Cervical Lymphadenopathy

This patient with CLL appears to have been the victim of an explosion in a jelly bean factory.
Lymph node enlargement is often used synonymously with lymphadenopathy, which is not strictly correct. Lymphadenopathy is, if anything, a broader term, referring to any pathology of lymph nodes, not necessarily resulting in increased size. The term includes abnormal number of nodes, or derangement of internal architecture (e.g. cystic necrotic nodes). In addition, increase in size is not always pathologic; some nodes are bigger than others normally (e.g compare jugulodigastric nodes, to mesenteric nodes), and reactive nodes are a healthy response and do not imply pathology of the node itself.
Size criteria for lymphadenopathy:
- most nodes ≥ 10mm in short-axis except…
- submental - submandibular ≥ 15mm
- retropharyngeal ≥ 8 mm
if using size criteria alone then 10 - 20% error rate.
The long to short axis ratio has also been proposed (ref 1) to help evaluate enlarged nodes in the setting of head and neck SCC. When nodes have a ratio of >2 (ie long and flat) 95% are benign. When the ratio is less than 2 (ie rounder) then a similar proportion are malignant.
Size-independent criteria:
- loss of fatty hilum
- focal necrosis
- cystic necrotic nodes
References
1. Steinkamp HJ. “Cervical lymphadenopathy: ratio of long- to short-axis diameter as a predictor of malignancy” BJR Vol 68, Issue 807 266-270
2. Harnsberger Handbook of H&N Imaging
3. Harnsberger - Diagnostic imaging series - Head and Neck - textbook
Credit: Dr Frank Gaillard
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