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Cervical Nodes
Cervical Nodes
NODAL PATHOLOGY
Abnormal Node Size:
Level 1, 2, 3
All other levels
Retropharyngeal
> 1.5 cm
> 1.0 cm
> 0.8 cm
Extracapsular Spread:
Spiculated margins.
Invasion of fatty hilum or surrounding fat.
Encasement of vessels.
CT versus MR:
CT = MR for detecting and sizing nodes.
CT better than MR for demonstrating necrosis.
CT better than MR for detecting extracapsular spread.
Pitfalls:
1. Inflammatory disease leading to pseudo necrosis with TB or abnormal
enlargement with cat scratch, sarcoid. Suppuration can look like necrosis.
2. Post inflammatory fatty infiltration
Lymphoma:
1. Non-Hodgkin's lymphoma most common: Large nodes, enlargement of
Waldeyer's ring, extra lymphatic enlargement of particular glands such as the
thyroid.
2. Hodgkin's lymphoma may be present (25 percent of head & neck lymphoma)
particularly if there is also a mediastinal involvement.
3. Lymphomas can cross fascial planes easily.
4. Can undergo rapid enlargement.
5. Differential diagnosis: squamous cell cancer, viral and granulomatous dz.
Tuberculosis:
1. Painless posterior neck mass.
2. Scrofula: Common in Southeast Asia, (California).
3. Necrotic nodes particularly in level 5.
4. Multi-loculated disturbed fat planes, thick rim enhancement.
5. May calcify following treatment.
Castleman's:
1. Abnormal nodes in chest and head and neck.
2. Usually non-necrotic but brightly enhanced with contrast.
Infectious Mononucleosis:
1. Multiple large non-necrotic nodes.
2. Enlargement of Waldeyer's ring.
3. Appears similar to AIDS, sarcoid, leukemia, lymphoma.
HIV:
1.
2.
3.
4.
The internal jugular chain is a common pathway for drainage from parotid, retropharynx,
and submandibular/submental groups. It drains to the subclavian vein and/or internal
jugular vein and/or into the right lymphatic duct and thoracic duct.
Spinal accessory (posterior triangle) nodal group receives occipital/mastoid, lateral neck,
scalp, nasal pharyngeal sources. Abnormal spinal accessory nodes may indicate the
presence of an early nasal pharyngeal cancer.
Transverse cervical chain receives drainage from deep cervical, supraclavicular,
subclavicular, upper chest, and anterior lateral neck. The drainage is the same as for the
internal jugular chain.
Submental/Submandibular Chain
Submental nodes receive drainage from adjacent skin, lips, floor of the mouth, and drain
to the submandibular nodal group.
Submandibular nodes are extra glandular and receive drainage from anterior face, flow of
the mouth, anterior oral cavity, and submental nodal group. Drainage is to the high
internal jugular chain.