Knowledge of invasion of the walls of the cervical vessels by tumor is of great clinicalThe aim of this study was to determine the value of sonography in detecting invasion of the carotid artery and jugular vein by lymph node metastases.
Subjects and MethodsDuring a 3-year period,we examined 83 patients with palpable cervical lymph node metastases in the region of the carotid bifurcation. Sixty-three were men, 20 were women; the mean age was 63 years. All patients had primary tumors of the ear, nose, or throat. Ninety-six percent of the tumors were squamous cell carcinomas; 4% were adenoid cystic carcinomas.No patients with malignant lymphomas were included. Sonography was performed with 5.0-, 7.5-, or 1 0.0-MHz mechanical sector transducers or a 7.5-MHz linear array transducer, depending on location or depth of the tumor infiltration. Our sonographic criteria for cervical lymph node metastases were reported earlier [4]. When a lesion was adjacent to the carotid artery, we identified the external and internal carotid artery by morphology (localization and branching of the external carotid artery) and by Doppler frequency shift. All lesions were palpated with the nonscanning hand, and an attempt was made to move the lesion toward the wall of the vessel during real-time scanning.This maneuver is called sonopalpation.Furthermore, the patient was instructed to swallow, so that we could assess possible displacement of the vessel from the tumor. When the tumor was mobile, invasion could be excluded.
Nineteen deep cervical lipomas and five patients with cervical lipomatosis were examined with computed tomography (CT) and Sonography. By means of CT, which is the imaging method of choice for both diseases, it is possible to differentiate between circumscribed lipomas and infiltrating intramuscular lipomas. In addition, an exact localization in parenchymatous organs is possible. Cervical lipomatosis is also clearly delineated. Sonography is the first imaging method in cervical swelling or lesions; therefore, knowledge of the sonomorphology of fatty tumors is mandatory. Cervical lipomas have a fairly typical sonomorphology, but it is not as pathognomonic as the density values are by means of CT. In cervical lipomatosis, an adequate pretherapeutic assessment of the depth of infiltration is not possible sonographically. Only the cervical vessels can be clearly differentiated in this condition.
32 patients with osseous destruction of the mandible were examined sonographically. The results were compared with those of plain radiographs. In 30 patients, discontinuation of the cortex was clearly evident. Sonography could detect osteolytic lesions in the corpus region, in the angle and on the buccal side of the rami of the mandible. 2 cases of osteodestruction on the lingual side could not be seen.
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