Lymphadenopathy in the Head and Neck Region

Fig.13.25a Contrast-enhanced axial T1-weighted MR imaging shows the approximate level of the vocal cords. The enhancing mass posterior to the airway causes an obvious asymmetry—an essential radiological observation in the complex head and neck area. This proved to be a carcinoma of the hypopharynx. b The enlargement and peripheral irregular contrast enhancement of a left sided regional lymph node (arrows) lateral to the signal void of the carotid artery on this T1-weighted image proves the regional lymphatic spread. For your orientation: in the middle of the image you see the airway; craniallyon both sides at a distance the relatively signal-free mandibular bone with the masseter muscle lateral and the pterygoid muscle medial to it.

is particularly true for tumors of the oral cavity. Parotid tumors are also often first noticed by the patients themselves. Histopathological examination is required in most cases before a treatment decision can be made; biopsy is facilitated by ultrasound guidance in deep lesions. MRI is the most comprehensive modality to evaluate the local extent and regional lymph node involvement (Fig. 13.25b) in patients with head and neck cancer.

Lymph node enlargement: Lymphadenopathy may be due to lymphoma, metastatic disease, or reactive inflammation, for example, in tuberculosis. An ultrasound examination (Fig. 13.26a) with subsequent removal of a tissue core a

Neck Lymph Node Removal

Fig. 13.26a Ultrasound shows a significantly enlarged lymph node (arrows) in the direct vicinity of the jugular vein. The Dop-pler signal helps distinguish vessels inside the node and in its neighborhood. This patient had a lymphoma. b The CT demonstrates the whole extent of the lymphatic spread dorsal to the mandibular angle (arrows). Multiple nodes of different size are seen. CT of chest and abdomen was subsequently performed for complete staging.

Fig. 13.26a Ultrasound shows a significantly enlarged lymph node (arrows) in the direct vicinity of the jugular vein. The Dop-pler signal helps distinguish vessels inside the node and in its neighborhood. This patient had a lymphoma. b The CT demonstrates the whole extent of the lymphatic spread dorsal to the mandibular angle (arrows). Multiple nodes of different size are seen. CT of chest and abdomen was subsequently performed for complete staging.

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