JE Table 17 Differential diagnosis of enlarged lymph nodes


Diagnosis Sonographic signs

Inflamed lymph nodes (p. 110) Variable size, L/W ratio j 2, prominent echogenic hilum

Lymph node metastases (p. 112) Variable size, L/W ratio < 2, absent hilar sign, aberrant vessels

Malignant lymphoma (p. 113) Variable size, L/W ratio often < 2, absent hilar sign, variable pattern of involvement, variable echogenicity, increased vascularity on CDS

|8© (T) Porta hepatis Visceral

© Splenic hilum lymph nodes

(T) Celiacgroup

(4) Superior and inferior mesenteric group © Para-aortic group 0 Parietal ©Iliac group lymph nodes

Fig. 143 Localization: abdominal lymph node groups

Healthy Lymph Nodes
Fig. 144 Sonographic morphology of peripheral lymph nodes (after Vasallo et al.

Fig. 145a, b Echogenicity. a Enlarged lymph node with an echogenic hilum and hypoechoic cortical parenchyma. b The hilar vessels course within the echogenic hilum

Sonographic Features Lymphnodes

o n Causes: Table 18 reviews the most frequent causes of enlarged lymph nodes. Ultrasound examination contributes significantly to benign-malignant differentiation.

Table 18 ■ Most frequent

Inflamed lymph nodes







Mesenteric lymphadenitis Ileitis

Appendicitis Diverticulitis Hepatitis Cholecystitis, etc.

causes of enlarged lymph nodes Metastatic lymph nodes Malignant lymphoma

Ifl C


ENT carcinoma Bronchial carcinoma Thyroid carcinoma Breast carcinoma Esophageal carcinoma Gastric carcinoma Gallbladder carcinoma Colon carcinoma Malignant melanoma Sarcoma, etc.

Low-grade NHL High-grade NHL Hodgkin disease

n Most frequent causes: see Table 18.

n Clinical manifestations: The clinical findings often suggest the correct diagnosis (local infection with regional lymphadenopathy) and may include inflammatory signs, tenderness to palpation, and positive serology. n Sonographic diagnosis: The sonographic criteria for benign-malignant differentiation are helpful in the evaluation of peripheral lymphadenopathy (Figs. 144 and 145).

• Prominent echogenic hilum; occasional concentric or eccentric cortical widening

• Frequent visualization of hilar vessels or a branched vascular pattern n Sonographic findings: See Figs. 146-149.

n Sonographic findings: See Figs. 146-149.

Ileocecal Tuberculosis
Fig. 146 Multiple paracolic lymph nodes (L) in a patient with ileocecal tuberculosis. CE = cecum


Ifl c lo

Fig. 147 Solitary hypoechoic lymph node (L) at the porta hepatis in infectious hepatitis. HA = hepatic artery, SA = splenic artery, CT = celiac trunk

Sonographic Images Lymphangioma
Fig. 148 Multiple large lymph nodes (l) along the right psoas muscle in a patient with mesenteric lymphadenitis

Fig. 149 Small lymph nodes (arrows) produce a speckled echo texture in the mesentery of a patient with gastroenteritis. VC = vena cava, AO = aorta

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