretation of images of anatomical structures, while the latter group includes, among other things, similar ultrasound images of different pathologies. For instance, a lymph node, whether normal or abnormal, may be mimicked by anatomical structures, such as a partially visible, compressed vein. Lymph nodes in lymphomas may be indistinguishable from reactive lymph nodes, even when using Doppler option, as well as morphologically difficult to distinguish from metastases. Metastatic lymph nodes can mimic e.g. nodular, separated postoperative thyroid fragments, a lateral neck cyst, chemodectoma (carotid body tumor) or neuroma. The appearance of lymph nodes in granulomatous diseases, such as tuberculosis or sarcoidosis, can be very similar to that of typical metastatic lymph nodes or lymphomas. Anechoic or hypoechoic areas in a lymph node can represent necrosis or metastatic hemorrhages, but also suppuration in inflamed lymph nodes. Lymph nodes in lymphomas, metastatic and reactive lymph nodes can adopt the classical characteristics of a simple cyst. The overall ultrasound picture along with all criteria for the assessment of a lymph node should be taken into account during ultrasound imaging. It seems that the safest management is to refer patients diagnosed with lymph node abnormalities for ultrasound-guided targeted fine needle aspiration biopsy followed by a total lymph node resection for histopathological examination in the case of suspected lymphoma.

No MeSH data available.


Related in: MedlinePlus

An axillary lymph node. The thin parenchymal layer is hypoechoic (arrows) and is followed by another, internal hyperechoic layer, which represents translocated connective tissue of the hilum along with blood and lymphatic vessels (arrowheads). An extensive hypoechoic area representing homogeneous fat cells with a relatively small number of vessels (arrow) is visualized centrally. The image should not be confused with a focal thickening of the parenchymal layer, which can occur in metastases and requires US guided FNAB.
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f0001: An axillary lymph node. The thin parenchymal layer is hypoechoic (arrows) and is followed by another, internal hyperechoic layer, which represents translocated connective tissue of the hilum along with blood and lymphatic vessels (arrowheads). An extensive hypoechoic area representing homogeneous fat cells with a relatively small number of vessels (arrow) is visualized centrally. The image should not be confused with a focal thickening of the parenchymal layer, which can occur in metastases and requires US guided FNAB.

Mentions: The knowledge on the details of histological and ultrasonographic correlation of normal lymph node structure increases diagnostic accuracy and the value of ultrasound. For example, axillary lymph nodes may present a specific picture due to hilar steatosis (Fig. 1). Apart from the hypoechoic crescent-shaped parenchymal layer followed by an internal hyperechoic layer representing translocated connective tissue of the hilum along with blood and lymphatic vessels, a central hypoechoic (usually large) region, which represents homogeneous fat cells with a relatively small number of vessels, can be often seen(2). This area should not be confused with a focal thickening of the parenchymal layer, which belongs to images suggestive of a metastatic focus and should be verified based on ultrasound guided fine needle aspiration biopsy (US-FNAB).


Mistakes in ultrasound diagnosis of superficial lymph nodes
An axillary lymph node. The thin parenchymal layer is hypoechoic (arrows) and is followed by another, internal hyperechoic layer, which represents translocated connective tissue of the hilum along with blood and lymphatic vessels (arrowheads). An extensive hypoechoic area representing homogeneous fat cells with a relatively small number of vessels (arrow) is visualized centrally. The image should not be confused with a focal thickening of the parenchymal layer, which can occur in metastases and requires US guided FNAB.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5392555&req=5

f0001: An axillary lymph node. The thin parenchymal layer is hypoechoic (arrows) and is followed by another, internal hyperechoic layer, which represents translocated connective tissue of the hilum along with blood and lymphatic vessels (arrowheads). An extensive hypoechoic area representing homogeneous fat cells with a relatively small number of vessels (arrow) is visualized centrally. The image should not be confused with a focal thickening of the parenchymal layer, which can occur in metastases and requires US guided FNAB.
Mentions: The knowledge on the details of histological and ultrasonographic correlation of normal lymph node structure increases diagnostic accuracy and the value of ultrasound. For example, axillary lymph nodes may present a specific picture due to hilar steatosis (Fig. 1). Apart from the hypoechoic crescent-shaped parenchymal layer followed by an internal hyperechoic layer representing translocated connective tissue of the hilum along with blood and lymphatic vessels, a central hypoechoic (usually large) region, which represents homogeneous fat cells with a relatively small number of vessels, can be often seen(2). This area should not be confused with a focal thickening of the parenchymal layer, which belongs to images suggestive of a metastatic focus and should be verified based on ultrasound guided fine needle aspiration biopsy (US-FNAB).

View Article: PubMed Central - PubMed

ABSTRACT

The article discusses basic mistakes that can occur during ultrasound imaging of superficial lymph nodes. Ultrasound is the first imaging method used in the diseases of superficial organs and tissues, including lymph nodes. The causes of mistakes can be either dependent or independent of the performing physician. The first group of mistakes includes inappropriate interpretation of images of anatomical structures, while the latter group includes, among other things, similar ultrasound images of different pathologies. For instance, a lymph node, whether normal or abnormal, may be mimicked by anatomical structures, such as a partially visible, compressed vein. Lymph nodes in lymphomas may be indistinguishable from reactive lymph nodes, even when using Doppler option, as well as morphologically difficult to distinguish from metastases. Metastatic lymph nodes can mimic e.g. nodular, separated postoperative thyroid fragments, a lateral neck cyst, chemodectoma (carotid body tumor) or neuroma. The appearance of lymph nodes in granulomatous diseases, such as tuberculosis or sarcoidosis, can be very similar to that of typical metastatic lymph nodes or lymphomas. Anechoic or hypoechoic areas in a lymph node can represent necrosis or metastatic hemorrhages, but also suppuration in inflamed lymph nodes. Lymph nodes in lymphomas, metastatic and reactive lymph nodes can adopt the classical characteristics of a simple cyst. The overall ultrasound picture along with all criteria for the assessment of a lymph node should be taken into account during ultrasound imaging. It seems that the safest management is to refer patients diagnosed with lymph node abnormalities for ultrasound-guided targeted fine needle aspiration biopsy followed by a total lymph node resection for histopathological examination in the case of suspected lymphoma.

No MeSH data available.


Related in: MedlinePlus