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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

Multiple enlarged lymph nodes (arrows) along the sternocleidomastoid muscle (M): oval, round and longitudinal, hypoechoic, with no clearly visible hilum. The ultrasound image is ambiguous – it could indicate lymphoma, however, metastases cannot be excluded. Final diagnosis: sarcoidosis.
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f0005: Multiple enlarged lymph nodes (arrows) along the sternocleidomastoid muscle (M): oval, round and longitudinal, hypoechoic, with no clearly visible hilum. The ultrasound image is ambiguous – it could indicate lymphoma, however, metastases cannot be excluded. Final diagnosis: sarcoidosis.

Mentions: Lymph nodes in granulomatous diseases, such as tuberculosis or sarcoidosis, can resemble metastatic lymph nodes (i.e. include calcifications, anechoic areas, lack the hilum, show heterogeneous structure) or lymphomas (i.e. present as hypoechoic, have no clear hilum) (Fig. 5)(6). The differential diagnosis of these conditions is particularly problematic, especially in the world regions of their common coexistence. The optimal management is to first perform US-FNAB and, depending on the findings, perform another biopsy or a total resection of the lymph node (following an exclusion of metastatic lesions) and a chest X-ray. Visualization of oval, heterogeneous focal lesions, possibly with anechoic areas and calcifications, within the neck in a patient with a primary neoplastic focus indicates high probability of metastases. In the case of accidental detection of a lesion or lesions with the above characteristics, other primary tumors that can occur in this region as well as non-neoplastic lesions and primary lymph node diseases should be considered in the differential diagnosis. Preferably, US-FNAB should be performed, together with further diagnosis aimed to search for the primary tumor.


Mistakes in ultrasound diagnosis of superficial lymph nodes
Multiple enlarged lymph nodes (arrows) along the sternocleidomastoid muscle (M): oval, round and longitudinal, hypoechoic, with no clearly visible hilum. The ultrasound image is ambiguous – it could indicate lymphoma, however, metastases cannot be excluded. Final diagnosis: sarcoidosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f0005: Multiple enlarged lymph nodes (arrows) along the sternocleidomastoid muscle (M): oval, round and longitudinal, hypoechoic, with no clearly visible hilum. The ultrasound image is ambiguous – it could indicate lymphoma, however, metastases cannot be excluded. Final diagnosis: sarcoidosis.
Mentions: Lymph nodes in granulomatous diseases, such as tuberculosis or sarcoidosis, can resemble metastatic lymph nodes (i.e. include calcifications, anechoic areas, lack the hilum, show heterogeneous structure) or lymphomas (i.e. present as hypoechoic, have no clear hilum) (Fig. 5)(6). The differential diagnosis of these conditions is particularly problematic, especially in the world regions of their common coexistence. The optimal management is to first perform US-FNAB and, depending on the findings, perform another biopsy or a total resection of the lymph node (following an exclusion of metastatic lesions) and a chest X-ray. Visualization of oval, heterogeneous focal lesions, possibly with anechoic areas and calcifications, within the neck in a patient with a primary neoplastic focus indicates high probability of metastases. In the case of accidental detection of a lesion or lesions with the above characteristics, other primary tumors that can occur in this region as well as non-neoplastic lesions and primary lymph node diseases should be considered in the differential diagnosis. Preferably, US-FNAB should be performed, together with further diagnosis aimed to search for the primary tumor.

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