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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

A cross-sectional (on the left) and a longitudinal (on the right) ultrasound of the region at the left base of the neck. A longitudinal, hypoechoic focal lesion (marked in grey in the lower images), which can be confused with an abnormal lymph node or other solid lesion (e.g. an enlarged thyroid gland) is visualized laterally to the common carotid artery and below the internal jugular vein. This corresponds to the branch of the internal jugular vein with erythrocyte rouleaux (visible segmentallys). Minor rouleaux can be also seen in the longitudinal view – in the internal jugular vein below the valve (arrow).
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f0003: A cross-sectional (on the left) and a longitudinal (on the right) ultrasound of the region at the left base of the neck. A longitudinal, hypoechoic focal lesion (marked in grey in the lower images), which can be confused with an abnormal lymph node or other solid lesion (e.g. an enlarged thyroid gland) is visualized laterally to the common carotid artery and below the internal jugular vein. This corresponds to the branch of the internal jugular vein with erythrocyte rouleaux (visible segmentallys). Minor rouleaux can be also seen in the longitudinal view – in the internal jugular vein below the valve (arrow).

Mentions: At the base of the neck, compression of the veins located in the region of the upper thoracic outlet can occur. This may lead to erythrocyte rouleau formation in the internal jugular vein or its branches, which results in a hypoechoic image of the inside of the vein, simulating solid tissue in an ultrasound image. The visualized segments of the internal jugular vein branch may, in this case, appear like an longitudinal hypoechoic or hyperechoic focal lesion with no visible internal blood flow, which can be confused with a pathological lymph node or other solid lesion, such as an enlarged parathyroid gland (Fig. 3). Different inhomogeneities or artifacts (e.g. reverberation) can suggest the presence of a hyperechoic hilum and further confirm the mistake. A change in the position of the head or an examination in a sitting position should restore normal, spontaneous blood flow in the vein and explain the mistake.


Mistakes in ultrasound diagnosis of superficial lymph nodes
A cross-sectional (on the left) and a longitudinal (on the right) ultrasound of the region at the left base of the neck. A longitudinal, hypoechoic focal lesion (marked in grey in the lower images), which can be confused with an abnormal lymph node or other solid lesion (e.g. an enlarged thyroid gland) is visualized laterally to the common carotid artery and below the internal jugular vein. This corresponds to the branch of the internal jugular vein with erythrocyte rouleaux (visible segmentallys). Minor rouleaux can be also seen in the longitudinal view – in the internal jugular vein below the valve (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f0003: A cross-sectional (on the left) and a longitudinal (on the right) ultrasound of the region at the left base of the neck. A longitudinal, hypoechoic focal lesion (marked in grey in the lower images), which can be confused with an abnormal lymph node or other solid lesion (e.g. an enlarged thyroid gland) is visualized laterally to the common carotid artery and below the internal jugular vein. This corresponds to the branch of the internal jugular vein with erythrocyte rouleaux (visible segmentallys). Minor rouleaux can be also seen in the longitudinal view – in the internal jugular vein below the valve (arrow).
Mentions: At the base of the neck, compression of the veins located in the region of the upper thoracic outlet can occur. This may lead to erythrocyte rouleau formation in the internal jugular vein or its branches, which results in a hypoechoic image of the inside of the vein, simulating solid tissue in an ultrasound image. The visualized segments of the internal jugular vein branch may, in this case, appear like an longitudinal hypoechoic or hyperechoic focal lesion with no visible internal blood flow, which can be confused with a pathological lymph node or other solid lesion, such as an enlarged parathyroid gland (Fig. 3). Different inhomogeneities or artifacts (e.g. reverberation) can suggest the presence of a hyperechoic hilum and further confirm the mistake. A change in the position of the head or an examination in a sitting position should restore normal, spontaneous blood flow in the vein and explain the mistake.

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