Reactive lymphnodes

[Katrina Matras]

Is it necessary to report reactive lymph nodes if its fairly small

[Stephen Bird]

Hi Katrina,

Yes, I would mention any nodes that look reactive and are part of the patients clinical presentation.

If they are ovoid, have a normal hilarious flow pattern with Doppler, symmetrical cortex and an echogenic hilum they are almost certainly benign reactive nodes.

You can use 9mm in short axis for the upper limit of normal reactive nodes in level 2 including the jugulo digastric node and then use 8mm in short axis for all other levels.

If there are any atypical features then they can be followed up with a repeat scan or if there is clinical concern such as a previous history of melanoma etc they can be sampled using a fine needle aspiration and cytology and flow cytometry can be performed.

The clinical presentation is always important with these cases.

A paediatric patient who has been suffering a virus or upper respiratory tract infection is a classic example where the neck is full of chunky nodes, but it is virtually always a benign process requiring only clinical follow up for resolution.

You can contrast this with a patient with a history of melanoma of thyroid cancer where my index of suspicion is much greater,

Steve

[Author]

Posts